Smith Lindsay A, Vennelle Marjorie, Gardner Roy S, McDonagh Theresa A, Denvir Martin A, Douglas Neil J, Newby David E
Cardiovascular Research, Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK.
Eur Heart J. 2007 May;28(10):1221-7. doi: 10.1093/eurheartj/ehm131. Epub 2007 Apr 30.
Obstructive sleep apnoea (OSA) is highly prevalent in patients with chronic heart failure (CHF) and may contribute to CHF progression. We aimed to determine whether treatment of OSA with continuous positive airway pressure (CPAP) would improve subjective and objective measures of heart failure severity in patients with CHF and OSA.
Twenty-six patients with stable symptomatic CHF and OSA were randomized to nocturnal auto-titrating CPAP or sham CPAP for 6 weeks each in crossover design. Study co-primary endpoints were changes in peak VO(2) and 6 min walk distance. Secondary endpoints were changes in left ventricular ejection fraction, VE/VCO(2) slope, plasma neurohormonal markers, and quality-of-life measures. Twenty-three patients completed the study protocol. Mean CPAP and sham CPAP usage were 3.5 +/- 2.5 and 3.3 +/- 2.2 h/night, respectively (P = 0.31). CPAP treatment was associated with improvements in daytime sleepiness (Epworth Sleepiness Score 7 +/- 4 vs. 8 +/- 5, P = 0.04) but not in other quality-of-life measures. There were no changes in other study endpoints.
In patients with CHF and OSA, auto-titrating CPAP improves daytime sleepiness but not other subjective or objective measures of CHF severity. These data suggest that the potential therapeutic benefits of CPAP in CHF are achieved by alleviation of OSA rather than by improvement in cardiac function.
阻塞性睡眠呼吸暂停（OSA）在慢性心力衰竭（CHF）患者中高度流行，可能促使CHF病情进展。我们旨在确定持续气道正压通气（CPAP）治疗OSA是否能改善CHF合并OSA患者心力衰竭严重程度的主观和客观指标。
26例症状稳定的CHF合并OSA患者采用交叉设计，随机分为夜间自动调压CPAP组或假CPAP组，每组各治疗6周。研究的共同主要终点是峰值摄氧量（VO₂）和6分钟步行距离的变化。次要终点包括左心室射血分数、VE/VCO₂斜率、血浆神经激素标志物及生活质量指标的变化。23例患者完成了研究方案。CPAP和假CPAP的平均使用时间分别为3.5±2.5小时/晚和3.3±2.2小时/晚（P = 0.31）。CPAP治疗可改善日间嗜睡情况（爱泼沃斯嗜睡量表评分从8±5降至7±4，P = 0.04），但对其他生活质量指标无改善作用。其他研究终点均无变化。
在CHF合并OSA患者中，自动调压CPAP可改善日间嗜睡，但对CHF严重程度的其他主观或客观指标无改善作用。这些数据表明，CPAP在CHF中的潜在治疗益处是通过减轻OSA而非改善心功能实现的。
