Javaheri Shahrokh, Shukla Rakesh, Zeigler Haoyue, Wexler Laura
Department of Veterans Affairs Medical Center, Cincinnati, Ohio 45220, USA.
J Am Coll Cardiol. 2007 May 22;49(20):2028-34. doi: 10.1016/j.jacc.2007.01.084. Epub 2007 May 4.
The purpose of this study was to determine whether central sleep apnea (CSA) contributes to mortality in patients with heart failure (HF).
Cheyne-Stokes breathing with CSA commonly occurs in patients with systolic HF. Consequences of CSA, including altered blood gases and neurohormonal activation, could result in further left ventricular dysfunction. Therefore, we hypothesized that CSA might contribute to mortality of patients with HF.
We followed 88 patients with systolic HF (left ventricular ejection fraction < or =45%) with (n = 56) or without (n = 32) CSA. The median follow-up was 51 months.
The mean (+/-SD) of apnea-hypopnea index was significantly higher in patients with CSA (34 +/- 25/h) than those without CSA (2 +/- 1/h). Most of these events were central apneas. In Cox multiple regression analysis, 3 of 24 confounding variables independently correlated with survival. The median survival of patients with CSA was 45 months compared with 90 months of those without CSA (hazard ratio = 2.14, p = 0.02). The other 2 variables that correlated with poor survival were severity of right ventricular systolic dysfunction and low diastolic blood pressure.
In patients with systolic HF, CSA, severe right ventricular systolic dysfunction, and low diastolic blood pressure might have an adverse effect on survival.
本研究旨在确定中枢性睡眠呼吸暂停（CSA）是否会导致心力衰竭（HF）患者死亡。
伴有CSA的陈-施呼吸常见于收缩性HF患者。CSA的后果，包括血气改变和神经激素激活，可能导致进一步的左心室功能障碍。因此，我们假设CSA可能导致HF患者死亡。
我们对88例收缩性HF患者（左心室射血分数≤45%）进行了随访，其中伴有CSA的患者56例，不伴有CSA的患者32例。中位随访时间为51个月。
CSA患者的呼吸暂停低通气指数平均（±标准差）显著高于无CSA患者（34±25次/小时对2±1次/小时）。这些事件大多为中枢性呼吸暂停。在Cox多元回归分析中，24个混杂变量中有3个与生存独立相关。CSA患者的中位生存期为45个月，而无CSA患者为90个月（风险比=2.14，p=0.02）。与生存不良相关的其他2个变量是右心室收缩功能障碍的严重程度和舒张压降低。
在收缩性HF患者中，CSA、严重右心室收缩功能障碍和舒张压降低可能对生存产生不利影响。
