Ulrich Silvia, Fischler Manuel, Speich Rudolf, Bloch Konrad E
Pulmonary Division, University Hospital Zurich, Zurich, Switzerland.
Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland.
Chest. 2008 Jun;133(6):1375-1380. doi: 10.1378/chest.07-3035. Epub 2008 Mar 13.
Cheyne-Stokes respiration (CSR) and central sleep apnea (CSA) are common in patients with left-heart failure. We investigated the hypothesis that sleep-disordered breathing is also prevalent in patients with right ventricular dysfunction due to pulmonary hypertension (PH).
We studied 38 outpatients (median age, 61 years; quartiles, 51 to 72) with pulmonary arterial hypertension (n = 23) or chronic thromboembolic PH (n = 15). New York Heart Association (NYHA) class was II to IV, and median 6-min walk distance was 481 m (quartiles, 429 to 550). In-laboratory polysomnography (n = 22) and ambulatory cardiorespiratory sleep studies (n = 38) including pulse oximetry were performed. Quality of life and sleepiness by the Epworth sleepiness score were assessed.
The median apnea/hypopnea index was 8 events/h (quartiles, 4 to 19), with 8 central events (quartiles, 4 to 17), and 0 obstructive events (quartiles, 0 to 0.3) per hour. Seventeen patients (45%) had > or = 10 apnea/hypopnea events/h. Comparison of 13 patients with > or = 10 CSR/CSA events/h with 21 patients with < 10 CSR/CSA events/h (excluding 4 patients with > or = 10 obstructive events/h from this analysis) revealed no difference in regard to hemodynamics, NYHA class, and Epworth sleepiness scores. However, patients with > or = 10 CSR/CSA events/h had a reduced quality of life in the physical domains. Ambulatory cardiorespiratory sleep studies accurately predicted > or = 10 apnea/hypopnea events/h during polysomnography in patients who underwent both studies (area under the receiver operating characteristic curve, 0.93; SE +/- 0.06; p = 0.002). The corresponding value for pulse oximetry was 0.63 +/- 0.14 (p = not significant).
In patients with PH, CSR/CSA is common, but obstructive sleep apnea also occurs. Sleep-related breathing disorders are not associated with excessive sleepiness but affect quality of life. They should be evaluated by polysomnography or cardiorespiratory sleep studies because pulse oximetry may fail to detect significant sleep apnea.
陈-施呼吸（CSR）和中枢性睡眠呼吸暂停（CSA）在左心衰竭患者中很常见。我们研究了这样一个假设，即因肺动脉高压（PH）导致右心室功能障碍的患者中，睡眠呼吸障碍也很普遍。
我们研究了38名门诊患者（中位年龄61岁；四分位数间距为51至72岁），其中肺动脉高压患者23例，慢性血栓栓塞性PH患者15例。纽约心脏协会（NYHA）心功能分级为II至IV级，6分钟步行距离中位数为481米（四分位数间距为429至550米）。进行了实验室多导睡眠图检查（n = 22）和包括脉搏血氧饱和度测定的动态心肺睡眠研究（n = 38）。通过Epworth嗜睡量表评估生活质量和嗜睡程度。
呼吸暂停/低通气指数中位数为每小时8次事件（四分位数间距为4至19次），其中中枢性事件每小时8次（四分位数间距为4至17次），阻塞性事件每小时0次（四分位数间距为0至0.3次）。17例患者（45%）呼吸暂停/低通气事件每小时≥10次。将13例呼吸暂停/低通气事件每小时≥10次的患者与21例呼吸暂停/低通气事件每小时<10次的患者（本分析中排除4例阻塞性事件每小时≥10次的患者）进行比较，结果显示在血流动力学、NYHA心功能分级和Epworth嗜睡量表评分方面无差异。然而，呼吸暂停/低通气事件每小时≥10次的患者在身体领域的生活质量较低。在同时进行两项检查的患者中，动态心肺睡眠研究能准确预测多导睡眠图检查时呼吸暂停/低通气事件每小时≥10次（受试者操作特征曲线下面积为0.93；标准误±0.06；p = 0.002）。脉搏血氧饱和度测定的相应值为0.63±0.14（p = 无显著性差异）。
在PH患者中，CSR/CSA很常见，但阻塞性睡眠呼吸暂停也会发生。与睡眠相关的呼吸障碍与过度嗜睡无关，但会影响生活质量。应通过多导睡眠图或心肺睡眠研究对其进行评估，因为脉搏血氧饱和度测定可能无法检测到明显的睡眠呼吸暂停。
