Ruttanaumpawan Pimon, Gilman Matthew P, Usui Kengo, Floras John S, Bradley T Douglas
Sleep and Cardiovascular Physiology Research Laboratories of the Mount Sinai Hospital, Toronto, Ontario, Canada.
J Hypertens. 2008 Jun;26(6):1163-8. doi: 10.1097/HJH.0b013e3282fb81ed.
Patients with either heart failure or obstructive sleep apnea have a reduced baroreflex sensitivity for heart rate, a sign of poor prognosis. We previously demonstrated that nocturnal application of continuous positive airway pressure to heart failure patients with obstructive sleep apnea increased baroreflex sensitivity acutely, but it is not known whether these effects persist into wakefulness.
To determine whether treating obstructive sleep apnea in heart failure patients with continuous positive airway pressure improves baroreflex sensitivity during wakefulness.
Spontaneous baroreflex sensitivity was assessed during wakefulness in 33 heart failure patients (left ventricular ejection fraction < or = 45%) with obstructive sleep apnea (apnea-hypopnea index > or = 20). Subsequently, baroreflex sensitivity was reassessed 1 month after patients were randomly allocated to nocturnal continuous positive airway pressure treatment or no treatment (control).
Compared with the 14 control patients, the 19 continuous positive airway pressure-treated patients experienced a greater increase in baroreflex sensitivity [median, (25%, 75%)] [from 5.4 (2.2, 8.3) to 7.9 (4.4, 9.4) ms/mmHg; P = 0.01] and left ventricular ejection fraction (P < 0.001). In addition, daytime systolic blood pressure and heart rate decreased more in the continuous positive airway pressure group (from 122 +/- 15 to 113 +/- 12 mmHg; P = 0.02, and from 66 +/- 8 to 62 +/- 8 bpm; P < 0.001, respectively) than in the control group.
Treatment of coexisting obstructive sleep apnea by continuous positive airway pressure in heart failure patients improves baroreflex sensitivity during wakefulness in addition to improving left ventricular ejection fraction and lowering blood pressure and heart rate. These data indicate that the improved autonomic regulation of heart rate in heart failure patients treated for obstructive sleep apnea during sleep persists into wakefulness.
心力衰竭或阻塞性睡眠呼吸暂停患者的心率压力反射敏感性降低，这是预后不良的一个迹象。我们之前证明，夜间对合并阻塞性睡眠呼吸暂停的心力衰竭患者应用持续气道正压通气可使压力反射敏感性急性增加，但尚不清楚这些效应在清醒状态下是否持续存在。
确定用持续气道正压通气治疗心力衰竭患者的阻塞性睡眠呼吸暂停是否能改善清醒状态下的压力反射敏感性。
对33例合并阻塞性睡眠呼吸暂停（呼吸暂停低通气指数≥20）的心力衰竭患者（左心室射血分数≤45%）在清醒状态下评估其自发性压力反射敏感性。随后，在患者被随机分配接受夜间持续气道正压通气治疗或不治疗（对照组）1个月后，重新评估压力反射敏感性。
与14例对照患者相比，19例接受持续气道正压通气治疗的患者的压力反射敏感性[中位数，(25%，75%)]有更大幅度的增加[从5.4(2.2，8.3)增至7.9(4.4，9.4)毫秒/毫米汞柱；P = 0.01]，左心室射血分数也增加（P < 0.001）。此外，持续气道正压通气组的日间收缩压和心率下降幅度分别比对照组更大（分别从122±15降至113±12毫米汞柱；P = 0.02，以及从66±8降至62±8次/分；P < 0.001）。
心力衰竭患者通过持续气道正压通气治疗并存的阻塞性睡眠呼吸暂停，除了能改善左心室射血分数、降低血压和心率外，还能改善清醒状态下的压力反射敏感性。这些数据表明，睡眠期间接受阻塞性睡眠呼吸暂停治疗的心力衰竭患者心率自主调节的改善在清醒状态下仍持续存在。
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