心力衰竭伴睡眠呼吸障碍患者的肺毛细血管楔压和肺动脉压。
Pulmonary capillary wedge pressure and pulmonary arterial pressure in heart failure patients with sleep-disordered breathing.
机构信息
Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstrasse 11, D-32545 Bad Oeynhausen, Germany.
出版信息
Sleep Med. 2009 Aug;10(7):726-30. doi: 10.1016/j.sleep.2008.08.004. Epub 2009 Jan 8.
BACKGROUND
There is a high prevalence of central sleep apnea (CSA) in patients with chronic heart failure (CHF). The present study investigates the hypotheses that CSA in CHF patients reflects heart failure severity as measured by cardiac index (CI), pulmonary artery pressure (PAP) and pulmonary capillary wedge pressure (PCWP).
METHODS
In 105 patients with stable CHF (NYHAII, LV-EF40%) cardiorespiratory polygraphy and simultaneous right and left heart catheterization was performed.
RESULTS
CSA was present in 58% and obstructive sleep apnea (OSA) in 23% of patients. In CSA patients, PAP and PCWP were significantly higher when compared to patients without SDB. In CSA patients, but not in OSA patients, PCWP showed a significant correlation with apnea-hypopnea index (AHI; r=0.41, p=0.005), apnea index (AI; r=0.44, p=0.003) and central AI (cAI; r=0.358, p=0.015). Cardiac index was more impaired in CSA (1.93+/-0.5 l/min/m(2)) than in OSA patients (2.55+/-1.0 l/min/m(2)) or those without SDB (2.22+/-0.4 l/min/m(2)). A negative correlation of CI and cAI (r=-0.344, p=0.008), AI (r=-0.31, p=0.02) and AHI (r=-0.21, p<0.05) was documented exclusively in CSA patients.
CONCLUSION
The present study supports the hypotheses that the occurrence and severity of CSA in CHF patients reflects heart failure severity.
背景
慢性心力衰竭（CHF）患者中存在较高的中枢性睡眠呼吸暂停（CSA）发生率。本研究旨在验证以下假设，即 CHF 患者的 CSA 反映了心力衰竭严重程度，可通过心指数（CI）、肺动脉压（PAP）和肺毛细血管楔压（PCWP）来测量。
方法
对 105 例稳定期 CHF 患者（NYHA II 级，左心室射血分数 40%）进行心肺多导睡眠图和右心及左心导管检查。
结果
58%的患者存在 CSA，23%的患者存在阻塞性睡眠呼吸暂停（OSA）。与无睡眠呼吸障碍（SDB）的患者相比，CSA 患者的 PAP 和 PCWP 明显更高。在 CSA 患者中，而不是在 OSA 患者中，PCWP 与呼吸暂停-低通气指数（AHI；r=0.41，p=0.005）、呼吸暂停指数（AI；r=0.44，p=0.003）和中枢性 AI（cAI；r=0.358，p=0.015）呈显著相关。CSA 患者的 CI（1.93+/-0.5 l/min/m(2)）较 OSA 患者（2.55+/-1.0 l/min/m(2)）或无 SDB 患者（2.22+/-0.4 l/min/m(2)）更差。CI 与 cAI（r=-0.344，p=0.008）、AI（r=-0.31，p=0.02）和 AHI（r=-0.21，p<0.05）呈负相关，仅在 CSA 患者中存在。
结论
本研究支持以下假设，即 CHF 患者 CSA 的发生和严重程度反映了心力衰竭的严重程度。
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