Hôpital cardiologique du Haut-Lévêque, avenue de Magellan, 33604 Pessac cedex, France.
Arch Cardiovasc Dis. 2009 Oct;102(10):711-20. doi: 10.1016/j.acvd.2009.06.005. Epub 2009 Oct 14.
Nasal continuous positive airway pressure (CPAP) is generally recommended for the treatment of obstructive sleep apnoea. CPAP lowers the cardiovascular morbidity and mortality associated with severe obstructive sleep apnoea. At least 50% of patients presenting with chronic heart failure (HF) have sleep apnoea; a subset of these patients may have obstructive sleep apnoea and may derive a survival benefit from CPAP. However, this population is also prone to developing central sleep apnoea, Cheyne-Stokes respiration or both (CSA/CSR), for which CPAP lowers the apnoea-hypopnoea index only partially and for which the overall effect of CPAP on survival remains to be determined, particularly as it has been observed to increase the mortality rate in subsets of patients. Other treatments may prove effective in patients with chronic HF and CSA/CSR, although none, thus far, has been found to confer a survival benefit. New ventilatory modes include bi-level positive airway pressure and automated adaptive servoventilation, the latter being most effective against CSA/CSR. Measures that can alleviate CSA/CSR indirectly include beta-adrenergic blockers and renin-angiotensin-aldosterone system inhibitors, nocturnal supplemental oxygen and cardiac resynchronization therapy (CRT). The effects of theophylline, acetazolamide and nocturnal CO(2) have also been studied. The second part of this review describes the applications and effects of therapies that are available for sleep apnoea in patients with chronic HF.
鼻腔持续气道正压通气（CPAP）通常被推荐用于治疗阻塞性睡眠呼吸暂停。CPAP 可降低与严重阻塞性睡眠呼吸暂停相关的心血管发病率和死亡率。至少有 50%的慢性心力衰竭（HF）患者存在睡眠呼吸暂停；这些患者中的一部分可能患有阻塞性睡眠呼吸暂停，并可能从 CPAP 中获益生存。然而，这部分人群也容易发生中枢性睡眠呼吸暂停、Cheyne-Stokes 呼吸或两者并存（CSA/CSR），CPAP 仅部分降低呼吸暂停低通气指数，CPAP 对生存的总体影响仍有待确定，特别是因为在某些亚组患者中观察到死亡率增加。其他治疗方法可能对患有慢性 HF 和 CSA/CSR 的患者有效，尽管迄今为止，尚未发现任何治疗方法能带来生存获益。新的通气模式包括双水平气道正压通气和自动适应性伺服通气，后者对 CSA/CSR 最有效。可间接缓解 CSA/CSR 的措施包括β-肾上腺素能阻滞剂和肾素-血管紧张素-醛固酮系统抑制剂、夜间补充氧气和心脏再同步治疗（CRT）。茶碱、乙酰唑胺和夜间 CO2 的作用也已被研究过。本文第二部分描述了可用于慢性 HF 患者睡眠呼吸暂停的治疗方法的应用和效果。
