Wang Han-qiao, Chen Gang, Li Jing, Hao Shu-min, Pang Jiang-na, Gu Xin-shun, Fu Xiang-hua
Sleep Breathing Disorder Department of the Third Hospital of Hebei Medical University, Shijiazhuang, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2009 Aug;32(8):598-602.
To investigate the changes of the characteristics of sleep apnea in heart failure patients with periodic breathing disorder and to explore the influencing factors.
According to the characteristics of sleep apnea after polysomnography (PSG) for 2 nights, 54 patients with heart failure were divided into 3 groups: obstructive sleep apnea (OSA), central sleep apnea (CSA) and OSA-CSA switching groups, with 18 patients each. t test was used for comparison between the first and the second PSG data, left ventricular ejection fraction (LVEF), periodic breathing cycle length (PBCL) and lung to finger circulation time (LFCT) in the same patient. Analysis of variance was performed for comparison within groups and Pearson correlation test was used for correlation analysis between 2 variables.
When the events of sleep apnea changed from OSA to CSA, the mean wake and sleep stage II (S2) PtcCO(2) decreased significantly [(41.0 +/- 1.3) cm H(2)O vs (34.9 +/- 1.0) cm H(2)O, 1 cm H(2)O = 0.098 kPa, P < 0.01;(42.1 +/- 1.2) cm H(2)O vs (36.3 +/- 1.1) cm H(2)O, P < 0.01], while PBCL and LCFT increased significantly [(51.9 +/- 2.1) s vs (62.3 +/- 1.9) s, P < 0.01, (54.4 +/- 1.8) s vs (65.3 +/- 1.6) s, P < 0.01]. Furthermore, there was a significant decrease in LVEF [(32.1 +/- 2.5)% vs (19.9 +/- 3.5)%, P < 0.05], and LVEF was negatively correlated with PBCL and LFCT (r = 0.687, P < 0.05;r = -0.591, P < 0.05). When sleep apnea changed from CSA to OSA, the mean wake and S2 PtcCO(2) increased significantly [(39.2 +/- 0.5) cm H(2)O vs (42.7 +/- 1.0) cm H(2)O, P < 0.05], while PBCL and LFCT decreased significantly [(61.5 +/- 3.4) s vs (49.7 +/- 2.8) s, P < 0.05, (66.1 +/- 2.1) s vs (52.1 +/- 1.6) s, P < 0.01)]. In addition, there was a negative correlation between PtcCO(2) and PBCL (r = -0.586, P < 0.05). However, PtcCO(2) showed no significant correlation with LFCT (r = -0.381, P > 0.05). There were no statistical differences between the first and the second mean wake and S2 PtcCO(2), PBCL and LFCT in the OSA and the CSA group, but AHI showed a significant correlation with LVEF in the CSA group (r = -0.474, P < 0.05).
The characteristics of sleep apnea can change when periodic breathing happens in heart failure patients with OSA or CSA. The change can be affected by wake and sleep PtcCO(2), PBCL and LFCT, and possibly by heart function.
探讨合并周期性呼吸障碍的心力衰竭患者睡眠呼吸暂停特征的变化，并探究其影响因素。
根据连续两晚多导睡眠图（PSG）监测的睡眠呼吸暂停特征，将54例心力衰竭患者分为3组：阻塞性睡眠呼吸暂停（OSA）组、中枢性睡眠呼吸暂停（CSA）组和OSA-CSA转换组，每组18例。采用t检验比较同一患者首次和第二次PSG数据、左心室射血分数（LVEF）、周期性呼吸周期长度（PBCL）及肺-手指循环时间（LFCT）。采用方差分析进行组内比较，采用Pearson相关检验进行两个变量间的相关性分析。
当睡眠呼吸暂停事件从OSA转变为CSA时，平均清醒及睡眠Ⅱ期（S2）的经皮二氧化碳分压（PtcCO₂）显著降低[（41.0±1.3）cm H₂O比（34.9±1.0）cm H₂O，1 cm H₂O = 0.098 kPa，P<0.01；（42.1±1.2）cm H₂O比（36.3±1.1）cm H₂O，P<0.01]，而PBCL和LCFT显著增加[（51.9±2.1）s比（62.3±1.9）s，P<0.01，（54.4±1.8）s比（65.3±1.6）s，P<0.01]。此外，LVEF显著降低[（32.1±2.5）%比（19.9±3.5）%，P<0.05]，且LVEF与PBCL和LFCT呈负相关（r = 0.687，P<0.05；r = -0.591，P<0.05）。当睡眠呼吸暂停从CSA转变为OSA时，平均清醒及S2的PtcCO₂显著增加[（39.2±0.5）cm H₂O比（42.7±1.0）cm H₂O，P<0.05]，而PBCL和LFCT显著降低[（61.5±3.4）s比（49.7±2.8）s，P<0.05，（66.1±2.1）s比（52.1±1.6）s，P<0.01]。此外，PtcCO₂与PBCL呈负相关（r = -0.586，P<0.05）。然而，PtcCO₂与LFCT无显著相关性（r = -0.381，P>0.05）。OSA组和CSA组首次与第二次平均清醒及S2的PtcCO₂、PBCL和LFCT无统计学差异，但CSA组中呼吸暂停低通气指数（AHI）与LVEF显著相关（r = -0.474，P<0.05）。
合并OSA或CSA的心力衰竭患者发生周期性呼吸时，睡眠呼吸暂停特征会发生变化。这种变化受清醒及睡眠时的PtcCO₂、PBCL和LFCT影响，可能还受心功能影响。
