Department of Internal Medicine, Georg-August-University Goettingen, Robert-Koch-Str 40, 37075 Goettingen, Germany.
Lung. 2010 Aug;188(4):309-13. doi: 10.1007/s00408-009-9208-9. Epub 2009 Dec 12.
In patients with congestive heart failure (CHF), a high prevalence of sleep-disordered breathing has been described. Cheyne-Stokes respiration (CSR) is present in up to 40% of patients with CHF. During the last decade, the medical treatment has been substantially improved. This study was designed to analyze the prognosis of CSR in modern-treated patients with CHF. For this purposes, in 57 patients with CHF who received modern treatment, a 5-year follow-up after initial full night polysomnography was performed. The mean follow-up period was 38 +/- 18 months. Mean age was 62 +/- 13 years and the mean ejection fraction was 25 +/- 7 percent. Respiratory polygraphy revealed CSR with a respiratory disturbance index >5 per hour of sleep in 39 of 57 patients. Twelve patients died. CSR was only characterized by a tendency of worsening (log-rank test, p = 0.25). However, there was a significant difference toward positive outcome for patients who received cardiac resynchronization therapy (log-rank test, p = 0.036). Using Multivariate Cox's proportional hazard regression with the factors resynchronization and CSR, the effect of resynchronization was almost significant (p = 0.08). In conclusion, no significant change of Cheyne-Stokes prevalence can be found in our small group of modern-treated patients with CHF. Cardiac resynchronization therapy was associated with improved patient outcome.
在充血性心力衰竭（CHF）患者中，描述了睡眠呼吸障碍的高发率。多达 40％的 CHF 患者存在 Cheyne-Stokes 呼吸（CSR）。在过去的十年中，医学治疗得到了实质性的改善。本研究旨在分析现代治疗的 CHF 患者 CSR 的预后。为此，对 57 名接受现代治疗的 CHF 患者进行了初始整夜多导睡眠图检查后的 5 年随访。平均随访期为 38 +/- 18 个月。平均年龄为 62 +/- 13 岁，平均射血分数为 25 +/- 7％。呼吸描记法显示，39/57 例患者的睡眠中每小时呼吸干扰指数> 5 例 CSR。有 12 名患者死亡。CSR 仅表现出恶化的趋势（对数秩检验，p = 0.25）。但是，接受心脏再同步治疗的患者的阳性结果有显著差异（对数秩检验，p = 0.036）。使用具有再同步和 CSR 因素的多变量 Cox 比例风险回归，再同步的效果几乎具有统计学意义（p = 0.08）。总之，在我们接受现代治疗的 CHF 小患者组中，CSR 的流行率没有明显变化。心脏再同步治疗与改善患者预后相关。
