稳定心力衰竭患者睡眠呼吸暂停的患病率和特征：心力衰竭诊所的结果。
Prevalence and characteristics of sleep apnoea in patients with stable heart failure: Results from a heart failure clinic.
机构信息
Internal Medicine Department, São João Hospital, Oporto Medical University, Cardiovascular Research Unit, Alameda Professor Doutor Hernâni Monteiro, 4200-319 Porto, Portugal.
出版信息
BMC Pulm Med. 2010 Mar 3;10:9. doi: 10.1186/1471-2466-10-9.
BACKGROUND
Heart failure (HF) and sleep apnoea (SA) association has been recognized but whether it results from confounding factors (hypertension, ischaemia, obesity) remains unclear.We aimed to determine the prevalence of SA in HF and to identify potential risk factors for SA in HF population.
METHODS
We prospectively evaluated 103 patients with stable HF on optimized therapy. In-laboratory polysomnography was performed. Type and severity of SA were defined according international criteria. Demographic, anthropometric and clinical characteristics were collected. Continuous data are expressed as median and interquartile range.
RESULTS
SA was found in 72.8%, moderate to severe in a significant proportion (apnoea-hypopnoea index > or = 15- 44.7% of all patients) and predominantly obstructive (60.0% of patients with SA). Most patients were non-sleepy (Epworth < 10- 66%). SA patients were predominantly men (85.3 vs 60.7%, p-0.015), had larger neck (38.0 (35.0-42.0) vs 35.0 (33.2-38.0) cm, p-0.003), severe systolic dysfunction, (63.9 vs 33.3%, p-0.018), left ventricle (LV) hypertrophy (16.2 vs 0.0%, p-0.03), LV and left atria (LA) dilatation (49.0 (44.0-52.0) vs 42.0 (38.0-48.0) mm, p < 0.001; 60.0 (54.0-65.0) vs 56.0 (52.0-59.0) mm, p-0.01). However, only LA diameter was an independent predictor of SA. Higher body-mass index (BMI) was associated with moderate to severe SA. Patients with obstructive SA had larger neck and a trend for higher BMI, snoring and sleepiness. Hypocapnia was not associated with central SA.
CONCLUSIONS
In our HF population, SA was prevalent, frequently asymptomatic and without characteristic risk factors. Unlike previously reported, obstructive SA was the predominant type. These results suggest that SA is underdiagnosed in HF and there is a possible correlation between them, independent of confounding factors. Recent advances in HF therapy might influence prevalence and type of SA in this population.
背景
心力衰竭（HF）和睡眠呼吸暂停（SA）之间的关联已得到确认，但它是否是由混杂因素（高血压、缺血、肥胖）引起的仍不清楚。我们旨在确定 HF 患者中 SA 的患病率，并确定 HF 人群中 SA 的潜在危险因素。
方法
我们前瞻性评估了 103 名接受优化治疗的稳定 HF 患者。进行了实验室多导睡眠图检查。根据国际标准确定 SA 的类型和严重程度。收集人口统计学、人体测量学和临床特征。连续数据表示为中位数和四分位距。
结果
72.8%的患者存在 SA，其中相当一部分为中重度（呼吸暂停低通气指数>或= 15-44.7%的所有患者），主要为阻塞性（60.0%的 SA 患者）。大多数患者不嗜睡（Epworth<10-66%）。SA 患者主要为男性（85.3%比 60.7%，p=0.015），颈围较大（38.0（35.0-42.0）cm 比 35.0（33.2-38.0）cm，p=0.003），严重收缩功能障碍（63.9%比 33.3%，p=0.018），左心室（LV）肥厚（16.2%比 0.0%，p=0.03），LV 和左心房（LA）扩张（49.0（44.0-52.0）mm 比 42.0（38.0-48.0）mm，p<0.001；60.0（54.0-65.0）mm 比 56.0（52.0-59.0）mm，p=0.01）。然而，只有 LA 直径是 SA 的独立预测因子。较高的体重指数（BMI）与中重度 SA 相关。阻塞性 SA 患者颈围较大，BMI、打鼾和嗜睡的趋势较高。低碳酸血症与中枢性 SA 无关。
结论
在我们的 HF 患者人群中，SA 很常见，通常无症状，且没有特征性的危险因素。与之前的报告不同，阻塞性 SA 是主要类型。这些结果表明，HF 患者中 SA 诊断不足，两者之间可能存在关联，且与混杂因素无关。HF 治疗的最新进展可能会影响该人群中 SA 的患病率和类型。
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