Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN; Department of Internal Medicine, Hospital of Saint Raphael, Yale University School of Medicine, New Haven, CT.
Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN.
Chest. 2012 Apr;141(4):967-973. doi: 10.1378/chest.11-0975. Epub 2011 Sep 8.
An important consequence of sleep-disordered breathing (SDB) is excessive daytime sleepiness (EDS). EDS often predicts a favorable response to treatment of SDB, although in the setting of cardiovascular disease, particularly heart failure, SDB and EDS do not reliably correlate. Atrial fibrillation (AF) is another highly prevalent condition strongly associated with SDB. We sought to assess the relationship between EDS and SDB in patients with AF.
We conducted a prospective study of 151 patients referred for direct current cardioversion for AF who also underwent sleep evaluation and nocturnal polysomnography. The Epworth Sleepiness Scale (ESS) was administered prior to polysomnography and considered positive if the score was ≥ 11. The apnea-hypopnea index (AHI) was tested for correlation with the ESS, with a cutoff of ≥ 5 events/h for the diagnosis of SDB.
Among the study participants, mean age was 69.1 ± 11.7 years, mean BMI was 34.1 ± 8.4 kg/m(2), and 76% were men. The prevalence of SDB in this population was 81.4%, and 35% had EDS. The association between ESS score and AHI was low (R(2) = 0.014, P = .64). The sensitivity and specificity of the ESS for the detection of SDB in patients with AF were 32.2% and 54.5%, respectively.
Despite a high prevalence of SDB in this population with AF, most patients do not report EDS. Furthermore, EDS does not appear to correlate with severity of SDB or to accurately predict the presence of SDB. Further research is needed to determine whether EDS affects the natural history of AF or modifies the response to SDB treatment.
睡眠呼吸障碍（SDB）的一个重要后果是白天过度嗜睡（EDS）。EDS 通常预示着 SDB 的治疗效果良好，尽管在心血管疾病的背景下，特别是心力衰竭，SDB 和 EDS 并不可靠地相关。心房颤动（AF）是另一种与 SDB 强烈相关的高发性疾病。我们试图评估 AF 患者中 EDS 与 SDB 之间的关系。
我们对 151 例因 AF 接受直流电复律的患者进行了前瞻性研究，这些患者还接受了睡眠评估和夜间多导睡眠图检查。在进行多导睡眠图检查之前，使用 Epworth 嗜睡量表（ESS）进行评估，如果得分≥11，则认为 ESS 为阳性。检测呼吸暂停低通气指数（AHI）与 ESS 的相关性，以≥5 次/小时作为 SDB 的诊断标准。
在研究参与者中，平均年龄为 69.1±11.7 岁，平均 BMI 为 34.1±8.4kg/m2，76%为男性。该人群 SDB 的患病率为 81.4%，35%的人有 EDS。ESS 评分与 AHI 之间的相关性较低（R2=0.014，P=0.64）。ESS 检测 AF 患者 SDB 的敏感性和特异性分别为 32.2%和 54.5%。
尽管在 AF 患者中 SDB 的患病率较高，但大多数患者并不报告 EDS。此外，EDS 似乎与 SDB 的严重程度无关，也不能准确预测 SDB 的存在。需要进一步研究以确定 EDS 是否会影响 AF 的自然病史或改变 SDB 治疗的反应。
