Saitama Medical Center, Jichi Medical University, Omiya-ku, Saitama, Japan.
J Cardiol. 2012 Mar;59(2):110-6. doi: 10.1016/j.jjcc.2011.12.008.
Sleep disordered breathing including obstructive sleep apnea (OSA) and central sleep apnea (CSA) with Cheyne-Stokes respiration (CSR) is often accompanied by heart failure. Treatment of OSA centered on continuous positive airway pressure (CPAP) is established. However, treatment of CSR-CSA is still controversial. Since CSR-CSA occurs as a consequence of heart failure, optimization of heart failure is essential to treat CSR-CSA. For treatment directed at CSR-CSA itself, a variety of treatment approaches including night oxygen therapy and noninvasive positive pressure ventilation have been applied. Among them, night oxygen therapy improves patients' symptoms, quality of life (QOL), and left ventricular function, but had yet been shown to improve clinical outcome. For CPAP, there are responders and non-responders and for responders CPAP can also improve survival. Adaptive servo-ventilation (ASV), which most effectively treats CSR-CSA, improves exercise capacity, QOL, and cardiac function. Recent reports suggested ASV may also prevent cardiac events in patients with heart failure. However, further studies are needed to conclude that this treatment improves patient survival.
睡眠呼吸障碍包括阻塞性睡眠呼吸暂停(OSA)和伴有 Cheyne-Stokes 呼吸(CSR)的中枢性睡眠呼吸暂停(CSA),常伴有心力衰竭。以持续气道正压通气(CPAP)为中心的 OSA 治疗已确立。然而,CSR-CSA 的治疗仍存在争议。由于 CSR-CSA 是心力衰竭的后果,因此优化心力衰竭对于治疗 CSR-CSA 至关重要。对于针对 CSR-CSA 本身的治疗,已经应用了多种治疗方法,包括夜间氧疗和无创正压通气。其中,夜间氧疗可改善患者症状、生活质量(QOL)和左心室功能,但尚未显示可改善临床结局。对于 CPAP,存在有反应者和无反应者,对于有反应者,CPAP 也可以改善生存率。自适应伺服通气(ASV)是最有效地治疗 CSR-CSA 的方法,可改善运动能力、QOL 和心功能。最近的报告表明,ASV 还可能预防心力衰竭患者的心脏事件。然而,需要进一步的研究来得出结论,即这种治疗可以改善患者的生存率。