Klinik und Poliklinik fur Innere Medizin II, Universitätsklinikum Regensburg, Germany.
Eur Respir J. 2012 Nov;40(5):1173-9. doi: 10.1183/09031936.00172211. Epub 2012 Mar 22.
The aim of this study was to test whether an improvement of left ventricular ejection fraction (EF) in the early phase after acute myocardial infarction is associated with a reduction of the severity of central and obstructive sleep apnoea. 40 consecutive patients with acute myocardial infarction underwent polysomnography and cardiovascular magnetic resonance imaging within 5 days and 12 weeks after the event to assess sleep apnoea and cardiac function. We stratified the sample in patients who improved their left ventricular EF within 12 weeks by ≥ 5% (improved EF group, ΔEF 9 ± 1%, n=16) and in those who did not (unchanged EF group, ΔEF -1 ± 1%, n=24). Prevalence of sleep apnoea (≥ 15 apnoea and hypopnoea events·h(-1)) within ≤ 5 days after myocardial infarction was 55%. Apnoea and hypopnoea events·h(-1) were significantly more reduced in the improved EF group compared with the unchanged EF group (-10 ± 3 versus 1 ± 3 events·h(-1); p=0.036). This reduction was based on a significant alleviation of obstructive events (-7 ± 2 versus 4 ± 3 events·h(-1); p=0.009), while the reduction of central events was similar between groups (p=0.906). An improvement of cardiac function early after myocardial infarction is associated with an alleviation of sleep apnoea. This finding suggests that re-evaluation of treatment indication for sleep apnoea is needed when a change in cardiac function occurs.
这项研究的目的是检验急性心肌梗死后早期左心室射血分数（EF）的改善是否与中心型和阻塞型睡眠呼吸暂停严重程度的降低相关。40 例连续急性心肌梗死患者在事件后 5 天和 12 周内接受多导睡眠图和心血管磁共振成像检查，以评估睡眠呼吸暂停和心功能。我们将样本分层为在 12 周内左心室 EF 改善≥5%的患者（EF 改善组，ΔEF 9±1%，n=16）和未改善的患者（EF 不变组，ΔEF-1±1%，n=24）。心肌梗死后≤5 天内睡眠呼吸暂停（≥15 次呼吸暂停和低通气事件·h(-1)）的发生率为 55%。EF 改善组的呼吸暂停和低通气事件·h(-1)明显低于 EF 不变组（-10±3 与 1±3 事件·h(-1)；p=0.036）。这种减少是基于阻塞性事件的显著缓解（-7±2 与 4±3 事件·h(-1)；p=0.009），而两组之间的中枢性事件减少相似（p=0.906）。心肌梗死后早期心功能的改善与睡眠呼吸暂停的缓解相关。这一发现表明，当心脏功能发生变化时，需要重新评估睡眠呼吸暂停的治疗指征。
