Sleep Heart Program, Ohio State University, Columbus, OH 43210, USA.
J Card Fail. 2012 Jul;18(7):534-40. doi: 10.1016/j.cardfail.2012.05.003.
Hospitalized heart failure patients have a high readmission rate. We sought to determine the independent risk due to central sleep apnea (CSA) of readmission in patients with systolic heart failure (SHF).
This was a prospective observational cohort study of hospitalized patients with SHF. Patients underwent sleep studies during their hospitalization and were followed for 6 months to determine their rate of cardiac readmissions; 784 consecutive patients were included; 165 patients had CSA and 139 had no sleep-disordered breathing (SDB); the remainder had obstructive sleep apnea (OSA). The rate ratio for 6 months' cardiac readmissions was 1.53 (95% confidence interval 1.1-2.2; P = .03) in CSA patients compared with no SDB. This rate ratio was adjusted for systolic function, type of cardiomyopathy, age, weight, sex, diabetes, coronary disease, length of stay, admission sodium, creatinine, hemoglobin, blood pressure, and discharge medications. Severe OSA was also an independent predictor of readmissions with an adjusted rate ratio of 1.49 (P = .04).
In this first evaluation of the impact of SDB on cardiac readmissions in heart failure, CSA was an independent risk factor for 6 months' cardiac readmissions. The effect size of CSA exceeded that of all known predictors of heart failure readmissions.
住院心力衰竭患者的再入院率较高。我们旨在确定与中心性睡眠呼吸暂停（CSA）相关的收缩性心力衰竭（SHF）患者再入院的独立风险。
这是一项针对住院 SHF 患者的前瞻性观察性队列研究。患者在住院期间接受睡眠研究，并随访 6 个月以确定其心脏再入院率；共纳入 784 例连续患者；165 例患者有 CSA，139 例患者无睡眠呼吸障碍（SDB）；其余患者有阻塞性睡眠呼吸暂停（OSA）。与无 SDB 相比，CSA 患者 6 个月的心脏再入院率比值比为 1.53（95%置信区间 1.1-2.2；P=0.03）。这个比值比是根据收缩功能、心肌病类型、年龄、体重、性别、糖尿病、冠心病、住院时间、入院时钠、肌酐、血红蛋白、血压和出院药物进行调整的。严重 OSA 也是再入院的独立预测因素，调整后的比值比为 1.49（P=0.04）。
在首次评估 SDB 对心力衰竭患者心脏再入院的影响中，CSA 是 6 个月心脏再入院的独立危险因素。CSA 的效应大小超过了心力衰竭再入院的所有已知预测因素。
