1st Department of Cardiology, "Korgialenio-Benakio", Red Cross Hospital of Athens, Greece.
Int J Cardiol. 2013 Sep 20;168(1):157-62. doi: 10.1016/j.ijcard.2012.09.101. Epub 2012 Oct 2.
Sleep disordered breathing (SDB) is highly prevalent in patients with chronic heart failure (CHF) and is associated with adverse effects on cardiac geometry and function. Continuous positive airway pressure (CPAP) has been proved an effective treatment modality for obstructive sleep apnoea (OSA), whereas adaptive servoventilation (ASV) is more effective in patients with central sleep apnoea (CSA). The impact of selection of therapy and effective apnoea alleviation on cardiac performance and reverse left ventricular remodelling (r-LVR) has not yet been evaluated.
Eighty five patients with stable CHF were screened for SDB and underwent polysomnography and treatment according to the type of SDB. Clinical evaluation and a comprehensive echocardiographic study was performed before initiation of therapy and after six months of effective treatment (ventilator use >5h/day with AHI <5 events/h).
Seventeen compliant patients under effective treatment were included in the analysis (8 OSA under Autoset CPAP and 9 CSA under ASV). In both groups, a significant improvement in all measured, conventional and TDI LV systolic indexes was recorded, including LVEF (32% ± 6% vs. 27% ± 6%, p<0.001). A decrease in LV end-systolic volume (189 ± 94 ml vs. 211 ± 88 ml, p=0.015, difference >10%) was indicative of r-LVR. Furthermore, RV systolic parameters were also increased (TAPSE, p<0.001; systolic TDI wave from lateral tricuspid annular aspect, p=0.001), whereas right heart dimensions and areas were diminished, indicating better pulmonary haemodynamics. Moreover, a significant improvement in patients' clinical status, as evaluated by New York Heart Association Class was also documented at the end of six months follow-up.
Effective alleviation of SDB in CHF patients is associated with significant improvements in LV and RV systolic function and r-LVR. Longitudinal studies are needed to evaluate effects on morbidity and mortality.
睡眠呼吸障碍（SDB）在慢性心力衰竭（CHF）患者中非常普遍，并且与心脏几何形状和功能的不良影响有关。持续气道正压通气（CPAP）已被证明是治疗阻塞性睡眠呼吸暂停（OSA）的有效方法，而适应性伺服通气（ASV）在治疗中枢性睡眠呼吸暂停（CSA）患者时更为有效。选择治疗方法和有效缓解呼吸暂停对心脏功能和左心室逆向重构（r-LVR）的影响尚未得到评估。
对 85 例稳定的 CHF 患者进行 SDB 筛查，并根据 SDB 的类型进行多导睡眠图和治疗。在开始治疗前和经过 6 个月的有效治疗（呼吸机使用> 5 小时/天，AHI <5 次/小时）后，进行临床评估和全面的超声心动图研究。
17 例依从性良好且接受有效治疗的患者纳入分析（8 例 OSA 患者接受 Autoset CPAP 治疗，9 例 CSA 患者接受 ASV 治疗）。在这两组中，所有测量的、传统的和 TDI 的 LV 收缩指数均有显著改善，包括 LVEF（32%±6%比 27%±6%，p<0.001）。LV 收缩末期容积（189±94ml 比 211±88ml，p=0.015，差异>10%）的减少表明 r-LVR。此外，RV 收缩参数也增加（TAPSE，p<0.001；从外侧三尖瓣环的收缩期 TDI 波，p=0.001），而右心尺寸和面积减小，表明肺血流动力学得到改善。此外，还记录了患者的临床状况在六个月的随访结束时也有显著改善，这通过纽约心脏协会（NYHA）心功能分级进行评估。
有效缓解 CHF 患者的 SDB 与 LV 和 RV 收缩功能和 r-LVR 的显著改善有关。需要进行纵向研究来评估对发病率和死亡率的影响。
