Division of Respirology, University Hospital Regensburg, Regensburg.
Eur Respir J. 2013 Nov;42(5):1244-54. doi: 10.1183/09031936.00083312. Epub 2012 Dec 6.
We tested the hypotheses that in patients with congestive heart failure (CHF) and sleep disordered breathing (SDB) auto-servoventilation (ASV) improves cardiac function and quality of life. Between March 2007 and September 2009, patients with stable CHF (left ventricular ejection fraction (LVEF) ≤ 40%) and SDB (apnoea/hypopnoea index ≥ 20 events · h(-1)) were randomised to receive either ASV (BiPAP ASV (Philips Respironics, Murrysville, PA, USA), n=37) and optimal medical management, or optimal medical management alone (n=35). Outcomes were assessed at baseline and 12 weeks. The apnoea/hypopnoea index assessed with polysomnography scored in one core laboratory was significantly more reduced in the ASV group (-39 ± 16 versus -1 ± 13 events · h(-1); p<0.001) with an average use of 4.5 ± 3.0 h · day(-1). Both groups showed similar improvements of the primary end-point LVEF (+3.4 ± 5 versus +3.5 ± 6%; p=0.915) assessed with echocardiography. In the ASV group, reduction of N-terminal pro-brain natriuretic peptide (NT-proBNP) was significantly greater (-360 ± 569 versus +135 ± 625 ng · mL(-1); p=0.010). No differences were observed between the groups in subjective quality of life. In patients with CHF and SDB, ASV reduced NT-proBNP levels, but improvement of LVEF or quality of life was not greater than in the control group. The data support that such patients can be randomised in large-scale, long-term trials of positive airway pressure therapy versus control to determine effects on cardiovascular outcome.
我们检验了以下假设，即对于充血性心力衰竭（CHF）和睡眠呼吸紊乱（SDB）患者，自动伺服通气（ASV）可改善心功能和生活质量。2007 年 3 月至 2009 年 9 月，我们对稳定的 CHF（左心室射血分数（LVEF）≤40%）和 SDB（呼吸暂停/低通气指数（apnoea/hypopnoea index，AHI）≥20 次·h(-1))患者进行了随机分组，分别接受 ASV（双水平气道正压通气 ASV（Philips Respironics，Murrysville，PA，美国），n=37）和最佳药物治疗（n=35）。在基线和 12 周时评估结局。多导睡眠图评估的 AHI 在一个核心实验室评分显著降低，ASV 组减少了（-39±16 比-1±13 次·h(-1))，平均使用时间为 4.5±3.0 小时·天(-1)。两组患者的主要终点 LVEF（超声心动图评估）均有相似的改善（+3.4±5 比+3.5±6%；p=0.915）。ASV 组的 N 端脑利钠肽前体（N-terminal pro-brain natriuretic peptide，NT-proBNP）降低更显著（-360±569 比+135±625 ng·mL(-1))，p=0.010）。两组患者的生活质量主观评分无差异。在 CHF 和 SDB 患者中，ASV 降低了 NT-proBNP 水平，但 LVEF 或生活质量的改善并不优于对照组。该数据支持将此类患者随机分组纳入大规模、长期的气道正压治疗与对照组的试验，以确定对心血管结局的影响。
