Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
Eur J Heart Fail. 2013 Sep;15(9):1003-10. doi: 10.1093/eurjhf/hft066. Epub 2013 May 3.
We examined whether the severity of central sleep apnoea (CSA) and the level of C-reactive protein are associated with the prevalence and complexity of arrhythmias, and whether these factors contribute to increased risk of nocturnal sudden death.
We prospectively examined 178 patients (age 70 ± 1 years) who were admitted to our hospital due to worsening heart failure. We recorded a simultaneous overnight cardiorespiratory polygraph and Holter ECG. Obstructive sleep apnoea was excluded and patients were dichotomized based on the median value of the central apnoea index (CAI) of 7.5/h. The prevalence and complexity of arrhythmias were compared between daytime (06:00 h to 15:00 h) and night-time (21:00 h to 06:00 h). A multivariate logistic regression analysis revealed that the CAI was associated with prevalence of atrial fibrillation (AF) [odds ratio 1.03, 95% confidence interval (CI) 1.02-2.51)] and sinus pause during the night-time period (1.12, 95% CI 1.08-1.35). The CAI and C-reactive protein were independently associated with non-sustained ventricular tachycardia during both daytime (1.22, 95% CI 1.00-6.92; and 5.82, 2.58-56.1, respectively) and night-time periods (3.57, 95% CI 1.06-13.1; and 10.7, 3.30-44.4, respectively). During a mean follow-up period of 22 months, 30 (17%) patients had cardiovascular deaths and the CSA was an independent predictor (hazard ratio 1.29, 95% CI 1.16-2.32); only 5 (2.8%) of them died due to ventricular tachyarrhythmia, occurring during wakefulness.
We demonstrated that the severity of CSA and C-reactive protein levels are independently associated with the prevalence and complexity of arrhythmias. CSA was associated with increased mortality risk, but it was not related directly to nocturnal death due to ventricular tachyarrhythmia.
我们研究了中枢性睡眠呼吸暂停（CSA）的严重程度和 C 反应蛋白水平与心律失常的发生率和复杂性是否相关，以及这些因素是否会增加夜间猝死的风险。
我们前瞻性地检查了 178 名（年龄 70±1 岁）因心力衰竭恶化而住院的患者。我们记录了一次同时进行的夜间心肺多导睡眠图和动态心电图。排除了阻塞性睡眠呼吸暂停，并根据中枢性呼吸暂停指数（CAI）的中位数（7.5/h）将患者分为两组。比较了白天（06:00 小时至 15:00 小时）和夜间（21:00 小时至 06:00 小时）心律失常的发生率和复杂性。多变量逻辑回归分析显示，CAI 与夜间心房颤动（AF）的发生率相关[优势比 1.03，95%置信区间（CI）1.02-2.51)]和窦性停搏（1.12，95%CI 1.08-1.35）。CAI 和 C 反应蛋白与白天和夜间非持续性室性心动过速独立相关（1.22，95%CI 1.00-6.92；和 5.82，2.58-56.1）。在平均 22 个月的随访期间，30 名（17%）患者发生心血管死亡，CSA 是独立的预测因子（危险比 1.29，95%CI 1.16-2.32）；只有 5 名（2.8%）患者死于室性心动过速，发生在清醒时。
我们证明了 CSA 的严重程度和 C 反应蛋白水平与心律失常的发生率和复杂性独立相关。CSA 与死亡率升高相关，但与夜间室性心动过速引起的死亡无关。
