Cardiol J. 2013;20(4):345-55. doi: 10.5603/CJ.2013.0092.
Sleep disordered breathing (SDB) is a common co-morbidity in patients with heart failure (HF). Both its forms - central and obstructive sleep apnea - are highly prevalent in this population. SDB fragments sleep, impairs life quality, worsens exercise tolerance, worsens HF and is an independent predictor of poor prognosis. Still, SDB remains largely undiagnosed. Therefore, early detection of SDB seems to be of primary importance, especially in the presence of new diagnostic and therapeutic methods. Treatment with continuous positive airway pressure (CPAP) increases left ventricular ejection fraction and stroke volume in virtually all HF patients with obstructive and in 50% with central sleep apnea. For those in whom central sleep apnea is not suppressed by CPAP, a trial of adaptive servoventilation is recommended. Although no randomized, controlled trials have shown improvement in mortality, several observational studies have shown that effective treatment of both forms of sleep apnea with various positive airway pressure devices improves survival of HF patients. Currently, 2 large trials with newer masked based therapies with adaptive servoventilation are in progress. This article is a brief overview of present knowledge, the pathophysiology, diagnostic approach and therapy of SDB.
睡眠呼吸障碍（SDB）是心力衰竭（HF）患者常见的合并症。其两种形式——中枢性和阻塞性睡眠呼吸暂停——在该人群中发病率很高。SDB 会打断睡眠、降低生活质量、降低运动耐量、加重 HF，并且是预后不良的独立预测因素。尽管如此，SDB 仍然很大程度上未被诊断。因此，早期发现 SDB 似乎尤为重要，尤其是在出现新的诊断和治疗方法的情况下。持续气道正压通气（CPAP）治疗可增加几乎所有阻塞性和 50%的中枢性睡眠呼吸暂停 HF 患者的左心室射血分数和每搏量。对于那些 CPAP 不能抑制中枢性睡眠呼吸暂停的患者，建议进行适应性伺服通气试验。尽管没有随机对照试验显示死亡率有所改善，但多项观察性研究表明，使用各种正压通气设备有效治疗两种形式的睡眠呼吸暂停均可改善 HF 患者的生存率。目前，正在进行两项使用新型基于掩蔽的适应性伺服通气疗法的大型试验。本文简要概述了 SDB 的现有知识、病理生理学、诊断方法和治疗。
