Department of Respiratory Medicine, the First Affiliated Hospital of Nanjing Medical University, China.
J Clin Sleep Med. 2013 Aug 15;9(8):781-7. doi: 10.5664/jcsm.2920.
Sleep disordered breathing (SDB) is common in patients with chronic heart failure secondary to non-valvular heart disease; however, the prevalence and characteristics of SDB in patients with rheumatic valvular heart disease (RVHD) are unclear. This study was designed to determine the prevalence, characteristics, and risk factors for SDB in RVHD patients.
A cross-sectional study was conducted in 260 RVHD patients. The following data were recorded: types of heart valve lesions, electrocardiographic, echocardiographic, arterial blood gas analysis findings, baseline medication, 6-minute walk test (6MWT) distance, and sleep parameters.
Compared to patients with single leftsided valve lesions, patients with left- and rightsided valve lesions had a higher prevalence of SDB (46.2% vs. 31.2%, p = 0.013); the increased prevalence of SDB only involved central sleep apnea (CSA) (31.1% vs. 14.1%, p = 0.001). Patients with obstructive sleep apnea (OSA) or CSA were older and had a shorter 6MWT distance, lower left ventricle ejection fraction and PaO₂, a longer lung-to-finger circulation time, and a higher prevalence of atrial fibrillation (AF) and hypertension (all p < 0.05) as compared with patients without SDB. Multinomial logistic regression analysis showed that PaO2 ≤ 85 mm Hg was the only risk factor for OSA. Male gender, AF, 6MWT distance ≤ 300 m, PaO₂ ≤ 85 mmHg, and PaCO₂ ≤ 40 mm Hg were risk factors for CSA.
Patients with RVHD had a high prevalence of SDB (predominantly CSA). RVHD patients with SDB, particularly those who had CSA, manifested more severe symptoms and greater impairment of cardiac function. Assessments of clinical manifestations of cardiac dysfunction may be important for predicting the risk factors for SDB.
非瓣膜性心脏病继发慢性心力衰竭患者常合并睡眠呼吸障碍（SDB）；然而，风湿性心脏瓣膜病（RVHD）患者 SDB 的患病率和特点尚不清楚。本研究旨在确定 RVHD 患者 SDB 的患病率、特点和危险因素。
对 260 例 RVHD 患者进行横断面研究。记录以下数据：心脏瓣膜病变类型、心电图、超声心动图、动脉血气分析结果、基础用药、6 分钟步行试验（6MWT）距离和睡眠参数。
与单纯左侧瓣膜病变患者相比，左侧和右侧瓣膜病变患者 SDB 的患病率更高（46.2% vs. 31.2%，p = 0.013）；SDB 患病率的增加仅涉及中枢性睡眠呼吸暂停（CSA）（31.1% vs. 14.1%，p = 0.001）。与无 SDB 的患者相比，患有阻塞性睡眠呼吸暂停（OSA）或 CSA 的患者年龄较大，6MWT 距离较短，左心室射血分数和 PaO₂较低，肺-指循环时间较长，心房颤动（AF）和高血压的患病率较高（均 p < 0.05）。多项逻辑回归分析显示，PaO2≤85mmHg 是 OSA 的唯一危险因素。男性、AF、6MWT 距离≤300m、PaO₂≤85mmHg 和 PaCO₂≤40mmHg 是 CSA 的危险因素。
RVHD 患者 SDB 患病率较高（主要为 CSA）。合并 SDB 的 RVHD 患者，尤其是 CSA 患者，表现出更严重的症状和更严重的心功能障碍。评估心功能障碍的临床表现可能对预测 SDB 的危险因素很重要。
