心力衰竭合并中枢性睡眠呼吸暂停对持续气道正压通气无反应患者的心脏功能和神经激素状态的适应性伺服通气。
Adaptive servo-ventilation in cardiac function and neurohormonal status in patients with heart failure and central sleep apnea nonresponsive to continuous positive airway pressure.
机构信息
Sleep Center, Toranomon Hospital, Tokyo, Japan; Cardio-Respiratory Sleep Medicine, Juntendo University School of Medicine, Tokyo, Japan; Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan.
Sleep Center, Toranomon Hospital, Tokyo, Japan.
出版信息
JACC Heart Fail. 2013 Feb;1(1):58-63. doi: 10.1016/j.jchf.2012.11.002. Epub 2013 Feb 4.
OBJECTIVES
The aim of this study was to investigate whether effective suppression of central sleep apnea (CSA) by adaptive servo-ventilation (ASV) improves underlying cardiac dysfunction among patients with heart failure (HF) in whom CSA was not effectively suppressed by continuous positive airway pressure (CPAP).
BACKGROUND
The presence of CSA in HF is associated with a poor prognosis, whereas CPAP treatment improves HF. However, in a large-scale trial, CPAP failed to improve survival, probably due to insufficient CSA suppression. Recently, ASV was reported as the most effective alternative to CSA suppression. However, the effects of sufficient CSA suppression by ASV on cardiac function are unknown.
METHODS
Patients with New York Heart Association class ≥II HF, left ventricular ejection fraction <50%, and CSA that was unsuppressed (defined as an apnea-hypopnea index ≥15) despite ≥3 months of CPAP were randomly assigned to receive ASV in either CPAP mode or ASV mode.
RESULTS
Of 23 patients enrolled, 12 were assigned to the ASV-mode group and 11 were assigned to the CPAP-mode group. Three months after randomization, the ASV mode was significantly more effective in suppressing the apnea-hypopnea index (from 25.0 ± 6.9 events/h to 2.0 ± 1.4 events/h; p < 0.001) compared to the CPAP mode. Compliance was signi-ficantly greater with the ASV mode than with the CPAP mode. Improvement in left ventricular ejection fraction was greater with the ASV mode (32.0 ± 7.9% to 37.8 ± 9.1%; p < 0.001) than with the CPAP mode.
CONCLUSIONS
Patients with HF and unsuppressed CSA despite receiving CPAP may receive additional benefit by having CPAP replaced with ASV. Additionally, effective suppression of CSA may improve cardiac function in HF patients.
目的
本研究旨在探讨自适应伺服通气（ASV）是否能有效抑制中枢性睡眠呼吸暂停（CSA），从而改善因持续气道正压通气（CPAP）治疗无效而导致 CSA 持续存在的心力衰竭（HF）患者的潜在心功能障碍。
背景
HF 患者存在 CSA 与预后不良相关，而 CPAP 治疗可改善 HF。然而，在一项大规模试验中，CPAP 并未改善生存率，这可能是由于 CSA 抑制不足。最近，ASV 被报道为 CSA 抑制的最有效替代方法。然而，充分抑制 CSA 对心功能的影响尚不清楚。
方法
入选的 NYHA 分级≥II 级 HF、左心室射血分数<50%、CPAP 治疗≥3 个月但 CSA 仍未被抑制（定义为呼吸暂停低通气指数≥15）的患者，随机分为接受 CPAP 模式或 ASV 模式下的 ASV 治疗。
结果
共纳入 23 例患者，其中 12 例被分配到 ASV 模式组，11 例被分配到 CPAP 模式组。随机分组 3 个月后，ASV 模式较 CPAP 模式更有效地抑制呼吸暂停低通气指数（从 25.0±6.9 次/小时降至 2.0±1.4 次/小时；p<0.001）。ASV 模式的依从性显著高于 CPAP 模式。ASV 模式较 CPAP 模式左心室射血分数改善更显著（从 32.0±7.9%增至 37.8±9.1%；p<0.001）。
结论
CPAP 治疗后仍存在 CSA 未被抑制的 HF 患者，用 ASV 替代 CPAP 可能会带来额外获益。此外，有效抑制 CSA 可能会改善 HF 患者的心功能。
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