Geib Tanja, Plappert Nina, Roth Tatjana, Popp Roland, Birner Christoph, Maier Lars S, Pfeifer Michael, Arzt Michael
Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
Department of Psychiatry and Psychotherapy, Center of Sleep Medicine, University of Regensburg, Regensburg, Germany.
Can J Cardiol. 2015 Jul;31(7):839-45. doi: 10.1016/j.cjca.2015.02.025. Epub 2015 Feb 25.
Sleep-disordered breathing (SDB) is highly prevalent in patients with chronic heart failure (CHF) and is associated with a poor prognosis. Data on SDB-related symptoms and vigilance impairment in patients with CHF and SDB are rare. Thus, the objective of the present study was to assess a wide spectrum of SDB-related symptoms and objective vigilance testing in patients with CHF with and without SDB.
Patients with CHF (n = 222; average age, 62 years; left ventricular ejection fraction [LVEF], 34%) underwent polysomnography regardless of the presence or absence of SDB-related symptoms. Patients were stratified into those with no SDB (apnea-hypopnea index [AHI] < 15 episodes/h), moderate SDB (AHI ≥ 15 to < 30 episodes/h), and severe SDB (AHI ≥ 30 episodes/h). A standardized institutional questionnaire assessing a wide spectrum of SDB-related symptoms was applied. A subset of patients underwent objective vigilance testing (Quatember Maly, 100 stimuli within 25 minutes).
Daytime fatigue (no SDB, moderate SDB, and severe SDB: 53%, 69%, and 80%, respectively; P = 0.005), unintentional sleep (9%, 15%, and 32%, respectively; P = 0.004), and xerostomia (52%, 49%, and 70%, respectively; P = 0.018), as well as an impaired objective vigilance test result (mean reaction time, 0.516, 0.497, and 0.579 ms, respectively; P < 0.001) occurred more frequently with increasing severity of SDB. Seventy-eight percent of patients with CHF and SDB had at least 3 SDB-related symptoms. In a linear multivariable regression model, the frequency of daytime fatigue (P = 0.014), unintentional sleep (P = 0.001), xerostomia (P = 0.016), and mean reaction time (P = 0.001) were independently associated with increasing AHI independent of age, body mass index, New York Heart Association functional class, and LVEF.
The majority of patients with CHF and SDB have several potential SDB-related symptoms and objective impairment of vigilance as potential treatment targets.
睡眠呼吸障碍（SDB）在慢性心力衰竭（CHF）患者中高度流行，且与不良预后相关。关于CHF合并SDB患者的SDB相关症状及警觉性损害的数据很少。因此，本研究的目的是评估有或无SDB的CHF患者广泛的SDB相关症状及客观警觉性测试。
CHF患者（n = 222；平均年龄62岁；左心室射血分数[LVEF]为34%）无论有无SDB相关症状均接受多导睡眠图检查。患者被分为无SDB（呼吸暂停低通气指数[AHI]<15次/小时）、中度SDB（AHI≥15至<30次/小时）和重度SDB（AHI≥30次/小时）。应用一份评估广泛SDB相关症状的标准化机构问卷。一部分患者接受客观警觉性测试（Quatember Maly，25分钟内100次刺激）。
白天疲劳（无SDB、中度SDB和重度SDB分别为53%、69%和80%；P = 0.005）|无意睡眠（分别为9%、15%和32%；P = 0.004）、口干（分别为52%、49%和70%；P = 0.018）以及客观警觉性测试结果受损（平均反应时间分别为0.516、0.497和0.579毫秒；P<0.001）随着SDB严重程度增加而更频繁出现。78%的CHF合并SDB患者至少有3种SDB相关症状。在一个线性多变量回归模型中，白天疲劳频率（P = 0.014）、无意睡眠（P = 0.001）、口干（P = 0.016）和平均反应时间（P = 0.001）与AHI增加独立相关，独立于年龄、体重指数、纽约心脏协会功能分级和LVEF。
大多数CHF合并SDB患者有几种潜在的SDB相关症状及客观警觉性损害，可作为潜在治疗靶点。
