University Health Network and Mount Sinai Hospital Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
University Health Network and Mount Sinai Hospital Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Can J Cardiol. 2016 Dec;32(12):1402-1410. doi: 10.1016/j.cjca.2016.02.047. Epub 2016 Feb 13.
BACKGROUND: The study aim was to determine whether phasic left atrial (LA) function of patients with heart failure with reduced ejection fraction differs between those with obstructive sleep apnea (OSA) and central sleep apnea (CSA). METHODS: Participation in the Adaptive Servo Ventilation for Therapy of Sleep Apnea in Heart Failure (ADVENT-HF) trial requires 2-dimensional echocardiographic documentation of left ventricular ejection fraction ≤ 45% and a polysomnographic apnea hypopnea index (AHI) ≥ 15 events per hour. Of initial enrollees, we identified 132 patients in sinus rhythm (82 with predominantly OSA and 50 with CSA). To determine LA reservoir (expansion index; EI), conduit (passive emptying index; PEI), and booster function (active emptying index), we blindly quantified maximum and minimum LA volume and LA volume before atrial contraction. RESULTS: Each of EI (P = 0.004), PEI (P < 0.001), and active emptying index (P = 0.045) was less in participants with CSA compared with those with OSA, whereas average left ventricular ejection fraction and LA and left ventricular volumes were similar. Multivariable analysis identified an independent relationship between central AHI and LA EI (P = 0.040) and PEI (P = 0.005). In contrast, the obstructive AHI was unrelated to any LA phasic index, and slopes relating central AHI to EI and PEI differed significantly from corresponding relationships with obstructive AHI (P = 0.018; P = 0.006). CONCLUSIONS: In these ADVENT-HF patients with heart failure with reduced ejection fraction, all 3 components of LA phasic function (reservoir, conduit, and contractile) were significantly reduced in those with CSA compared with participants with OSA. The severity of CSA, but not OSA associated inversely and independently with LA reservoir and conduit function. Impaired LA phasic function might be consequent to or could exacerbate CSA.
背景：本研究旨在确定射血分数降低的心力衰竭患者中，阻塞性睡眠呼吸暂停（OSA）和中枢性睡眠呼吸暂停（CSA）患者的左心房（LA）时相功能是否存在差异。
方法：参与适应性伺服通气治疗心力衰竭合并睡眠呼吸暂停试验（ADVENT-HF）需要二维超声心动图记录左心室射血分数≤45%和多导睡眠图记录呼吸暂停低通气指数（AHI）≥15 次/小时。在最初入组的患者中，我们确定了 132 名窦性节律患者（82 名主要为 OSA，50 名 CSA）。为了确定 LA 储备（扩张指数；EI）、管道（被动排空指数；PEI）和助推功能（主动排空指数），我们盲目地量化了最大和最小 LA 容积以及心房收缩前的 LA 容积。
结果：与 OSA 患者相比，CSA 患者的 EI（P=0.004）、PEI（P<0.001）和主动排空指数（P=0.045）均较低，而平均左心室射血分数、LA 和左心室容积相似。多变量分析确定了 CSA 与 LA EI（P=0.040）和 PEI（P=0.005）之间的独立关系。相反，阻塞性 AHI 与任何 LA 时相指数均无关，且 CSA 与 EI 和 PEI 之间的斜率与阻塞性 AHI 的斜率有显著差异（P=0.018；P=0.006）。
结论：在这些射血分数降低的心力衰竭 ADVENT-HF 患者中，与 OSA 患者相比，CSA 患者的 LA 时相功能的所有 3 个组成部分（储备、管道和收缩性）均显著降低。CSA 的严重程度，但不是 OSA，与 LA 储备和管道功能呈负相关且独立相关。LA 时相功能障碍可能是 CSA 的结果或可使其恶化。
Can J Cardiol. 2016-2-13
Curr Sleep Med Rep. 2019-6
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