Chen R K, Hong C, Zhou Y M, Kuang A L, Zhang Y T, Qing S M, Liu C L, Zhang N F
State Key Laboratory of Respiratory Diseases, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Diseases, National Research Center of Clinical Medicine, Guangzhou 510120, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2017 Jan 12;40(1):46-51. doi: 10.3760/cma.j.issn.1001-0939.2017.01.010.
To study the relationship between dilated cardiomyopathy and obstructive sleep apnea-hypopnea syndrome (OSAHS) and to evaluate the curative effects of continuous positive airway pressure (CPAP) in OSAHS complicated with dilated cardiomyopathy. We reported one case with the symptom of exertional dyspnea for 1 year and aggravating for 1 month. The patient finally was diagnosed with severe OSAHS complicated with dilated cardiomyopathy leading to pulmonary hypertension. A systematic literature review was performed for similar published cases in Pubmed, Wanfang and CNKI database, using the keywords (obstructive sleep apnea) OR(OSA) OR(OSAHS) AND(dilated cardiomyopathy OR DCM)from January 1990 to May 2016. Our patient had no significant improvement after receiving initial treatments, including reducing cardiac preload, improving myocardial metabolism, increasing myocardial contractility, and anticoagulants. After the patient was diagnosed as having severe OSAHS by polysomnography(PSG) and treated with CPAP, his symptoms improved remarkably. The enlarged heart became smaller and the patient had no repeated dyspnea at follow-up examination. By literature review, we found 4 English original articles and 6 Chinese articles (1 review article, 1 expert note, 1 original article and 3 case reports) on OSAHS complicated by DCM.Four Chinese and 1 English articles reported that the symptoms and parameters of OSAHS with DCM was improved remarkably after treatment with CPAP. For patients with dilated cardiomyopathy which fails to conventional therapy, especially those accompanied by obesity, snoring, daytime sleepiness, morning dry mouth and other related symptoms, PSG should be carried out. Early CPAP therapy could improve symptoms and prognosis of OSAHS associated with DCM.
研究扩张型心肌病与阻塞性睡眠呼吸暂停低通气综合征（OSAHS）之间的关系，并评估持续气道正压通气（CPAP）对OSAHS合并扩张型心肌病的治疗效果。我们报告了1例劳力性呼吸困难1年、加重1个月的患者。该患者最终被诊断为重度OSAHS合并扩张型心肌病导致肺动脉高压。使用关键词（阻塞性睡眠呼吸暂停）或（OSA）或（OSAHS）与（扩张型心肌病或DCM），对1990年1月至2016年5月期间Pubmed、万方和知网数据库中类似的已发表病例进行了系统的文献综述。该患者在接受包括减轻心脏前负荷、改善心肌代谢、增强心肌收缩力和抗凝等初始治疗后无明显改善。在通过多导睡眠图（PSG）诊断该患者为重度OSAHS并给予CPAP治疗后，其症状明显改善。增大的心脏变小，且在随访检查中患者未再出现呼吸困难。通过文献综述，我们发现了4篇关于OSAHS合并DCM的英文原文和6篇中文文章（1篇综述文章、1篇专家笔记、1篇原文和3篇病例报告）。4篇中文文章和1篇英文文章报道，OSAHS合并DCM患者经CPAP治疗后症状和相关参数明显改善。对于常规治疗无效的扩张型心肌病患者，尤其是伴有肥胖、打鼾、日间嗜睡、晨起口干等相关症状者，应进行PSG检查。早期CPAP治疗可改善OSAHS合并DCM患者的症状和预后。
