Selim Bernardo J, Ramar Kannan
Division of Pulmonary and Critical Care Medicine, Mayo Clinic Center for Sleep Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
Division of Pulmonary and Critical Care Medicine, Mayo Clinic Center for Sleep Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
Sleep Med Clin. 2017 Mar;12(1):107-121. doi: 10.1016/j.jsmc.2016.10.004. Epub 2016 Dec 20.
Central sleep apnea (CSA) and obstructive sleep apnea (OSA) are prevalent in heart failure (HF) and associated with a worse prognosis. Nocturnal oxygen therapy may decrease CSA events, sympathetic tone, and improve left ventricular ejection fraction, although mortality benefit is unknown. Although treatment of OSA in patients with HF is recommended, therapy for CSA remains controversial. Continuous positive airway pressure use in HF-CSA may improve respiratory events, hemodynamics, and exercise capacity, but not mortality. Adaptive servo ventilation is contraindicated in patients with symptomatic HF with predominant central sleep-disordered events. The role of phrenic nerve stimulation in CSA therapy is promising.
中枢性睡眠呼吸暂停（CSA）和阻塞性睡眠呼吸暂停（OSA）在心力衰竭（HF）中普遍存在，且与更差的预后相关。夜间氧疗可能会减少CSA事件、交感神经张力，并改善左心室射血分数，尽管其对死亡率的益处尚不清楚。虽然推荐对HF患者的OSA进行治疗，但CSA的治疗仍存在争议。在HF-CSA患者中使用持续气道正压通气可能会改善呼吸事件、血流动力学和运动能力，但不能降低死亡率。对于以中枢性睡眠障碍事件为主的有症状HF患者，禁忌使用适应性伺服通气。膈神经刺激在CSA治疗中的作用很有前景。
