充血性心力衰竭患者的中枢性睡眠呼吸暂停

Central Sleep Apnea in Patients with Congestive Heart Failure.

作者信息

Rowley James A, Badr M Safwan

机构信息

Division of Pulmonary, Critical Care & Sleep Medicine, Harper University Hospital, Wayne State University School of Medicine, 3990 John R, 3 Hudson, Detroit, MI 48201, USA.

Division of Pulmonary, Critical Care & Sleep Medicine, Harper University Hospital, John D. Dingell VAMC, Wayne State University School of Medicine, 3990 John R, 3 Hudson, Detroit, MI 48201, USA.

出版信息

Sleep Med Clin. 2017 Jun;12(2):221-227. doi: 10.1016/j.jsmc.2017.03.001.

DOI:10.1016/j.jsmc.2017.03.001

PMID:28477776

Abstract

Central sleep apnea and Cheyne-Stokes respiration are commonly observed breathing patterns during sleep in patients with congestive heart failure. Common risk factors are male gender, older age, presence of atrial fibrillation, and daytime hypocapnia. Proposed mechanisms include augmented peripheral and central chemoreceptor sensitivity, which increase ventilator instability during both wakefulness and sleep; diminished cerebrovascular reactivity and increased circulation time, which impair the normal buffering of Paco and hydrogen ions and delay the detection of changes in Paco during sleep; and rostral fluid shifts that predispose to hypocapnia.

摘要

中枢性睡眠呼吸暂停和潮式呼吸是充血性心力衰竭患者睡眠期间常见的呼吸模式。常见的危险因素包括男性、老年、房颤的存在以及日间低碳酸血症。提出的机制包括外周和中枢化学感受器敏感性增强，这会增加清醒和睡眠期间的通气不稳定性；脑血管反应性降低和循环时间延长，这会损害对动脉血二氧化碳分压（Paco）和氢离子的正常缓冲，并延迟睡眠期间对Paco变化的检测；以及导致低碳酸血症的头端液体转移。