Oates Connor P, Ananthram Manjula, Gottlieb Stephen S
School of Medicine, University of Maryland, Baltimore, MD, USA.
Curr Heart Fail Rep. 2018 Jun;15(3):123-130. doi: 10.1007/s11897-018-0387-7.
This paper reviews treatment options for sleep disordered breathing (SDB) in patients with heart failure. We sought to identify therapies for SDB with the best evidence for long-term use in patients with heart failure and to minimize uncertainties in clinical practice by examining frequently discussed questions: what is the role of continuous positive airway pressure (CPAP) in patients with heart failure? Is adaptive servo-ventilation (ASV) safe in patients with heart failure? To what extent is SDB a modifiable risk factor?
Consistent evidence has demonstrated that the development of SDB in patients with heart failure is a poor prognostic indicator and a risk factor for cardiovascular mortality. However, despite numerous available interventions for obstructive sleep apnea and central sleep apnea, it remains unclear what effect these therapies have on patients with heart failure. To date, all major randomized clinical trials have failed to demonstrate a survival benefit with SDB therapy and one major study investigating the use of adaptive servo-ventilation demonstrated harm. Significant questions persist regarding the management of SDB in patients with heart failure. Until appropriately powered trials identify a treatment modality that increases cardiovascular survival in patients with SDB and heart failure, a patient's heart failure management should remain the priority of medical care.
本文综述了心力衰竭患者睡眠呼吸障碍（SDB）的治疗选择。我们试图确定有最佳证据支持可长期用于心力衰竭患者的SDB治疗方法，并通过审视经常讨论的问题来尽量减少临床实践中的不确定性：持续气道正压通气（CPAP）在心力衰竭患者中起什么作用？适应性伺服通气（ASV）对心力衰竭患者是否安全？SDB在多大程度上是一个可改变的危险因素？
一致的证据表明，心力衰竭患者发生SDB是预后不良的指标和心血管死亡的危险因素。然而，尽管有多种针对阻塞性睡眠呼吸暂停和中枢性睡眠呼吸暂停的干预措施，但这些治疗方法对心力衰竭患者有何影响仍不清楚。迄今为止，所有主要的随机临床试验均未能证明SDB治疗能带来生存获益，一项调查适应性伺服通气使用情况的主要研究显示其有危害。关于心力衰竭患者SDB的管理仍存在重大问题。在有足够效力的试验确定一种能提高SDB合并心力衰竭患者心血管生存率的治疗方式之前，患者的心力衰竭管理应始终是医疗护理的重点。
