Woehrle H, Oldenburg O, Stadler S, Arzt M
Schlaf- und Beatmungszentrum Blaubeuren, Lungenzentrum Ulm, Ulm, Deutschland.
Klinik für Kardiologie, Herz- und Diabeteszentrum NRW, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland.
Internist (Berl). 2018 May;59(5):428-438. doi: 10.1007/s00108-018-0412-7.
Since sleep apnea often occurs in heart failure, physicians regularly need to decide whether further diagnostic procedures and/or treatment are required.
Which types of sleep apnea occur in heart failure patients? When is treatment needed? Which treatments and treatment goals are appropriate?
Clinical trials and guidelines as well as their implementation in clinical practice are discussed.
At least 40% of patients with heart failure, both with reduced and preserved left ventricular ejection fraction (HFrEF and HFpEF, respectively), suffer from relevant sleep apnea. In heart failure patients both obstructive and central sleep apnea are associated with increased mortality. In HFrEF as well as in HFpEF patients with obstructive sleep apnea, treatment with continuous positive airway pressure (CPAP) achieves symptomatic and functional improvements. In patients with HFpEF, positive airway pressure treatment of central sleep apnea may be beneficial. In patients with HFrEF and left ventricular ejection fraction ≤45%, adaptive servoventilation is contraindicated.
Sleep apnea is highly prevalent in heart failure patients and its treatment in specific patient groups can improve symptoms and functional outcomes. Thus, testing for sleep apnea is recommended.
由于睡眠呼吸暂停常发生于心力衰竭患者中，医生经常需要决定是否需要进一步的诊断程序和/或治疗。
心力衰竭患者会出现哪些类型的睡眠呼吸暂停？何时需要治疗？哪些治疗方法和治疗目标是合适的？
讨论了临床试验和指南及其在临床实践中的应用。
至少40%的心力衰竭患者，无论左心室射血分数降低（分别为HFrEF）还是保留（HFpEF），都患有相关的睡眠呼吸暂停。在心力衰竭患者中，阻塞性和中枢性睡眠呼吸暂停均与死亡率增加相关。在HFrEF以及患有阻塞性睡眠呼吸暂停的HFpEF患者中，持续气道正压通气（CPAP）治疗可实现症状和功能改善。在HFpEF患者中，中枢性睡眠呼吸暂停的气道正压通气治疗可能有益。在左心室射血分数≤45%的HFrEF患者中，适应性伺服通气是禁忌的。
睡眠呼吸暂停在心力衰竭患者中非常普遍，在特定患者群体中对其进行治疗可改善症状和功能结局。因此，建议对睡眠呼吸暂停进行检测。
