University of Medicine and Pharmacy, Dr Victor Babes, Eftimie Murgu Square 2, 300041 Timisoara, Romania.
Cardiology Department, University of Medicine and Pharmacy, Dr Victor Babes, Eftimie Murgu Square 2, 300041 Timisoara, Romania.
Medicina (Kaunas). 2019 Aug 7;55(8):449. doi: 10.3390/medicina55080449.
: Obstructive sleep apnea syndrome (OSAS) and heart failure (HF) are increasing in prevalence with a greater impact on the health system. The aim of this study was to assess the particularities of patients with OSAS and HF, focusing on the new class of HF with mid-range ejection fraction (HFmrEF, EF = 40%-49%), and comparing it with reduced EF (HFrEF, EF < 40%) and preserved EF (HFpEF, EF ≥ 50%). : A total of 143 patients with OSAS and HF were evaluated in three sleep labs of "Victor Babes" Hospital and Cardiovascular Institute, Timisoara, Western Romania. We collected socio-demographic data, anthropometric sleep-related measurements, symptoms through sleep questionnaires and comorbidity-related data. We performed blood tests, cardio-respiratory polygraphy and echocardiographic measurements. Patients were divided into three groups depending on ejection fraction. : Patients with HFmrEF were older ( = 0.0358), with higher values of the highest systolic blood pressure (mmHg) ( = 0.0016), higher serum creatinine ( = 0.0013), a lower glomerular filtration rate ( = 0.0003), higher glycemic levels ( = 0.008) and a larger left atrial diameter ( = 0.0002). Regarding comorbidities, data were presented as percentage, HFrEF vs. HFmrEF vs. HFpEF. Higher prevalence of diabetes mellitus (52.9 vs. 72.7 vs. 40.2, = 0.006), chronic kidney disease (17.6 vs. 57.6 vs. 21.5, < 0.001), tricuspid insufficiency (76.5 vs. 84.8 vs.59.1, = 0.018) and aortic insufficiency (35.3 vs.42.4 vs. 20.4, = 0.038) were observed in patients with HFmrEF, whereas chronic obstructive pulmonary disease(COPD) (52.9 vs. 24.2 vs.18.3, = 0.009), coronary artery disease(CAD) (82.4 vs. 6.7 vs. 49.5, = 0.026), myocardial infarction (35.3 vs. 24.2 vs. 5.4, < 0.001) and impaired parietal heart kinetics (70.6 vs. 68.8 vs. 15.2, < 0.001) were more prevalent in patients with HFrEF. : Patients with OSAS and HF with mid-range EF may represent a new group with increased risk of developing life-long chronic kidney disease, diabetes mellitus, tricuspid and aortic insufficiency. COPD, myocardial infarction, impaired parietal kinetics and CAD are most prevalent comorbidities in HFrEF patients but they are closer in prevalence to HFmrEF than HFpEF.
阻塞性睡眠呼吸暂停综合征（OSAS）和心力衰竭（HF）的患病率呈上升趋势，对医疗系统的影响也越来越大。本研究旨在评估合并 OSAS 和 HF 患者的特点，重点关注射血分数处于中间范围的心力衰竭（HFmrEF，EF=40%-49%），并将其与射血分数降低的心力衰竭（HFrEF，EF<40%）和射血分数保留的心力衰竭（HFpEF，EF≥50%）进行比较。
共有 143 名合并 OSAS 和 HF 的患者在罗马尼亚西部蒂米什瓦拉的“Victor Babes”医院和心血管研究所的三个睡眠实验室接受了评估。我们收集了社会人口统计学数据、与睡眠相关的人体测量学测量值、通过睡眠问卷评估的症状以及合并症相关数据。我们进行了血液检查、心肺多导睡眠图和超声心动图测量。根据射血分数，患者被分为三组。
HFmrEF 组患者年龄更大（=0.0358），最高收缩压（mmHg）值更高（=0.0016），血清肌酐值更高（=0.0013），肾小球滤过率更低（=0.0003），血糖水平更高（=0.008），左心房直径更大（=0.0002）。在合并症方面，数据以百分比形式呈现，HFrEF 与 HFmrEF 与 HFpEF 进行比较。HFmrEF 组的糖尿病患病率更高（52.9%比 72.7%比 40.2%，=0.006），慢性肾病患病率更高（17.6%比 57.6%比 21.5%，<0.001），三尖瓣关闭不全患病率更高（76.5%比 84.8%比 59.1%，=0.018），主动脉瓣关闭不全患病率更高（35.3%比 42.4%比 20.4%，=0.038）。然而，HFmrEF 组的慢性阻塞性肺疾病（COPD）患病率更高（52.9%比 24.2%比 18.3%，=0.009），冠状动脉疾病（CAD）患病率更高（82.4%比 6.7%比 49.5%，=0.026），心肌梗死患病率更高（35.3%比 24.2%比 5.4%，<0.001），室壁运动障碍患病率更高（70.6%比 68.8%比 15.2%，<0.001）。
因此，合并 OSAS 和 HF 且射血分数处于中间范围的患者可能代表一个新的群体，他们有发展为终身慢性肾病、糖尿病、三尖瓣和主动脉瓣关闭不全的风险增加。COPD、心肌梗死、室壁运动障碍和 CAD 是 HFrEF 患者最常见的合并症，但它们与 HFmrEF 的患病率更接近，而不是 HFpEF。
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