Hetland Arild, Vistnes Maria, Haugaa Kristina H, Liland Kristian Hovde, Olseng Margareth, Edvardsen Thor
Department of Cardiology, The Hospital of Oestfold, Oestfold, Norway.
Faculty of Medicine, University of Oslo, Oslo, Norway.
Cardiovasc Diagn Ther. 2020 Jun;10(3):396-404. doi: 10.21037/cdt.2020.03.02.
In chronic heart failure (CHF), obstructive sleep apnea (OSA) and Cheyne-Stokes respiration (CSR) are associated with increased mortality. The present study aimed to evaluate the prognostic effect of CSR compared to OSA, in otherwise similar groups of CHF patients.
Screening for sleep-disordered breathing (SDB) was conducted among patients with CHF of New York Heart Association (NYHA) class II-IV, and left ventricular ejection fraction (LVEF) of ≤45%. The study included 43 patients (4 women) with >25% CSR during sleeping time, and 19 patients (2 women) with OSA and an apnea-hypopnea index (AHI) of ≥6. Patients were followed for a median of 1,371 days. The primary endpoint was mortality, and the secondary endpoint was combined mortality and hospital admissions.
Baseline parameters did not significantly differ between groups, but CSR patients were older and had higher AHI values than OSA patients. Five OSA patients (26%) died, and 14 (74%) met the combined end-point of death or hospitalization. CSR patients had significantly higher risk for both end-points, with 23 (53%) deaths [log-rank P=0.040; HR, 2.70 (1.01-7.22); P=0.047] and 40 (93%) deaths or readmissions [log-rank P=0.029; HR, 1.96 (1.06-3.63); P=0.032]. After adjustment for confounding risk factors, the association between CSR and death remained significant [HR, 4.73 (1.10-20.28); P=0.037], hospital admission rates were not significantly different.
Among patients with CHF, CSR was associated with higher mortality than OSA independently of age and cardiac systolic function. CSR was also an age-independent predictor of unfavorable outcome, but hospital admission rates were not significantly different between the two groups after adjustment.
在慢性心力衰竭（CHF）中，阻塞性睡眠呼吸暂停（OSA）和潮式呼吸（CSR）与死亡率增加相关。本研究旨在评估在其他方面相似的CHF患者组中，与OSA相比，CSR的预后影响。
对纽约心脏协会（NYHA）II-IV级且左心室射血分数（LVEF）≤45%的CHF患者进行睡眠呼吸障碍（SDB）筛查。该研究纳入了43例患者（4例女性），其睡眠时间内CSR>25%，以及19例患者（2例女性），其患有OSA且呼吸暂停低通气指数（AHI）≥6。对患者进行了中位时间为1371天的随访。主要终点是死亡率，次要终点是死亡率和住院率的综合情况。
两组间基线参数无显著差异，但CSR患者比OSA患者年龄更大且AHI值更高。5例OSA患者（26%）死亡，14例（74%）达到死亡或住院的综合终点。CSR患者两个终点的风险均显著更高，有23例（53%）死亡[对数秩检验P=0.040；风险比（HR），2.70（1.01-7.22）；P=0.047]，40例（93%）死亡或再次入院[对数秩检验P=0.029；HR，1.96（1.06-3.63）；P=0.032]。在对混杂风险因素进行调整后，CSR与死亡之间的关联仍然显著[HR，4.73（1.10-20.28）；P=0.037]，住院率无显著差异。
在CHF患者中，独立于年龄和心脏收缩功能，CSR比OSA与更高的死亡率相关。CSR也是不良结局的年龄独立预测因素，但调整后两组间住院率无显著差异。
