Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi.
Pulmonary Medicine, Medipulse Hospital, Jodhpur.
Monaldi Arch Chest Dis. 2020 Nov 9;90(4). doi: 10.4081/monaldi.2020.1329.
Heart failure (HF) with preserved ejection fraction (HFpEF) represents nearly half of HF cases and is increasingly being recognized as a cause of morbidity and mortality. Hypertension (essential or secondary) is an important risk factor of HFpEF, owing to permanent structural changes in heart. A common cause of secondary hypertension is obstructive sleep apnea (OSA). In the present study, we have attempted to seek the frequency and characteristics of sleep disordered breathing (SDB) in HFpEF. Also, we tried to investigate if any correlation exists between the severity of SDB and the severity of diastolic dysfunction. This was a prospective, cross-sectional, case-control study in which 25 case patients with HFpEF and 25 control subjects were included. All the case patients and control subjects went through a detailed clinical, biochemical, echocardiography evaluation and overnight polysomnography. SDB was seen in 64% of the case patients having HFpEF and in 12% of control group with [odds ratio (OR)= 12.2, 95% confidence interval (CI) = 2.83-52.74; p<0.001]. A significant correlation of apnea-hypopnea index (AHI) severity was observed with degree of diastolic dysfunction (r = 0.67; p<0.001). Among HFpEF patients with SDB (16/25), 13 had OSA and only 3 had central sleep apnea (CSA). CSA was present in patients with severe diastolic dysfunction. There were no clinical or sleep quality differences among the OSA and the CSA group. To conclude, a higher frequency of SDB is observed in HFpEF patients. AHI severity correlates with degree of diastolic dysfunction. The underlying mechanisms of correlation between SDB and diastolic dysfunction either through uncontrolled hypertension or direct causation warrant further evaluation.
射血分数保留的心衰（HFpEF）占心衰病例的近一半，并且越来越被认为是发病率和死亡率的一个原因。高血压（原发性或继发性）是 HFpEF 的一个重要危险因素，这是由于心脏的永久性结构改变所致。继发性高血压的一个常见原因是阻塞性睡眠呼吸暂停（OSA）。在本研究中，我们试图寻找 HFpEF 中睡眠呼吸障碍（SDB）的频率和特征。我们还试图研究 SDB 的严重程度与舒张功能障碍的严重程度之间是否存在相关性。这是一项前瞻性、横断面、病例对照研究，纳入了 25 例 HFpEF 病例患者和 25 例对照组。所有病例患者和对照组均接受了详细的临床、生化、超声心动图评估和夜间多导睡眠图检查。64%的 HFpEF 病例患者存在 SDB，而对照组中仅有 12%存在 SDB[比值比（OR）=12.2，95%置信区间（CI）=2.83-52.74；p<0.001]。呼吸暂停低通气指数（AHI）严重程度与舒张功能障碍程度呈显著相关性（r=0.67；p<0.001）。在存在 SDB 的 HFpEF 患者（16/25）中，13 例患有 OSA，仅有 3 例患有中枢性睡眠呼吸暂停（CSA）。CSA 见于舒张功能障碍严重的患者。在 OSA 和 CSA 组之间，临床或睡眠质量没有差异。总之，HFpEF 患者中 SDB 的频率更高。AHI 严重程度与舒张功能障碍程度相关。SDB 与舒张功能障碍之间的相关性的潜在机制，无论是通过未控制的高血压还是直接因果关系，都需要进一步评估。
