Bisang Maya, Latshang Tsogyal D, Aeschbacher Sayaka S, Huber Fabienne, Flueck Deborah, Lichtblau Mona, Ulrich Stefanie, Hasler Elisabeth D, Scheiwiller Philipp M, Ulrich Silvia, Bloch Konrad E, Furian Michael
Department of Respiratory Medicine, Sleep Disorders Center, University Hospital of Zurich, Zurich, Switzerland.
Front Med (Lausanne). 2021 Mar 1;8:557369. doi: 10.3389/fmed.2021.557369. eCollection 2021.
Chronic obstructive pulmonary disease (COPD) is associated with cardiovascular disease. We investigated whether sleeping at altitude increases nocturnal heart rate (HR) and other markers of cardiovascular risk or arrhythmias in lowlanders with COPD and whether this can be prevented by nocturnal oxygen therapy (NOT). Twenty-four COPD patients, with median age of 66 years and forced expiratory volume in 1 s (FEV) 55% predicted, living <800 m underwent sleep studies at Zurich (490 m) and during 2 sojourns of 2 days each at St. Moritz (2,048 m) separated by 2-week washout at <800 m. During nights at 2,048 m, patients received either NOT (2,048 m NOT) or ambient air (2,048 m placebo) 3 L/min via nasal cannula according to a randomized, placebo-controlled crossover trial. Sleep studies comprised ECG and pulse oximetry to measure HR, rhythm, HR-adjusted QT interval (QTc), and mean oxygen saturation (SpO). In the first nights at 490 m, 2,048 m placebo, and 2,048 m NOT, medians (quartiles) of SpO were 92% (90; 94), 86% (83; 89), and 97% (95; 98) and of HR were 73 (66; 82), 82 (71; 85), and 78 bpm (67; 74) ( < 0.05 all respective comparisons). QTc increased from 417 ms (404; 439) at 490 m to 426 ms (405; 440) at 2,048 m placebo ( < 0.05) and was 420 ms (405; 440) at 2,048 m NOT ( = NS vs. 2,048 m placebo). The number of extrabeats and complex arrhythmias was similar over all conditions. While staying at 2,048 m, lowlanders with COPD experienced nocturnal hypoxemia in association with an increased HR and prolongation of the QTc interval. NOT significantly improved SpO and lowered HR, without changing QTc. Whether oxygen therapy would reduce HR and arrhythmia during longer altitude sojourns remains to be elucidated.
慢性阻塞性肺疾病（COPD）与心血管疾病相关。我们调查了在高原地区睡眠是否会增加慢性阻塞性肺疾病低地居民的夜间心率（HR）以及其他心血管风险标志物或心律失常，以及夜间氧疗（NOT）是否可以预防这种情况。24名慢性阻塞性肺疾病患者，年龄中位数为66岁，第1秒用力呼气量（FEV）为预测值的55%，居住在海拔<800米，在苏黎世（490米）进行睡眠研究，并在圣莫里茨（2048米）分两次各停留2天，期间在海拔<800米处进行为期2周的洗脱期。在海拔2048米的夜间，根据随机、安慰剂对照交叉试验，患者通过鼻导管以3升/分钟的流量接受夜间氧疗（2048米氧疗组）或环境空气（2048米安慰剂组）。睡眠研究包括心电图和脉搏血氧饱和度测定，以测量心率、心律、心率校正QT间期（QTc）和平均血氧饱和度（SpO）。在海拔490米、2048米安慰剂组和2048米氧疗组的第一个夜间，SpO的中位数（四分位数）分别为92%（90；94）、86%（83；89）和97%（95；98），心率的中位数分别为73（66；82）、82（71；85）和78次/分钟（67；74）（所有相应比较P<0.05）。QTc从海拔490米时的417毫秒（404；439）增加到海拔2048米安慰剂组时的426毫秒（405；440）（P<0.05），在海拔2048米氧疗组时为420毫秒（405；440）（与海拔2048米安慰剂组相比P=无显著性差异）。在所有情况下，早搏和复杂性心律失常的数量相似。在海拔2048米停留期间，患有慢性阻塞性肺疾病的低地居民出现夜间低氧血症，同时心率增加和QTc间期延长。夜间氧疗显著改善了SpO并降低了心率，但未改变QTc。在更长时间的高原停留期间，氧疗是否会降低心率和心律失常仍有待阐明。
