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你所需要的只是睡眠:睡眠呼吸暂停对心力衰竭患者的影响及治疗益处

All You Need Is Sleep: the Effects of Sleep Apnea and Treatment Benefits in the Heart Failure Patient.

作者信息

Holfinger Steven, Chan Lawrence, Donald Ryan

机构信息

Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.

出版信息

Curr Heart Fail Rep. 2021 Jun;18(3):144-152. doi: 10.1007/s11897-021-00506-1. Epub 2021 Mar 26.

Abstract

PURPOSE OF REVIEW

Recognition and treatment of sleep apnea is an important but easily overlooked aspect of care in the heart failure patient. This review summarizes the data behind the recommendations in current practice guidelines and highlights recent developments in treatment options.

RECENT FINDINGS

Neuromodulation using hypoglossal nerve stimulation has been increasingly used for treatment of OSA; however, it has not been studied in the heart failure population. Alternatively, phrenic nerve stimulation for treatment of CSA is effective for heart failure patients, and cardiac resynchronization therapy can be effective in improving CSA in pacing-induced cardiomyopathy. In patients suspected to have sleep apnea, polysomnography is recommended to better understand the prognosis and treatment options. Positive airway pressure is the standard treatment for sleep apnea; however, neurostimulation can be especially effective in those with predominantly central events. Understanding the pathophysiology of sleep apnea can guide further management decisions.

摘要

综述目的

识别和治疗睡眠呼吸暂停是心力衰竭患者护理中一个重要但容易被忽视的方面。本综述总结了当前实践指南中建议背后的数据,并强调了治疗选择的最新进展。

最新发现

使用舌下神经刺激进行神经调节已越来越多地用于治疗阻塞性睡眠呼吸暂停(OSA);然而,尚未在心力衰竭人群中进行研究。另外,膈神经刺激治疗中枢性睡眠呼吸暂停(CSA)对心力衰竭患者有效,心脏再同步治疗可有效改善起搏诱导性心肌病中的CSA。对于疑似患有睡眠呼吸暂停的患者,建议进行多导睡眠图检查以更好地了解预后和治疗选择。气道正压通气是睡眠呼吸暂停的标准治疗方法;然而,神经刺激对主要为中枢性事件的患者可能特别有效。了解睡眠呼吸暂停的病理生理学可以指导进一步的管理决策。

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