Department of Cardiology, State University of Medicine and Pharmacy "Nicolae Testemitanu", Chisinau, Republic of Moldova.
Anatol J Cardiol. 2021 Apr;25(4):216-224. doi: 10.5152/AnatolJCardiol.2021.63668.
Sleep-disordered breathing (SDB) is a complex syndrome with a high prevalence and a significant impact on the general well-being of the overall population. Heart failure (HF) is a major health issue with an increasing incidence, a high rate of hospitalizations, and high mortality in developing countries. Focusing on early recognition and management of HF comorbidities may have an important role in reducing the economic burden and public health impact of HF. The close interconnection between HF, heart rhythm disturbances, and sleep apnea is supported by the mutual risk factors such as age, smoking, obesity, and male sex. Central sleep apnea (CSA) may be considered a marker of advanced HF, often being associated with elevated pulmonary capillary wedge pressure, brain natriuretic peptide (BNP), and noradrenaline levels and with low left ventricular ejection fraction. In the same way, there is an important correlation between CSA and different types of arrhythmias. The large intraindividual rhythm variability reported in patients with SDB who underwent continuous monitoring by implantable loop recorder (ILR) demonstrated the incapacity of 24-hour and 48-hour Holter monitoring to accurately determine the incidence of cardiac arrhythmias. In patients with HF and CSA, the extended cardiac monitoring by ILR becomes compulsory because in-time interventions could be life saving, but with the absolute lack of solid evidence in this field, there is an acute need for extensive randomized trials to further highlight the potential beneficial effect of ILR monitoring in patients with CSA and HF.
睡眠障碍性呼吸（SDB）是一种复杂的综合征，其患病率高，对整个人群的整体健康有重大影响。心力衰竭（HF）是一个主要的健康问题，在发展中国家发病率不断上升，住院率高，死亡率高。关注 HF 合并症的早期识别和管理可能在降低 HF 的经济负担和公共卫生影响方面发挥重要作用。HF、心律失常和睡眠呼吸暂停之间的密切相互关系得到了年龄、吸烟、肥胖和男性等共同危险因素的支持。中心性睡眠呼吸暂停（CSA）可被视为 HF 晚期的标志物，通常与升高的肺毛细血管楔压、脑钠肽（BNP）和去甲肾上腺素水平以及低左心室射血分数有关。同样，CSA 与不同类型的心律失常之间存在重要相关性。通过植入式环路记录仪（ILR）对 SDB 患者进行连续监测报告的个体内节律变异性较大，表明 24 小时和 48 小时动态心电图监测无法准确确定心律失常的发生率。在 HF 和 CSA 患者中，ILR 的扩展心脏监测变得强制性，因为及时干预可能挽救生命，但由于该领域缺乏确凿证据，迫切需要进行广泛的随机试验，以进一步强调 ILR 监测对 CSA 和 HF 患者的潜在有益效果。
