Pediatric Noninvasive Ventilation and Sleep Unit, Hôpital Necker-Enfants Malades F-75015, Paris, France; Université de Paris, VIFASOM F-75004, Paris, France.
Pediatric Cardiology, Centre de Référence des Malformations Cardiaques Congénitales Complexes-M3C, Hôpital Necker-Enfants Malades, Paris, France.
Sleep Med. 2021 Jul;83:99-105. doi: 10.1016/j.sleep.2021.04.003. Epub 2021 Apr 19.
Sleep disordered breathing (SDB) is common in adults with chronic heart failure (CHF), but its prevalence in children remains unclear. Continuous positive airway pressure (CPAP) is the treatment of SDB but deleterious hemodynamic effects have been reported.
We prospectively analyzed SDB in children with CHF and the effect of CPAP on work of breathing (WOB) and cardiac index (CI). Children aged 6 months to 18 years old with CHF due to: 1) dilated cardiomyopathy (DM) with an ejection fraction < 45%, 2) functional single ventricle (SV) or 3) aortic or mitral valve disease awaiting surgery (VD) were eligible for the study. A polysomnography (PSG), measurement of WOB and CI during spontaneous breathing (SB) and CPAP (6, 8 and 10 cmHO) were performed.
Thirty patients with mean age of 6.4 ± 5 years were included (16 DM 16, 10 SV, 4 LV). Twenty (73%) patients had a normal sleep efficiency. Median apnoeas hypopnea index (IAH) was within normal range at 1.6 events/h (0, 14) events/hour. Only one patient had central sleep apnoeas, none had Cheyne-Stokes respiration, and 3 patients had an obstructive AHI between 5 and 10 events/hour. Optimal CPAP level decreased WOB (p = 0.05) and respiratory rate (p = 0.01).
Severe SDB was uncommon in children with CHF. However, CPAP may be beneficial by decreasing WOB and respiratory rate without deleterious effects on CI.
睡眠呼吸障碍（SDB）在慢性心力衰竭（CHF）的成年人中很常见，但在儿童中的患病率尚不清楚。持续气道正压通气（CPAP）是 SDB 的治疗方法，但已有报道称其对血液动力学有不良影响。
我们前瞻性分析了 CHF 儿童的 SDB 以及 CPAP 对呼吸功（WOB）和心指数（CI）的影响。年龄在 6 个月至 18 岁之间，患有 CHF 的儿童符合以下条件：1）扩张型心肌病（DM）射血分数<45%，2）功能性单心室（SV）或 3）主动脉瓣或二尖瓣疾病待手术（VD）。进行了多导睡眠图（PSG）、自主呼吸（SB）和 CPAP（6、8 和 10 cmHO）期间的 WOB 和 CI 测量。
30 名平均年龄为 6.4±5 岁的患者入选（16 名 DM，10 名 SV，4 名 LV）。20 名（73%）患者的睡眠效率正常。中位呼吸暂停低通气指数（IAH）为 1.6 次/小时（0，14）次/小时，处于正常范围内。仅有 1 例患者存在中枢性睡眠呼吸暂停，无 1 例患者存在 Cheyne-Stokes 呼吸，3 例患者存在 5 至 10 次/小时的阻塞性 AHI。最佳 CPAP 水平降低了 WOB（p=0.05）和呼吸频率（p=0.01）。
CHF 儿童中严重的 SDB 并不常见。然而，CPAP 可能通过降低 WOB 和呼吸频率而有益，而不会对 CI 产生不良影响。
