沙库巴曲缬沙坦对射血分数降低的心力衰竭患者中枢性和阻塞性呼吸暂停的影响。
Effects of sacubitril-valsartan on central and obstructive apneas in heart failure patients with reduced ejection fraction.
机构信息
Sleep Medicine Center, Charité-Universitätsmedizin, Charitéplatz 1, 10117, Berlin, Germany.
Universitätsmedizin Essen, Ruhrlandklinik - Westdeutsches Lungenzentrum, am Universitätsklinikum Essen GmbH, Tüschener Weg 40, 45239, Essen, Germany.
出版信息
Sleep Breath. 2023 Mar;27(1):283-289. doi: 10.1007/s11325-022-02623-0. Epub 2022 Apr 29.
OBJECTIVE
This study aimed to evaluate the effect of sacubitril-valsartan (SV) on central apneas (CA) and obstructive apneas (OA) in patients with heart failure with reduced ejection fraction (HFrEF).
METHODS
In patients with HFrEF, SV initiation was titrated to the highest tolerable dosage. Patients were evaluated with portable apnea monitoring, echocardiography, and cardiopulmonary exercise testing at baseline and 3 months later.
RESULTS
Of a total of 18 patients, 9 (50%) had OA, 7 (39%) had CA, and 2 (11%) had normal breathing. SV therapy was related to a reduction in NT-pro BNP and an improvement in LV function after 3 months. Portable apnea monitoring revealed a significant decrease of the respiratory event index (REI) after treatment with SV (20 ± 23 events/h to 7 ± 7 events/h, p = 0.003). When subgrouping according to type of apneas, REI, and time spent below 90% saturation (T90) decreased in patients with CA and OA (all p < 0.05).
CONCLUSION
In this prospective study, SV treatment for 3 months in patients with CA and OA is associated with a significant decrease in REI.
目的
本研究旨在评估沙库巴曲缬沙坦（SV）对射血分数降低的心力衰竭（HFrEF）患者中枢性呼吸暂停（CA）和阻塞性呼吸暂停（OA）的影响。
方法
在 HFrEF 患者中，滴定 SV 起始剂量至可耐受的最高剂量。患者在基线和 3 个月后分别接受便携式睡眠呼吸暂停监测、超声心动图和心肺运动试验评估。
结果
共 18 例患者中，9 例（50%）存在 OA，7 例（39%）存在 CA，2 例（11%）呼吸正常。SV 治疗 3 个月后与 NT-proBNP 降低和 LV 功能改善相关。便携式睡眠呼吸暂停监测显示，SV 治疗后呼吸事件指数（REI）显著降低（20±23 次/小时降至 7±7 次/小时，p=0.003）。根据呼吸暂停类型、REI 和 90%饱和度以下时间（T90）进行亚组分析，CA 和 OA 患者的 REI 和 T90 均降低（均 p<0.05）。
结论
在这项前瞻性研究中，CA 和 OA 患者 SV 治疗 3 个月与 REI 显著降低相关。
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