多导睡眠图参数在既往失代偿性心力衰竭患者中的预后作用

The Prognostic Role of Polysomnography Parameters in Heart Failure Patients with Previous Decompensation.

作者信息

Medvedeva Elena, Korostovtseva Lyudmila, Bochkarev Mihail, Shumeiko Anastasiya, Berezina Aelita, Simonenko Maria, Sazonova Yulia, Kozlenok Andrey, Sviryaev Yurii

机构信息

Almazov National Medical Research Centre, 197341 St. Petersburg, Russia.

出版信息

J Clin Med. 2022 Jun 24;11(13):3656. doi: 10.3390/jcm11133656.

Background: Sleep-disordered breathing (SDB) is a widespread comorbidity in patients with chronic heart failure (HF) and may have a deleterious effect on the pathogenesis of HF. We aimed to evaluate the prognostic role of polysomnography parameters in HF patients with previous decompensation. Methods: 123 patients were included in the prospective cohort study. In addition to the standard examination, all patients underwent polysomnography (PSG). Results: The Kaplan−Meier analysis showed the incidence of the combined endpoint differs between LVEF categories ≤25.5% vs. >25.5% (χ2 = 9.6, log rank p = 0.002), NTpro-BNP > 680 vs. ≤680 pg/mL (χ2 = 12.7, log rank p = 0.001), VO2peak categories <16 vs. ≥16 mL/min/kg (χ2 = 14.2, log rank p = 0.001), VE/VCO2 slope ≥38.5 vs. <38.5 (χ2 = 14.5, log rank p = 0.001), wake after sleep onset >40 min vs. ≤40 min (χ2 = 9.7, log rank p = 0.03), and sleep stage 2 (S2) <44% vs. ≥44% (χ2 = 12.4, log rank p = 0.001). Conclusion: Among the PSG parameters, WASO > 40 min and S2 < 44% were associated with a combined endpoint in patients with previous decompensation of HF. Moreover, higher NT-proBNP and VE/VCO2 slope, lower LVEF, and VO2peak were also independent factors of a poor prognosis.

背景

睡眠呼吸障碍（SDB）是慢性心力衰竭（HF）患者中普遍存在的合并症，可能对HF的发病机制产生有害影响。我们旨在评估多导睡眠图参数在既往有失代偿史的HF患者中的预后作用。方法：123例患者纳入前瞻性队列研究。除了标准检查外，所有患者均接受多导睡眠图（PSG）检查。结果：Kaplan-Meier分析显示，联合终点的发生率在左心室射血分数（LVEF）类别≤25.5%与>25.5%之间存在差异（χ2 = 9.6，对数秩检验p = 0.002），N末端脑钠肽前体（NTpro-BNP）> 680与≤680 pg/mL之间存在差异（χ2 = 12.7，对数秩检验p = 0.001），峰值摄氧量（VO2peak）类别<16与≥16 mL/min/kg之间存在差异（χ2 = 14.2，对数秩检验p = 0.001），二氧化碳通气当量（VE/VCO2）斜率≥38.5与<38.5之间存在差异（χ2 = 14.5，对数秩检验p = 0.001），睡眠开始后觉醒时间（WASO）> 40分钟与≤40分钟之间存在差异（χ2 = 9.7，对数秩检验p = 0.03），以及睡眠二期（S2）<44%与≥44%之间存在差异（χ2 = 12.4，对数秩检验p = 0.001）。结论：在PSG参数中，WASO> 40分钟和S2<44%与既往有失代偿史的HF患者的联合终点相关。此外，较高的NT-proBNP和VE/VCO2斜率、较低的LVEF和VO2peak也是预后不良的独立因素。