慢性心力衰竭患者睡眠呼吸障碍的患病率及其预测因素：SchlaHF-XT 登记研究。

Prevalence and predictors of sleep-disordered breathing in chronic heart failure: the SchlaHF-XT registry.

机构信息

Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.

Ludgerus-Kliniken Münster, Clemenshospital, Münster, Germany.

出版信息

ESC Heart Fail. 2022 Dec;9(6):4100-4111. doi: 10.1002/ehf2.14027. Epub 2022 Sep 2.

AIMS

Heart failure with preserved ejection fraction (HFpEF) is a condition with increasing prevalence. Sleep-disordered breathing (SDB) is an important co-morbidity in HFpEF. The SchlaHF-XT registry evaluated the sex-specific prevalence and predictors of SDB, including obstructive (OSA) and central sleep apnoea, in patients with HFpEF compared with heart failure with mildly reduced (HFmrEF) or reduced (HFrEF) ejection fraction.

METHODS AND RESULTS

Consecutive adults with chronic heart failure treated according to current guidelines were enrolled. The presence of moderate-to-severe SDB (apnoea-hypopnoea index ≥15/h) was determined using Type 3 polygraphic devices. Of 3289 patients included, 2032 had HFpEF, 559 had HFmrEF, and 698 had HFrEF, of whom 34, 21, 23, and 42%, respectively, were female. Prevalence of SDB in HFpEF was high, but significantly lower than in HFmrEF or HFrEF (36% vs. 41 and 48%, respectively). Rates of SDB in males and females were 41 and 28% in HFpEF, 44 and 30% in HFmrEF, and 50 and 40% in HFrEF. The proportion of males and females with SDB who had OSA was significantly greater in those with HFpEF vs. HFrEF. Male sex, older age, higher body mass index, and New York Heart Association functional Class III/IV were significant predictors of moderate-to-severe SDB in HFpEF patients.

CONCLUSIONS

Prevalence of SDB in HFpEF was high, but lower than in patients with HFmrEF or HFrEF. Moderate-to-severe SDB occurred more frequently in males than in females across the whole spectrum of heart failure. In both sexes, the proportion of OSA in SDB patients with HFpEF was higher than in those with HFrEF.

目的

射血分数保留的心力衰竭（HFpEF）是一种患病率不断增加的疾病。睡眠呼吸障碍（SDB）是 HFpEF 的重要合并症。SchlaHF-XT 登记研究评估了 HFpEF 患者中 SDB（包括阻塞性睡眠呼吸暂停低通气综合征（OSA）和中枢性睡眠呼吸暂停）的性别特异性患病率和预测因素，与射血分数轻度降低（HFmrEF）或降低（HFrEF）的心力衰竭患者相比。

方法和结果

连续纳入根据当前指南接受慢性心力衰竭治疗的成年患者。使用 3 型多导睡眠图设备确定中度至重度 SDB（呼吸暂停低通气指数≥15/h）的存在。在 3289 例患者中，2032 例为 HFpEF，559 例为 HFmrEF，698 例为 HFrEF，其中分别有 34%、21%、23%和 42%为女性。HFpEF 患者 SDB 的患病率较高，但明显低于 HFmrEF 或 HFrEF（分别为 36%、41%和 48%）。HFpEF 中男性和女性的 SDB 发生率分别为 41%和 28%，HFmrEF 中分别为 44%和 30%，HFrEF 中分别为 50%和 40%。HFpEF 中 SDB 患者中 OSA 的男女比例明显大于 HFrEF。男性、年龄较大、较高的体重指数和纽约心脏协会功能分级 III/IV 是 HFpEF 患者中中重度 SDB 的显著预测因素。