伴有阻塞性和中枢性睡眠呼吸暂停的心力衰竭患者的夜间心律失常
Nocturnal Cardiac Arrhythmias in Heart Failure With Obstructive and Central Sleep Apnea.
作者信息
Horvath Christian M, Fisser Christoph, Floras John S, Sossalla Samuel, Wang Stella, Tomlinson George, Rankin Fiona, Yatsu Shoichiro, Ryan Clodagh M, Bradley T Douglas, Arzt Michael
机构信息
Sleep Research Laboratories of the University Health Network, Toronto Rehabilitation Institute (KITE) and Toronto General Hospital and University of Toronto, Toronto, ON, Canada; Department of Medicine, University Health Network and Sinai Health and University of Toronto, Toronto, ON, Canada.
Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
出版信息
Chest. 2024 Dec;166(6):1546-1556. doi: 10.1016/j.chest.2024.08.003. Epub 2024 Aug 20.
BACKGROUND
Both obstructive and central sleep apnea (CSA) may contribute to nocturnal cardiac arrhythmias (NCAs). Data are scarce regarding the prevalence of clinically important nocturnal atrial and ventricular arrythmias in patients with heart failure with reduced ejection fraction (HFrEF) and OSA or CSA.
RESEARCH QUESTION
In a cohort of patients with HFrEF, how does the prevalence of NCA compare among those with OSA, CSA, and those with no to mild sleep apnea? Is the severity of OSA or CSA associated with atrial and ventricular NCAs?
STUDY DESIGN AND METHODS
This cross-sectional analysis is an ancillary study of the Effect of Adaptive Servo Ventilation on Survival and Hospital Admissions in Heart Failure (ADVENT-HF) trial. We compared the prevalence of NCAs (excessive supraventricular ectopic activity [ESVEA], defined as premature atrial complexes ≥ 30/h or supraventricular tachycardia ≥ 20 beats); atrial fibrillation/flutter [AF]; and > 10 premature ventricular complexes [PVCs/h]) on ECGs from polysomnograms of patients with HFrEF between those with OSA (apnea-hypopnea index [AHI ≥ 15 events/h]), those with CSA (AHI ≥ 15 events/h), and those with no to mild sleep apnea (AHI < 15 events/h [control]).
RESULTS
The prevalence of ESVEA was higher in patients with OSA (n = 430) and CSA (n = 150) compared with control participants (n = 76): 0%, 9%, and 12%, respectively. The prevalence of AF in the control, OSA, and CSA groups was 9%, 17%, and 27%; the prevalence of > 10 PVCs/h was 45%, 59%, and 63%. In multivariable regression analyses, premature atrial complexes/h was associated with OSA severity (obstructive AHI: 22.4% increase per 10 events/h [95% CI, 5.2-42.3; P = .009), although neither obstructive nor central AHI was associated with AF or > 10 PVC/h.
INTERPRETATION
In patients with HFrEF, the prevalences of nocturnal ESVEA, AF, and PVC > 10/h were higher in those with OSA or CSA than in those without OSA or CSA, and OSA severity was related to the burden of nocturnal atrial ectopy. Severity of OSA or CSA was not significantly related to AF or > 10 PVC/h.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov; No.: NCT01128816; URL: www.
CLINICALTRIALS
gov.
背景
阻塞性睡眠呼吸暂停（OSA）和中枢性睡眠呼吸暂停（CSA）均可能导致夜间心律失常（NCA）。关于射血分数降低的心力衰竭（HFrEF）合并OSA或CSA患者中具有临床意义的夜间房性和室性心律失常的患病率，数据较为匮乏。
研究问题
在一组HFrEF患者中，NCA的患病率在OSA、CSA以及无至轻度睡眠呼吸暂停的患者之间如何比较？OSA或CSA的严重程度与房性和室性NCA是否相关？
研究设计与方法
这项横断面分析是适应性伺服通气对心力衰竭患者生存和住院影响（ADVENT-HF）试验的一项辅助研究。我们比较了HFrEF患者多导睡眠图心电图上NCA（过度室上性异位活动[ESVEA]，定义为房性早搏≥30次/小时或室上性心动过速≥20次）、心房颤动/扑动[AF]以及>10次室性早搏[PVCs/小时]）的患病率，这些患者分别为OSA（呼吸暂停低通气指数[AHI≥15次/小时]）、CSA（AHI≥15次/小时）以及无至轻度睡眠呼吸暂停（AHI<15次/小时[对照组]）。
结果
与对照组参与者（n = 76）相比，OSA患者（n = 430）和CSA患者（n = 150）的ESVEA患病率更高，分别为0%、9%和12%。对照组、OSA组和CSA组的AF患病率分别为9%、17%和27%；>10次PVCs/小时的患病率分别为45%、59%和63%。在多变量回归分析中，房性早搏/小时与OSA严重程度相关（阻塞性AHI：每10次事件/小时增加22.4%[95%CI，5.2 - 42.3；P = .009]），尽管阻塞性和中枢性AHI均与AF或>10次PVC/小时无关。
解读
在HFrEF患者中，OSA或CSA患者的夜间ESVEA、AF和PVC>10/小时的患病率高于无OSA或CSA的患者，且OSA严重程度与夜间房性异位负担相关。OSA或CSA的严重程度与AF或>10次PVC/小时无显著相关性。
临床试验注册
ClinicalTrials.gov；编号：NCT01128816；网址：www. ClinicalTrials.gov 。
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