卡托普利和氧气对轻至中度充血性心力衰竭患者睡眠呼吸暂停的影响。
Effects of captopril and oxygen on sleep apnoea in patients with mild to moderate congestive cardiac failure.
作者信息
Walsh J T, Andrews R, Starling R, Cowley A J, Johnston I D, Kinnear W J
机构信息
Division of Cardiovascular Medicine, University Hospital, Nottingham.
出版信息
Br Heart J. 1995 Mar;73(3):237-41. doi: 10.1136/hrt.73.3.237.
OBJECTIVES
To determine the effects of captopril and oxygen on sleep quality in patients with mild to moderate cardiac failure.
DESIGN
An open observational study.
PATIENTS
12 patients with New York Heart Association class II-III heart failure were studied at baseline. 9 of these patients were then examined at the end of 1 month of treatment with captopril; 9 of the patients were separately assessed during a single night of supplementary oxygen.
MAIN OUTCOME MEASURES
Sleep patterns by polysomnography, overnight oximetry, and subjective sleep assessment using visual analogue scores.
RESULTS
Abnormal sleep was present in all baseline studies. Complete polysomnograms after treatment with captopril were obtained in 8 patients. Light sleep (stages 1 and 2) was reduced (mean (SEM) 61%(8)% to 48%(6)% actual sleep time, P < 0.05) but slow wave (stages 3 and 4) and REM (rapid eye movement) sleep increased (25%(6)% to 31%(5)%, 14%(2)% to 21%(5)% actual sleep time, P < 0.05). Apnoeic episodes (242(59) to 118(30), P < 0.05), desaturation events (171(60) to 73(37), P < 0.05), and arousals (33(5) to 18(3) P < 0.01) were reduced. Visual analogue scores of sleep quality increased 49(5) to 69(5), P < 0.01). Complete polysomnograms were obtained in 7 patients treated with oxygen. Light sleep duration was reduced (55% (7)% to 42%(5)% actual sleep time, P < 0.05) and slow wave sleep increased (30%(5)% to 38%(6)% actual sleep time, P < 0.05). REM sleep duration was not significantly different. Total arousals (33(6)% to 20(2) P < 0.05), desaturation events (140(33) to 38(10), P < 0.01), and apnoeic episodes (212(53) to 157(33), P < 0.05) were reduced. Visual analogue scores of sleep quality were unchanged.
CONCLUSIONS
Captopril and oxygen may improve sleep quality and reduce nocturnal desaturation in patients with mild to moderate cardiac failure. Improved sleep quality could explain the reduction in daytime symptoms seen after treatment in patients with chronic heart failure.
目的
确定卡托普利和吸氧对轻至中度心力衰竭患者睡眠质量的影响。
设计
开放性观察研究。
患者
12例纽约心脏病协会II-III级心力衰竭患者在基线时接受研究。其中9例患者在接受卡托普利治疗1个月结束时接受检查；9例患者在单独一晚的补充吸氧期间进行评估。
主要观察指标
通过多导睡眠图、夜间血氧饱和度测定以及使用视觉模拟评分进行主观睡眠评估来观察睡眠模式。
结果
所有基线研究中均存在睡眠异常。8例患者在接受卡托普利治疗后获得了完整的多导睡眠图。浅睡眠（1期和2期）减少（实际睡眠时间从平均（标准误）61%（8%）降至48%（6%），P<0.05），但慢波睡眠（3期和4期）和快速眼动（REM）睡眠增加（实际睡眠时间从25%（6%）增至31%（5%），从14%（2%）增至21%（5%），P<0.05）。呼吸暂停发作次数（从242（59）降至118（30），P<0.05）、血氧饱和度下降事件（从171（60）降至73（37），P<0.05）以及觉醒次数（从33（5）降至18（3），P<0.01）均减少。睡眠质量的视觉模拟评分从49（5）增至69（5），P<0.01）。7例吸氧治疗的患者获得了完整的多导睡眠图。浅睡眠持续时间减少（实际睡眠时间从55%（7%）降至42%（5%），P<0.05），慢波睡眠增加（实际睡眠时间从30%（5%）增至38%（6%），P<0.05）。REM睡眠持续时间无显著差异。总觉醒次数（从33（6%）降至20（2%），P<0.05）、血氧饱和度下降事件（从·140（33）降至38（10），P<0.01）以及呼吸暂停发作次数（从212（53）降至157（33），P<0.05）均减少。睡眠质量的视觉模拟评分未改变。
结论
卡托普利和吸氧可能改善轻至中度心力衰竭患者的睡眠质量并减少夜间血氧饱和度下降。睡眠质量的改善可以解释慢性心力衰竭患者治疗后日间症状的减轻。
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