Javaheri S, Parker T J, Wexler L, Michaels S E, Stanberry E, Nishyama H, Roselle G A
Sleep Disorders laboratory, Veterans Affairs Medical Center, Cincinnati, OH 45220.
Ann Intern Med. 1995 Apr 1;122(7):487-92. doi: 10.7326/0003-4819-122-7-199504010-00002.
To determine the prevalence and effect of sleep-disordered breathing in ambulatory patients with stable, optimally treated congestive heart failure.
A prospective, longitudinal study.
Referral sleep laboratory of a Department of Veterans Affairs medical center.
42 of the 48 eligible patients with stable congestive heart failure and left ventricular systolic dysfunction (left ventricular ejection fraction < or = 45%).
After an adaptation night, polysomnography and Holter monitoring were done in the sleep laboratory. Arterial blood gases and pH were measured, and cardiac radionuclide ventriculography and pulmonary, renal, and thyroid function tests were done.
Patients were divided into two groups. Group I (n = 23) had an hourly rate of apnea and hypopnea (apnea-hypopnea index) of 20 episodes per hour or less; group II (n = 19 [45%; CI, 30% to 60%]) had an index of more than 20 episodes per hour. In group II, the index varied from 26.5 to 82.2 episodes per hour (mean +/- SD, 44 +/- 13 episodes per hour; CI, 38 to 51 episodes per hour). Group II had significantly more arousals (24 +/- 12 compared with 3 +/- 3 in group I) that were directly attributable to episodes of apnea and hypopnea, longer periods of time with an arterial oxyhemoglobin saturation of less than 90% (23% +/- 24% of total sleep time compared with 2% +/- 4%), lower arterial oxyhemoglobin saturation during sleep (74% +/- 13% compared with 87% +/- 4%), lower left ventricular ejection fraction (22% +/- 9% compared with 30% +/- 10%), and a significantly increased number of episodes of nocturnal ventricular arrhythmias. Multiple regression analyses showed that left ventricular systolic dysfunction was an independent risk factor for sleep apnea in patients with congestive heart failure.
The prevalence of severe occult sleep-disordered breathing is high in ambulatory patients with stable, optimally treated chronic congestive heart failure. The breathing episodes are associated with severe nocturnal arterial blood oxyhemoglobin desaturation and excessive arousals. Severe untreated sleep-disordered breathing may adversely affect left ventricular function, resulting in a vicious cycle that could contribute to death in patients with congestive heart failure. Prospective, longitudinal studies on survival are needed.
确定在病情稳定、接受最佳治疗的门诊充血性心力衰竭患者中睡眠呼吸紊乱的患病率及其影响。
一项前瞻性纵向研究。
一家退伍军人事务医疗中心的转诊睡眠实验室。
48例符合条件的病情稳定的充血性心力衰竭和左心室收缩功能障碍（左心室射血分数≤45%）患者中的42例。
经过适应夜后，在睡眠实验室进行多导睡眠图和动态心电图监测。测量动脉血气和pH值，并进行心脏放射性核素心室造影以及肺、肾和甲状腺功能测试。
患者分为两组。第一组（n = 23）每小时呼吸暂停和低通气次数（呼吸暂停低通气指数）为20次或更少；第二组（n = 19 [45%；可信区间，30%至60%]）每小时指数超过20次。在第二组中，指数范围为每小时26.5至82.2次（均值±标准差，44±13次/小时；可信区间，38至51次/小时）。第二组因呼吸暂停和低通气发作直接导致的觉醒明显更多（24±12次，而第一组为3±3次），动脉血氧血红蛋白饱和度低于90%的时间更长（占总睡眠时间的23%±24%，而第一组为2%±4%），睡眠期间动脉血氧血红蛋白饱和度更低（74%±13%，而第一组为87%±4%），左心室射血分数更低（22%±9%，而第一组为30%±10%），夜间室性心律失常发作次数显著增加。多元回归分析表明，左心室收缩功能障碍是充血性心力衰竭患者睡眠呼吸暂停的独立危险因素。
病情稳定、接受最佳治疗的门诊慢性充血性心力衰竭患者中，严重隐匿性睡眠呼吸紊乱的患病率很高。呼吸发作与严重的夜间动脉血氧血红蛋白饱和度降低和过度觉醒有关。严重的未经治疗的睡眠呼吸紊乱可能对左心室功能产生不利影响, 导致恶性循环，这可能促使充血性心力衰竭患者死亡。需要进行关于生存情况的前瞻性纵向研究。
