Andreas S, Hagenah G, Moller C, Werner G S, Kreuzer H
Department of Cardiology and Pneumology, Georg August University, Gottingen, Germany.
Am J Cardiol. 1996 Dec 1;78(11):1260-4. doi: 10.1016/s0002-9149(96)00608-x.
Patients with congestive heart failure (CHF) frequently demonstrate Cheyne-Stokes respiration (CSR) with repetitive arousals and oxygen desaturations during sleep. Although it was evident from early publications that CSR during the daytime is a poor prognostic indicator in patients with CHF, it was speculated recently that CSR occurring during sleep could impede left ventricular function and even survival. We therefore followed up 36 patients with CHF and a left ventricular ejection fraction < or = 40% who underwent a sleep study at our institution. The patients showed a reduced ejection fraction (20 +/- 8%) and CSR with a median of 19% of total sleep time (lower and upper quartiles 9% and 56%). In 12 +/- 9% of their time in bed, the arterial oxygen saturation was <90%. No patient was lost to follow-up, which lasted for 32 +/- 15 months (range 11 to 53). One-year survival was 86 +/- 6%, and 2-year survival was 66 +/- 8%. Univariate comparisons for survival between groups stratified by the amount of CSR revealed no significant difference (log rank test, p = 0.84). However, the 20 patients with a left ventricular ejection fraction <20% had a shorter mean survival time than patients with an ejection fraction >20% (9.5 vs 28.3 months; log rank test, p = 0.013). Two patients with CSR during the daytime died within 1 month. No other patient had CSR during the daytime, and only 1 patient without daytime CSR died within 1 month (chi-square test, p <0.001). Higher age, reduced carbon dioxide end-tidal partial pressure, and increased transit time were found to be significantly related to the amount of nocturnal CSR. In conclusion, CSR occurring during sleep has no important prognostic impact in patients with CHF, but CSR present during the daytime suggests a high likelihood of dying within a few months.
充血性心力衰竭（CHF）患者在睡眠期间常表现出潮式呼吸（CSR），伴有反复觉醒和氧饱和度下降。尽管早期文献表明，白天的CSR是CHF患者预后不良的指标，但最近有人推测，睡眠期间发生的CSR可能会妨碍左心室功能甚至影响生存。因此，我们对36例CHF且左心室射血分数≤40%的患者进行了随访，这些患者在我们机构接受了睡眠研究。患者的射血分数降低（20±8%），CSR占总睡眠时间的中位数为19%（下四分位数和上四分位数分别为9%和56%）。在他们卧床时间的12±9%内，动脉血氧饱和度<90%。没有患者失访，随访持续了32±15个月（范围为11至53个月）。1年生存率为86±6%，2年生存率为66±8%。按CSR量分层的组间生存单因素比较无显著差异（对数秩检验，p = 0.84）。然而，左心室射血分数<20%的20例患者的平均生存时间比射血分数>20%的患者短（9.5个月对28.3个月；对数秩检验，p = 0.013）。2例白天有CSR的患者在1个月内死亡。没有其他患者白天有CSR，只有1例无白天CSR的患者在1个月内死亡（卡方检验，p<0.001）。发现年龄较大、呼气末二氧化碳分压降低和传输时间增加与夜间CSR量显著相关。总之，睡眠期间发生的CSR对CHF患者的预后没有重要影响，但白天出现的CSR提示在几个月内死亡的可能性很高。
