Traversi E, Callegari G, Pozzoli M, Opasich C, Tavazzi L
Department of Cardiology, Salvatore Maugeri Foundation, Montescano Medical Center.
G Ital Cardiol. 1997 May;27(5):423-9.
Cheyne-Stokes respiration can appear during sleep in patients with chronic heart failure and is generally attributed to a tendency to hyperventilate causing PCO2 to fall below the apnea threshold. We recorded sleep pattern and nocturnal arterial oxygen desaturation during Cheyne-Stokes respiration and correlated those with hemodynamic alterations, in order to investigate their possible role in the evolution of chronic heart failure. Sixty chronic heart failure patients, after optimization of therapy, underwent a polysomnographic study and hemodynamic and echocardiographic evaluations within a few days. The patients were then enrolled in the follow-up of our pre-transplantation program. Only slight alterations of sleep architecture were detected. During sleep, Cheyne-Stoke respiration was present in 50% and arterial oxygen desaturations in 54% of patients. An increased pulmonary wedge pressure (24.7 +/- 8.3 vs 16.7 +/- 8.9 mmHg, p < 0.000) was significantly correlated with the presence of nocturnal Cheyne-Stokes episodes, while cardiac index was not (1.9 +/- 0.6 vs 2.0 +/- 0.5 l m-2 min-1, p = 0.42). In a multivariate analysis of hemodynamic and polysomnographic data, mortality or heart transplantation in status 1 was predicted at the two year follow-up only by an increased pulmonary wedge pressure. In conclusion, in advanced chronic heart failure, with optimized therapy, nocturnal Cheyne-Stokes respiration is present in half of the cases, with concomitant falls in arterial oxygen desaturation. These events were not independently predictive of mortality. The strong correlation found between increased left ventricular filling pressure and presence of Cheyne Stokes respiration and the lack of correlation with cardiac index suggest that other hemodynamic mechanisms besides reduced cardiac output are responsible for this respiratory abnormality.
慢性心力衰竭患者在睡眠期间可能会出现潮式呼吸，一般认为这是由于过度通气倾向导致二氧化碳分压降至呼吸暂停阈值以下所致。我们记录了潮式呼吸期间的睡眠模式和夜间动脉血氧饱和度，并将其与血流动力学改变相关联，以研究它们在慢性心力衰竭发展过程中可能发挥的作用。60例慢性心力衰竭患者在优化治疗后，于数天内接受了多导睡眠图研究以及血流动力学和超声心动图评估。然后这些患者被纳入我们的移植前项目随访。仅检测到睡眠结构有轻微改变。睡眠期间，50%的患者存在潮式呼吸，54%的患者存在动脉血氧饱和度下降。肺楔压升高（24.7±8.3 vs 16.7±8.9 mmHg，p<0.000）与夜间潮式呼吸发作显著相关，而心脏指数则无相关性（1.9±0.6 vs 2.0±0.5 l m-2 min-1，p = 0.42）。在对血流动力学和多导睡眠图数据进行多变量分析时，仅通过肺楔压升高预测了1期患者两年随访时的死亡率或心脏移植情况。总之，在晚期慢性心力衰竭且治疗优化的情况下，半数病例存在夜间潮式呼吸，同时伴有动脉血氧饱和度下降。这些事件并非死亡率的独立预测因素。左心室充盈压升高与潮式呼吸存在之间存在强烈相关性，而与心脏指数缺乏相关性，这表明除心输出量减少外，其他血流动力学机制也导致了这种呼吸异常。
