Naughton M T, Bradley T D
Sleep Research Laboratory, Rehabilitation Institute of Toronto, University of Toronto, Ontario, Canada.
Clin Chest Med. 1998 Mar;19(1):99-113. doi: 10.1016/s0272-5231(05)70435-4.
Sleep-related breathing disorders, including obstructive sleep apnea (OSA) and Cheyne-Stokes respiration with central sleep apnea (CSR-CSA), commonly occur in patients with congestive heart failure (CHF). In this setting they can have adverse pathophysiologic effects on the cardiovascular system. OSA may lead to development or progression of left ventricular (LV) dysfunction by increasing LV afterload through the combined effects of elevations in systemic blood pressure and a generation of exaggerated negative intrathoracic pressure, and by activating the sympathetic nervous system through the influence of hypoxia and arousals from sleep. Abolition of OSA by continuous positive airway pressure (CPAP) can improve cardiac function in patients with CHF. In contrast to OSA, CSR-CSA is likely a consequence rather than a cause of CHF. Here, pulmonary congestion causes hyperventilation by stimulating pulmonary irritant receptors. This leads to reductions in PaCO2 below the apneic threshold during sleep, precipitating posthyperventilatory central apneas. CSR-CSA is associated with increased mortality in CHF, probably because of sympathetic nervous system activation caused by recurrent apnea-induced hypoxia and arousals from sleep. Treatment of CSR-CSA by supplemental O2, theophylline, and CPAP can alleviate central apneas. Of these treatments, however, only CPAP has been shown to improve cardiac function and symptoms of heart failure. We conclude that effective treatments of OSA and CSR-CSA may prove to be useful adjuncts to the standard pharmacologic therapy of patients with CHF.
睡眠相关呼吸障碍，包括阻塞性睡眠呼吸暂停（OSA）和伴有中枢性睡眠呼吸暂停的陈-施呼吸（CSR-CSA），在充血性心力衰竭（CHF）患者中很常见。在这种情况下，它们会对心血管系统产生不良的病理生理影响。OSA可能通过全身血压升高和产生过度的胸内负压的联合作用增加左心室（LV）后负荷，并通过缺氧和睡眠觉醒的影响激活交感神经系统，从而导致LV功能障碍的发生或进展。通过持续气道正压通气（CPAP）消除OSA可改善CHF患者的心脏功能。与OSA不同，CSR-CSA可能是CHF的结果而非原因。在这里，肺充血通过刺激肺刺激感受器引起过度通气。这导致睡眠期间PaCO2降至呼吸暂停阈值以下，引发过度通气后中枢性呼吸暂停。CSR-CSA与CHF患者死亡率增加相关，可能是由于反复呼吸暂停引起的缺氧和睡眠觉醒导致交感神经系统激活。通过补充氧气、茶碱和CPAP治疗CSR-CSA可减轻中枢性呼吸暂停。然而，在这些治疗中，只有CPAP已被证明可改善心脏功能和心力衰竭症状。我们得出结论，有效治疗OSA和CSR-CSA可能被证明是CHF患者标准药物治疗的有用辅助手段。
