Javaheri S, Parker T J, Liming J D, Corbett W S, Nishiyama H, Wexler L, Roselle G A
Sleep Disorders Laboratory, Department of Veterans Affairs Medical Center, Cincinnati, Ohio, USA.
Circulation. 1998 Jun 2;97(21):2154-9. doi: 10.1161/01.cir.97.21.2154.
Heart failure is a highly prevalent disorder that continues to be associated with repeated hospitalizations, high morbidity, and high mortality. Sleep-related breathing disorders with repetitive episodes of asphyxia may adversely affect heart function. The main aims of this study were to determine the prevalence, consequences, and differences in various sleep-related breathing disorders in ambulatory male patients with stable heart failure.
This article reports the results of a prospective study of 81 of 92 eligible patients with heart failure and a left ventricular ejection fraction < 45%. There were 40 patients without (hourly rate of apnea/hypopnea, 4 +/- 4; group 1) and 41 patients with (51% of all patients; hourly rate of apnea/hypopnea, 44 +/- 19; group 2) sleep apnea. Sleep disruption and arterial oxyhemoglobin desaturation were significantly more severe and the prevalence of atrial fibrillation (22% versus 5%) and ventricular arrhythmias were greater in group 2 than in group 1. Forty percent of all patients had central sleep apnea, and 11% had obstructive sleep apnea. The latter patients had significantly greater mean body weight (112 +/- 30 versus 75 +/- 16 kg) and prevalence of habitual snoring (78% versus 28%). However, the hourly rate of episodes of apnea and hypopnea (36 +/- 10 versus 47 +/- 21), episodes of arousal (20 +/- 14 versus 23 +/- 11), and desaturation (lowest saturation, 72 +/- 11% versus 78 +/- 12%) were similar in patients with these different types of apnea.
Fifty-one percent of male patients with stable heart failure suffer from sleep-related breathing disorders: 40% from central and 11% from obstructive sleep apnea. Both obstructive and central types of sleep apnea result in sleep disruption and arterial oxyhemoglobin desaturation. Patients with sleep apnea have a high prevalence of atrial fibrillation and ventricular arrhythmias.
心力衰竭是一种高度流行的疾病，仍然与反复住院、高发病率和高死亡率相关。伴有反复窒息发作的睡眠相关呼吸障碍可能对心脏功能产生不利影响。本研究的主要目的是确定门诊稳定型心力衰竭男性患者中各种睡眠相关呼吸障碍的患病率、后果及差异。
本文报告了对92例符合条件的心力衰竭且左心室射血分数<45%的患者中的81例进行的前瞻性研究结果。40例患者无睡眠呼吸暂停（呼吸暂停/低通气小时率，4±4；第1组），41例患者有睡眠呼吸暂停（占所有患者的51%；呼吸暂停/低通气小时率，44±19；第2组）。第2组的睡眠中断和动脉血氧血红蛋白去饱和明显更严重，心房颤动（22%对5%）和室性心律失常的患病率高于第1组。所有患者中有40%患有中枢性睡眠呼吸暂停，11%患有阻塞性睡眠呼吸暂停。后一组患者的平均体重明显更高（112±30对75±16kg），习惯性打鼾的患病率更高（78%对28%）。然而，这些不同类型呼吸暂停患者的呼吸暂停和低通气发作小时率（36±10对47±21）、觉醒发作（20±14对23±11）和去饱和（最低饱和度，72±11%对78±12%）相似。
51%的稳定型心力衰竭男性患者患有睡眠相关呼吸障碍：40%为中枢性，11%为阻塞性睡眠呼吸暂停。阻塞性和中枢性睡眠呼吸暂停均导致睡眠中断和动脉血氧血红蛋白去饱和。睡眠呼吸暂停患者心房颤动和室性心律失常的患病率很高。
