老年慢性收缩性心力衰竭与睡眠呼吸紊乱

The relationship between chronic heart failure and sleep-related respiration disorder

目的探讨慢性收缩性心力衰竭与睡眠呼吸紊乱的关系。方法 79例慢性收缩性心力衰竭患者, 按照是否合并睡眠呼吸紊乱将资料分为研究组和对照组,比较两组在临床症状和心脏超声指标上的差别;另外,又根据左室射血分数将研究组分为轻度心衰组和重度心衰组,比较两组睡眠期间呼吸紊乱情况及血氧和睡眠结构的变化。结果 68％慢性收缩性心力衰竭患者存在与睡眠有关的呼吸紊乱,与单纯心力衰竭患者相比,合并睡眠呼吸紊乱的心力衰竭患者心功能Ⅲ级和Ⅳ级所占比例明显增加(P<0．001),左室射血分数明显下降(P<0．01),并随着心功能不全而加重,睡眠期间平均血氧饱和度和最低血氧饱和度降低(P<0．05,P<0．05),中枢型呼吸暂停比例明显增加(P<0．01),浅睡眠增加(P<0．05)而深睡眠及快速动眼睡眠减少(P<0．05,P<0．05)。结论 68％慢性收缩性心力衰竭患者存在与睡眠有关的呼吸紊乱,这些患者睡眠时呼吸紊乱引发的低氧血症及睡眠结构变化可能是心功能恶化的主要因素之一。

Objective To investigate the relationship between chronic systolic heart failure （CSI-IF） and sleep-related respiration disorder （SRD）. Methods Seventy-nine patients with CSHF underwent polysomnography （PSG） test and Doppler echocardiography. The severity of CSHF was compared between the patients with and without SRD, and the sleep study parameter comparison was also done between the patients with LVEF 〈 30% and patients with LVEF 〉 30%. Results Sixty-eight percent of the CSHF patients had SRD as indicated by apnea-hypopnea index（AHI） 35. The patients with CSHF and SRD had a higher NYHA functional class scores （ P 〈 0.001） and a lower LVEF（ P 〈 0.01） than the patients without SRD. Patients who had beth CSHF with LVEF〈 30% and SRD had low SaO2, high percentage of central sleep apnea, high percentage of stage- Ⅰ and stage- Ⅱ sleep and low percentage of stage- Ⅲ, stage- Ⅳ and REM sleep. Conclusion SRD is very common in patients with CSHF, and the low SaO2 and fragmental sleep structure related to SRD might be risk factors to the deterioration of cardiac function.