睡眠呼吸暂停对充血性心力衰竭患者预后的影响

Impact of Sleep Apnea on Prognosis of Patients With Congestive Heart Failure

目的:评价睡眠呼吸暂停对充血性心力衰竭(CHF)患者预后的影响。方法:前瞻性病例对照研究。对年龄大于18岁、左心室射血分数≤0.45和纽约心功能分级(NYHA)Ⅱ～Ⅳ级的患者进行睡眠呼吸监测,根据结果分为CHF不合并睡眠呼吸暂停组、CHF合并阻塞型睡眠呼吸暂停组和CHF合并中枢型睡眠呼吸暂停组。并对其进行随访。随访结束时比较各组间死亡率。结果:共入选128例患者,其中男性105例,女性23例。128例入选患者中,CHF不合并睡眠呼吸暂停组23例、CHF合并阻塞型睡眠呼吸暂停组55例和CHF合并中枢型睡眠呼吸暂停组50例。平均随访35个月。不合并睡眠呼吸暂停组死亡率明显低于中枢型睡眠呼吸暂停组(分别为6.72/100人年和18.22/100人年,P=0.017),非存活患者中CHF合并睡眠呼吸暂停的比例明显高于存活者(分别为90%和79%,P=0.017)。多元分析显示校正年龄、性别、体重指数等混杂因素后,不管睡眠呼吸暂停的发生(包括OSA或CSA),还是睡眠呼吸暂停的严重程度(如呼吸暂停低通气指数和最低血氧饱和度)与CHF患者全因死亡均无明显独立相关。结论:CHF合并中枢型睡眠呼吸暂停患者死亡率高于不合并睡眠呼吸暂停的CHF患者,多因素分析显示睡眠呼吸暂停对CHF患者的预后未达独立相关作用。

Objective ：To assess the impact of untreated sleep apnea （SA） on prognosis of patients with congestive heart failure （CHF）. Methods：A total of 128 CHF patients including 105 male and 23 female were enrolled in this study. All patients met the following criteria： elder than 18 years of age, the lefJ ventricular ejection fraction ≤ 0.45, and NYHA class at II - IV. CHF patients were divided into three groups according to plysomonlography. CHF-N group, the patients without SA, n = 23, CHF-OSA group, the patients combined with obstructive SA, n = 55, and CHF-CSA group, the patients combined with central SA, n = 50. The average follow-up time was 35 months. At the end of follow-up, we compared the mortality rate in different groups. Results ： The mortality rate was significantly lower in CHF-N group than that in CHF-CSA group （6.72% vs. 18.22% ,P = 0. 017） ,and non-survivors showed the higher incidence of SA than the survivors （90% vs. 79% ,P = 0. 017）. While multivariate analysis indicated that with the adjustment of age and body weight index, the occurrence of OSA or CSA and the severity of SA had no obvious relationship to the death of the patients with CHF. Conclusion： Untreated OSA or CSA had no obvious impact on prognosis of patients with congestive heart failure.