老年心力衰竭与阻塞性睡眠呼吸暂停低通气综合征的相关性

Relationship between obstructive sleep apnea syndrome and heart failure in elderly patients

目的了解老年心力衰竭患者阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea syndrome,OSAHS)的发生情况并探讨不同程度睡眠呼吸障碍与心功能的关系。方法 58例老年心力衰竭患者,行多导睡眠图(polysomnography,PSG)监测,根据PSG监测结果,将老年心衰组分为单纯心衰、心衰合并轻度OSAHS、心衰合并中度OSAHS、心衰合并重度OSAHS4组,用超声心动图检测左室射血分数(left ventricular ejection fraction,LVEF),另将53例经超声检测无心功能异常者为对照组。结果老年心衰患者阻塞性睡眠呼吸暂停障碍发生率60.3%。与单纯心衰相比,心衰合并中重度OSAHS患者LVEF较低,夜间血氧饱和度较低,睡眠呼吸暂停低通气指数与LVEF呈负相关(r=-0.76,P<0.01)。结论老年心力衰竭患者阻塞性睡眠呼吸暂停障碍发生率高,严重阻塞性睡眠呼吸障碍可能影响左心功能,通过改善阻塞性睡眠呼吸障碍,可降低心衰的发生率。

Objective In order to discover the relationship between elderly heart failure patients complicated obstructive sleep apnea with the occurrence of varying degrees of sleep-disordered breathing and cardiac function.Methods Fifty-eight cases elderly patients with heart failure were selected by line polysomnography（PSG） monitoring results.Patients were divided into four groups： heart failure only;heart failure complicated with mild OSAHS;heart failure combined with moderate OSAHS,heart failure combined with severe OSAHS.The other 53 cases detected by ultrasound and indicated inadvertent dysfunction as the control group.All cases had left ventricular ejection fraction and echocardiography measurement.Results There were 60.3% of elderly heart failure patients with obstructive sleep apnea disorder.Patients combined with moderate to severe OSAHS had less LVEF,lower oxygen saturation at night when compared with those in heart failure only group.The index of sleep apnea/hypopnea from patients combined with moderate to severe OSAHS were negatively correlated with LVEF（r=-0.76,P0.01）.Conclusion The elderly heart failure patients have high frequency in combination with obstructive sleep apnea disorder.The severe obstructive sleep apnea may affect left ventricular function.Improving obstructive sleep apnea can reduce the incidence of heart failure.