应用便携式多导睡眠监测仪对边远地区慢性心力衰竭伴睡眠呼吸暂停患者的临床意义

Implication of Polysomnography in Portable Monitor for Detecting Sleep Apnea in Patients With Congestive Heart Failure in Remote Area

目的：应用便携式多导睡眠监测仪（PSG）监测边远地区慢性心力衰竭患者,分析其中睡眠呼吸暂停特别是中枢性睡眠呼吸暂停的临床意义。方法：选择云南省怒江傈僳族自治州人民医院心血管病内科住院的患者40例,应用PSG监测其中瓣膜性心脏病患者16例,其他病因引起的心脏扩大患者24例。根据呼吸暂停低通气指数（AHI）分为两组,即AHI≥5次/h组20例和AHI〈5次/h组20例,分析比较两组患者中枢性睡眠呼吸暂停与心功能的关系。结果：（1）AHI≥5次/h组患者美国纽约心脏协会（NYHA）心功能Ⅲ/Ⅳ级比例、左心房内径、左心室舒张末期内径、左心室收缩末期内径、左心室舒张末期容积、左心室收缩末期容积、AHI以及氧减指数均明显大于AHI〈5次/h组,而左心室射血分数低于AHI〈5次/h组,差异均有统计学意义（P均〈0.05）。（2）AHI≥5次/h组20例患者中以中枢性睡眠呼吸暂停为主16例,以阻塞性睡眠呼吸暂停为主4例。（3）多元Logistic向前逐步选择（Wald）回归分析结果表明,AHI≥5次/h与左心室射血分数[优势比（OR）=0.9,95%可信区间（CI）：0.8~1.0,P=0.017）]、最低氧饱和度（OR=0.9,95%CI：0.7~1.0,P=0.022）以及左心室后壁厚度（OR=0.3,95%CI：0.1~0.9,P=0.034）相关;中枢性睡眠呼吸暂停与NYHA心功能Ⅲ/Ⅳ级相关（OR=15.0,95%CI：3.2~71.4,P=0.001）。结论：睡眠呼吸暂停尤其中枢性睡眠呼吸暂停是严重慢性心力衰竭的一种表现,PSG应用于边远地区慢性心力衰竭患者的评估及治疗随访,具有现实意义。

Objective：To explore polysomnography（PSG） in portable monitor（PM） for detecting sleep apnea in patients with congestive heart failure（CHF） caused by mitral valve disease and cardiac dilatation,and to particularly analyze the meaning of central sleep apnea（CSA） in clinical practice.Methods：There were 16 patients with valvular disease and 24 with cardiac dilatation and other etiologiesselected by PM in our hospital whom from Yuanna Nujiang area.According to apnea-hyponea index（AHI）,the patients were divided into 2 groups：AHI≥5/h group and AHI〈5/h group.n=20 in each group.The relationship between CSA and cardiac function were studied and compared between 2 groups.Results：1 Compared with AHI 〈 5/h group,the patients in AHI ≥ 5/h group presented the higher ratio of NYHA III/IV,increased left atrium diameter（LAD）,left ventricle diastolic end diameter（LVDED）,left ventricle systolic end diameter（LVSED）,left ventricle diastolic end volume（LVDEV）,left ventricle systolic end volume（LVSEV） and oxygen de-saturation index,while decreased left ventricle ejection fraction（LVEF）,P 〈0.05.2 In AHI ≥ 5/h group,there were 16 patients with CSA and 4 with obstructive sleep apnea.3 Multi logistic regression with forward selection（Wald） analysis indicated that AHI ≥ 5/h was related to LVEF（OR=0.9,95.0% CI 0.8-1.0,P =0.017）,the minimum oxygen saturation（OR=0.9,95.0% CI 0.7-1.0,P =0.022） and left ventricular posterior wall depth（OR=0.3,95.0% CI 0.1-0.9,P =0.034）.However,CSA was related to the ratio of NYHA III/IV（OR=15.0,95.0% CI 3.2-71.4,P =0.001）.Conclusion：Sleep apnea,particularly CSA is one of the manifests in patients with severe CHF.Application of PSG in PM is practical for evaluating and treating the relevant patients during follow-up period in remote area.