心源性睡眠呼吸异常:心衰患者睡眠期间陈-施呼吸机制探讨的初步报告

Circulatory sleep apnea:Preliminary report of clinical observation on sleep apnea in patients with chronic heart failure

目的：探讨心衰患者陈施呼吸的发生率及发生机制。方法：连续入选2015年3月~2015年5月于阜外医院行睡眠呼吸监测的患者56例,分为心衰组和非心衰组。结果：两组睡眠呼吸暂停的发生率均较高,心衰组11例患者中呼吸暂停低通气指数（AHI）〉5的有10例,平均AHI指数23.93±14.63;非心衰组45例患者中AHI〉5的有33例,平均AHI指数16.20±18.76;心衰组中枢性睡眠呼吸暂停（CSA）次数占睡眠呼吸暂停总数的比例明显大于非心衰组病人,分别为80.21%±30.55%和27.16%±35.71%,P〈0.01。结论：心脏的循环功能和肺脏的呼吸功能是联合一体化,相互联系、互为因果而又互相影响。慢性心力衰竭的循环障碍促成了潮式呼吸的发生,所以称之为心源性呼吸睡眠异常。

Objective： The aim of this study is to investigate the occurrence and mechanism of Cheyne-Stokes breathing pattern in patients with heart failure. Methods： Fifty-six patients who performed polusomnography sleep testing at National Center of Cardiovascular Diseases Fuwai Hospital from March to May in 2015. We divided them into chronic heart failure （CHF） group and nonCHF group. Results： The occurrences of sleep apnea in two groups were high. In CHF group （ n=1 1 ） , there were 10 patients with apnea hypopnea index （AHI）〉5; and their AHI was 23.93±14.63. In non-CHF group （ n=45 ） , there were 33 patients whose AHI〉5; and their AHI was 16.20±18.76. The ratio of center sleep apnea to all gross sleep apnea ratio in CHF group was higher than that in non-CHF group （ 80.21%±30.55% vs 27.16%±35.71%, P〈0.01 ） . Conclusion： Based upon the new theory ofholistic integrative physiology and medicine, we explain the mechanism of circulatory dysfunction induce the oscillation breathing in patients with CHF. The sleep apnea and C-S respiration in CHF should be called circulatory sleep apnea, rather than central sleep apnea.