射血分数保留的心力衰竭患者睡眠间歇性低氧状况

Intermittent Hypoxemia in Patients with Heart Failure with Preserved Ejection Fraction

目的调查射血分数保留的心力衰竭(HFpEF)患者夜间发生间歇性低氧血症的概率。方法回顾2011年1月至2014年12月接受睡眠呼吸检测和超声心动图的854例患者,根据左心室射血分数(EF)将心力衰竭患者(n=216)分为射血分数保留心力衰竭(HFpEF)(EF≥50%)(n=112)组和射血分数降低心力衰竭(HFr EF)(EF <50%)(n=104)组。便携式睡眠呼吸监测设备记录呼吸事件和夜间最低血氧饱和度(min SaO_2)。计算睡眠期间血氧饱和度低于90%占总睡眠时间的比例(T90SaO_2)。结果 HFpEF和HFr EF组均比非心力衰竭患者的呼吸事件多[18 (6,36)/h和21 (8,45)/h比13 (5,29)/h,P <0. 001],min SaO_2显著偏低[82 (77,86)%和83 (78,87)%比85 (80,87)%,P <0. 001],T90SaO_2占比高[6. 0 (1. 5,24. 8)%和6. 7 (1. 3,14. 4)%比3. 0 (0. 4,15. 5)%,P <0. 001]。与非心力衰竭患者相比,HFpEF组患者发生中-重度低氧血症(min SaO_2<85%)的可能性大(OR=2. 02,95%CI=1. 34～3. 11,P <0. 001);这一差异在矫正年龄、性别、高血压、糖尿病、冠心病、肾功能不全、吸烟史等混杂因素后仍具有显著性(OR=1. 85,95%CI=1. 20～2. 90,P=0. 006)。结论 HFpEF患者易发生睡眠间歇低氧血症,需要进一步研究证实纠正夜间低氧能否改善此类患者的长期预后。

Objective To investigate the characteristics of nocturnal intermittent hypoxemia in patients with heart failure(HF)with preserved ejection fraction(HFpEF).Methods Patients(n=854)who completed sleep test and echocardiography from January 2011 to December 2014 were retrospectively studied.HF patients with an ejection fraction(EF)of≥50%were included in the HFpEF group(n=112)while HF patients with an EF of<50%included in the group of HF patients with reduced EF(HFrEF)(n=104).Respiratory events and minimum nocturnal saturation(minSaO 2)were recorded by home sleep testing,and the percentage of total sleep time with saturation<90%(T90SaO 2)were calculated.Results Compared with patients without HF,subjects with HFpEF and HFrEF had more breathing events[13(5,29)/h vs.18(6,36)/h,and 21(8,45)/h,P<0.001],lower minSaO 2[85(80,87)%vs.82(77,86)%and 83(78,87)%,P<0.001]and relatively longer T90SaO 2[3.0(0.4,15.5)%vs.6.0(1.5,24.8)%and 6.7(1.3,14.4)%,P<0.001].The HFpEF group had significantly higher odds of moderate-severe hypoxemia(minSaO 2<85%)during sleep than those without HF(OR=2.02,95%CI=1.34-3.11,P<0.001),with the significance persisting after adjusting for covariates including age,gender,hypertension,diabetes,coronary heart disease,renal dysfunction,and smoking(OR=1.85,95%CI=1.20-2.90,P=0.006).Conclusion Patients with HFpEF have frequent nocturnal intermittent hypoxemia,which warrants further investigations to evaluate if remission of night-time hypoxemia may improve long-term prognosis in this cohort.