慢性心力衰竭患者心脏移植术前后睡眠呼吸障碍的变化

Sleep-disordered breathing in patients with chronic heart failure before and after heart transplantation

目的探讨等待心脏移植患者睡眠呼吸障碍(SDB)的特征以及移植后SDB的变化。方法前瞻性纳入2018年9月至2019年12月入住武汉大学人民医院心血管内科及心血管外科并进行睡眠呼吸监测、等待心脏移植的慢性心力衰竭患者34例,其中男31例,女3例,年龄30~79(52.1±11.4)岁,分析患者心脏移植术前SDB的特征以及接受移植术后SDB的变化。结果34例等待心脏移植的患者中,22例存在中枢性睡眠呼吸暂停,4例合并阻塞性睡眠呼吸暂停,8例无SDB;存在潮式呼吸患者的循环时长与左心室射血分数呈负相关。对15例接受心脏移植的患者在移植术后再次进行睡眠呼吸监测,结果显示,移植后SDB明显好转,潮式呼吸完全消除。结论等待心脏移植患者的SDB发生率高,以伴有中枢性睡眠呼吸暂停的潮式呼吸为主,而心脏移植术可以消除慢性心力衰竭患者的潮式呼吸。

Objective To explore the characteristics of sleep-disordered breathing(SDB)in chronic heart failure patients waiting for heart transplantation and the changes of SDB after transplantation.Methods From September 2018 to December 2019,34 patients with chronic heart failure were prospectively enrolled into this study,who were hospitalized for waiting for heart transplantation in the departments of cardiovascular medicine and cardiovascular surgery,Renmin Hospital of Wuhan University.All of them received portable sleep physiological monitoring.The characteristics of their SDB were analyzed before and after heart transplantation.Results Of the 34 patients waiting for heart transplantation,22 had central sleep apnea,4 had obstructive sleep apnea and 8 had no SDB.The cycle length of Cheyne-Stokes respiration was negatively correlated with left ventricular ejection fraction.After heart transplantation,15 patients received repeat sleep physiological monitoring and their results showed that the SDB was significantly improved,with the elimination of Cheyne-Stokes respiration.Conclusions Patients waiting for heart transplantation had a high prevalence of SDB,with Cheyne-Stokes respiration with central sleep apnea as the main type.However,heart transplantation may eliminate the Cheyne-Stokes respiration in patients with chronic heart failure.