心力衰竭相关中枢型睡眠呼吸暂停综合征的危险因素探讨

Risk factors of central sleep apnea syndrome related to heart failure

目的 分析心力衰竭(简称心衰)患者的中枢型睡眠呼吸暂停综合征(CSAS)发病率,探讨发病的相关因素及可能发病机制,并建立多指标预测模型。方法 选取在呼吸科和心内科住院的78例慢性心衰患者为研究对象,纳入患者按发病部位分为左心衰组39例和右心衰组39例。分析患者睡眠监测指数,测定左室射血分数(EF)、右室前壁厚度、三尖瓣环收缩期位移(TAPSE)和三尖瓣环收缩期峰值流速(S′),联合年龄、体质量指数、性别、吸烟史以及血二氧化碳分压[p_(a)(CO_(2))]等进行关联分析,对回归分析结果中差异有统计学意义的指标绘制受试者工作特征(ROC)曲线。结果 右心衰组患者年龄高于左心衰组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果表明,左心衰、年龄≥60岁、p_(a)(CO_(2))基线水平<39 mmHg为CSAS的危险因素。ROC曲线分析结果表明,p_(a)(CO_(2))基线水平及心衰部位、年龄联合构建的回归预测模型对心衰患者预测CSAS的灵敏度、特异度分别为77.8%和82.9%。左心衰组发生呼吸暂停患者占比较高,右心衰组呼吸暂停患者均发生轻度TAPSE和S′下降,而左心衰组呼吸暂停患者EF均较低。结论 相较于EF,临床医师应该更关注低水平p_(a)(CO_(2))患者,此类患者存在更高的CSAS发生风险,右心衰患者中,呼吸暂停可能更倾向发生于轻度右心功能受损的患者,但需更大样本进行研究验证。

Objective To analyze the incidence of central sleep apnea syndrome(CSAS) in patients with heart failure,explore the related factors and possible pathogenesis,and establish a multi-index prediction model.Methods A total of 78 patients with chronic heart failure from the respiratory department and cardiology department were selected as study objects.The patients were divided into left heart failure group(39 cases) and right heart failure group(39 cases).Sleep monitoring index was analyzed,left ventricular ejection fraction(EF),right anterior ventricular wall thickness,tricuspid ring systolic displacement(TAPSE) and tricuspid ring systolic peak flow velocity(S′) were determined,and association analysis was performed combining with age,body mass index,gender,smoking history,and blood carbon dioxide partial pressure [p_a(CO_(2))].ROC curves were drawn for indicators with statistically significant differences in regression results.Results The age in the right heart failure group was higher than the left heart failure group(P<0.05).The results of multivariate Logistic regression showed that left heart failure,age ≥ 60 years old,and p_a(CO_(2))<39 mmHg were risk factors for CSAS.ROC analysis results showed that the sensitivity and specificity of regression prediction model constructed by combined application of p_a(CO_(2)) baseline level,left and right heart failure location,and age for CSAS prediction in patients with heart failure were 77.8% and 82.9%,respectively.Patients with apnea in left heart failure group accounted for a higher proportion,those with apnea in right heart failure group had mild TAPSE and S′ decrease,while EF was lower in left heart failure group.Conclusion Compared with the EF,clinical physicians should pay more attention to patients with lowpa(CO_(2)),because these patients have a higher risk of central sleep apnea.In the right heart failure patients,apnea may be more likely to occur in patients with mild right ventricular dysfunction,but it needs larger sample support for verification.