体位疗法对心力衰竭患者陈-施呼吸的疗效观察

目的 探讨体位疗法对心力衰竭患者陈-施呼吸的疗效.方法 50例合并中-重度陈-施呼吸的心力衰竭患者,连续行2晚多导睡眠监测,分别为基础状态和体位干预治疗法.体位疗法是指让患者保持侧卧位,避免平卧位.随后将2晚的睡眠参数进行比较.结果 体位疗法降低了呼吸暂停低通气指数(AHI)[(43.51±10.24)次/hvs (25.32±10.97)次/h,P＜0.05],同时减少了觉醒指数[(29.04±9.18)次/h vs (16.85±7.87)次/h,P＜0.05],增加了平均血氧饱和度[(93.56±2.54)％ vs (94.74±2.37)％,P＜0.05].体位疗法增加了深睡眠期的比例[(10.29±6.34)％ vs(17.99±7.12)％,P＜0.05],对总睡眠时间无明显影响[(3.34±0.36)h vs (3.36±0.30)h,P＞0.05].结论 体位疗法能有效减轻中枢性睡眠呼吸暂停-陈施呼吸的严重性,且对睡眠结构无不利影响.     

ASV在重度心衰合并陈-施呼吸患者中的应用

目的 探讨匹配压力支持伺服通气(Adaptive servo-ventilation,ASV)治疗重度心力衰竭的疗效与安全性。方法 选取重度心力衰竭合并陈-施呼吸(Cheyne-Stokes respiration,CSR)患者40例。随机分为ASV组(n=20)和持续气道正压通气(Continuous positive airway pressure, CPAP)组(n=20),治疗4周后比较两种疗法治疗前后的心功能相关指标、睡眠呼吸及睡眠结构和质量相关参数及并发症发生情况。结果 治疗后,ASV组和CPAP组的左心室射血分数(LVEF)和6min 步行距离均显著高于治疗前(P均<0.05)；且两组pro-BNP水平均显著低于治疗前(P均<0.05)；两组pro-BNP和6min步行试验改善情况,ASV组明显高于CPAP组(P均<0.05)。ASV能明显改善呼吸暂停低通气指数(apnea hypopnea index,AHI)、最低脉氧饱和度、微觉醒指数、I II期睡眠比率、Ⅲ Ⅳ期睡眠比率、快动眼睡眠比率及睡眠效率(P均<0.05),而CPAP只明显改善AHI和最低脉氧饱和度(P<0.05),且改善程度明显低于ASV组(P<0.05)。ASV组气胸发生率显著低于CPAP组(P<0.05)。结论 ASV可明显改善伴CSR的重症心衰患者的心功能和睡眠呼吸紊乱,且不增加并发症的发生率。     

充血性心力衰竭与睡眠呼吸障碍

充血性心力衰竭（CHF）是一种病死率很高的综合征。尽管近年来在其治疗方面有不少的进步，如血管紧张素转换酶抑制剂、β-受体阻滞剂等的问世及应用使其得到了很好的治疗。但CHF的发病率及死亡率仍然很高。已有研究报道，睡眠呼吸障碍的存在加重了充血性心力衰竭患者夜间缺氧及合并左室射血分数（LVEF）降低，对左心室功能产生负面影响。目前发现CHF患者广泛存在陈一施呼吸（CSR），主要发生在睡眠中非快速动眼期（NREM）的Ⅰ、Ⅱ期。近年研究证实CHF的病理生理与睡眠呼吸障碍相互促进，     

慢性心力衰竭患者中枢性睡眠呼吸暂停的诊治进展

慢性充血性心力衰竭(CHF)是一种复杂的临床综合征,发病率和病死率都极高.心力衰竭患者中睡眠呼吸障碍的发病率极高,对心力衰竭患者的预后产生极为不利的影响.陈-施呼吸(CSR)是最常见的一种中枢性呼吸暂停,但关于该综合征的确切的诊断标准、减少CSR的最有效方法、以及这是否能够降低CHF的致残率和病死率等方面,存在许多不同观点.另外,究竟CSR只是反应CHF严重程度的一个参数,还是一种可导致远期不良预后的严重并发症,亦尚存争议.本文对慢性心力衰竭患者的中枢性睡眠呼吸暂停的诊治进展进行了简要综述.     

慢性充血性心力衰竭与中枢性睡眠呼吸障碍研究进展

慢件充血性心力衰竭伴有睡眠障碍有很高的发生率,其中中枢性睡眠呼吸障碍及陈-施式呼吸发生率40%左右.本文从流行病学、分类、发病机制、临床表现、治疗等方面进行综述.     

通心络胶囊对老年睡眠期陈-施呼吸患者呼吸的影响

目的观察通心络胶囊对老年睡眠期陈-施呼吸（CSR）患者的影响。方法根据多导睡眠图监测（PSG）结果,除外心力衰竭病因者,入选老年睡眠期CSR患者30例,按呼吸暂停低通气指数分为轻度（n=11）、中度（n=9）及重度（n=10）CSR组,均予口服通心络胶囊2粒／次,3次,d,共30d。分析治疗前后PSG指标及症状的变化及与日间嗜睡程度的相关关系。日间嗜睡程度以Epworth嗜睡评分（ESS）评定。结果通心络胶囊治疗前后比较显示,3组中仅重度组呼吸暂停低通气指数显著降低[（37．4±4．3）vs（30．8±4．5）,P〈0．05];3组的日间ESS均有改善（P〈0．05）,轻度组由（8．8±2．0）降低到（6．0＋1．9）,中度组由（10．7±2．1）降至（8．0±2．3）,重度组由（13．4±2．4）降至（10．2±3．0）。相关性分析显示轻度组ESS与微觉醒指数呈正相关（r=0．775,P〈0．05）,而中重度组日间嗜睡评分与最低血氧饱和度呈负相关（分别为r=-0．751,P〈0．05;r=-0．739,P〈0．05）。结论通心络胶囊可改善老年睡眠期CSR者的日间嗜睡症状,可能部分降低重度老年睡眠期CSR的呼吸暂停低通气指数。     

持续正压通气治疗慢性心力衰竭合并睡眠呼吸紊乱的研究进展

心力衰竭是严重影响公共健康的心血管疾病之一,睡眠呼吸紊乱是心力衰竭中不可忽视的并发症,其引起的一系列病理生理反应,使得心力衰竭患者死亡的危险性增加,持续性正压通气可以显著改善心力衰竭患者睡眠呼吸紊乱,甚至提高心功能.这篇文章对睡眠呼吸紊乱与心力衰竭间病理生理的相互作用,以及持续性正压通气治疗对心力衰竭伴睡眠呼吸紊乱患者的影响方面做相关的回顾性评价.     

无创正压通气治疗2例慢性充血性心力衰竭合并陈-施呼吸患者经验总结及分析

目的 比较两种无创呼吸机治疗慢性充血性心力衰竭合并陈-施呼吸(cheyne-stoke respiration,CSR)患者效果.方法 选取北京市公安医院2例慢性充血性心力衰竭合并CSR患者,针对患者病情给予患者常规治疗,并在常规治疗的基础上分别采用压力支持自动伺服通气(Autoset CS)以及双水平无创正压通气(Bilevel PAP)进行治疗.比较治疗前后的呼吸频率、心率、血气变化情况(pH、PaO2、PaCO2、SaO2)、收缩压、舒张压、左室射血分数等情况.同时注意观察患者接受治疗后的不良反应,例如:局部皮肤损伤、鼻炎、明显腹胀、气压伤、误吸、低血压等.结果 采用Autoset CS治疗CSR显示出不仅有睡眠质量的提高、白天嗜睡的减轻及认知度的改善,而且心力衰竭患者的左室射血分数及心功能都有明显改善.另外采用BilevelPAP经鼻无创通气治疗CSR其参数设定吸气压通常为10.0 cm H2O;呼气压通常为6～8 cm H2O即可.吸气时间较治疗慢性阻塞性肺疾病的参数有所延长,通常为0.5～0.6 s;呼气时间较治疗慢性阻塞性肺疾病的参数有所减少,通常为0.3 S.结论 Autoset CS治疗CSR采用自动调节的伺服通气运算,提供一种全新的无创正压通气治疗形式,更及时完全地控制CSR.BilevelPAP经鼻无创通气治疗CSR其参数设定与治疗慢性阻塞性肺疾病的参数设定显著的不同.     

无创正压通气治疗2例慢性充血性心力衰竭合并陈-施呼吸患者经验总结及分析

目的 比较两种无创呼吸机治疗慢性充血性心力衰竭合并陈-施呼吸(cheyne-stoke respiration,CSR)患者效果.方法 选取北京市公安医院2例慢性充血性心力衰竭合并CSR患者,针对患者病情给予患者常规治疗,并在常规治疗的基础上分别采用压力支持自动伺服通气(Autoset CS)以及双水平无创正压通气(Bilevel PAP)进行治疗.比较治疗前后的呼吸频率、心率、血气变化情况(pH、PaO2、PaCO2、SaO2)、收缩压、舒张压、左室射血分数等情况.同时注意观察患者接受治疗后的不良反应,例如:局部皮肤损伤、鼻炎、明显腹胀、气压伤、误吸、低血压等.结果 采用Autoset CS治疗CSR显示出不仅有睡眠质量的提高、白天嗜睡的减轻及认知度的改善,而且心力衰竭患者的左室射血分数及心功能都有明显改善.另外采用BilevelPAP经鼻无创通气治疗CSR其参数设定吸气压通常为10.0 cm H2O;呼气压通常为6～8 cm H2O即可.吸气时间较治疗慢性阻塞性肺疾病的参数有所延长,通常为0.5～0.6 s;呼气时间较治疗慢性阻塞性肺疾病的参数有所减少,通常为0.3 S.结论 Autoset CS治疗CSR采用自动调节的伺服通气运算,提供一种全新的无创正压通气治疗形式,更及时完全地控制CSR.BilevelPAP经鼻无创通气治疗CSR其参数设定与治疗慢性阻塞性肺疾病的参数设定显著的不同.     

无创正压通气治疗2例慢性充血性心力衰竭合并陈-施呼吸患者经验总结及分析

目的 比较两种无创呼吸机治疗慢性充血性心力衰竭合并陈-施呼吸(cheyne-stoke respiration,CSR)患者效果.方法 选取北京市公安医院2例慢性充血性心力衰竭合并CSR患者,针对患者病情给予患者常规治疗,并在常规治疗的基础上分别采用压力支持自动伺服通气(Autoset CS)以及双水平无创正压通气(Bilevel PAP)进行治疗.比较治疗前后的呼吸频率、心率、血气变化情况(pH、PaO2、PaCO2、SaO2)、收缩压、舒张压、左室射血分数等情况.同时注意观察患者接受治疗后的不良反应,例如:局部皮肤损伤、鼻炎、明显腹胀、气压伤、误吸、低血压等.结果 采用Autoset CS治疗CSR显示出不仅有睡眠质量的提高、白天嗜睡的减轻及认知度的改善,而且心力衰竭患者的左室射血分数及心功能都有明显改善.另外采用BilevelPAP经鼻无创通气治疗CSR其参数设定吸气压通常为10.0 cm H2O;呼气压通常为6～8 cm H2O即可.吸气时间较治疗慢性阻塞性肺疾病的参数有所延长,通常为0.5～0.6 s;呼气时间较治疗慢性阻塞性肺疾病的参数有所减少,通常为0.3 S.结论 Autoset CS治疗CSR采用自动调节的伺服通气运算,提供一种全新的无创正压通气治疗形式,更及时完全地控制CSR.BilevelPAP经鼻无创通气治疗CSR其参数设定与治疗慢性阻塞性肺疾病的参数设定显著的不同.     

Cognitive impairment in heart failure with Cheyne-Stokes respiration

OBJECTIVES—To document the degree of cognitive impairment in stable heart failure, and to determine its relation to the presence of Cheyne-Stokes respiration during sleep.
SUBJECTS—104 heart failure patients and 21 healthy normal volunteers.
METHODS—Overnight oximetry was used (previously validated as a screening tool for Cheyne-Stokes respiration in heart failure). Cognitive function was assessed using a battery of neuropsychological tests. Left ventricular function was assessed by echocardiography.
RESULTS—Heart failure patients performed worse than the healthy volunteers in tests that measured vigilance. Reaction times were 48% slower (0.89 (0.03) s v 0.60 (0.05) s; p < 0.005) and they hit twice as many obstacles on the Steer Clear simulator (75 (6.4) v 33 (4.6); p < 0.005). Cognitive impairment within the heart failure group was unrelated to either the presence of Cheyne-Stokes respiration, the degree of left ventricular dysfunction, or indices of nocturnal oxygenation.
CONCLUSIONS—Vigilance was impaired in heart failure but this did not appear to be related to the presence of Cheyne-Stokes respiration during sleep. Impaired vigilance as measured on the Steer Clear test has been associated with an increased risk of motor vehicle accidents. The issue of fitness to drive in heart failure requires further attention.


Keywords: Cheyne-Stokes respiration; cognitive function; heart failure; driving     

Adaptive servoventilation improves cardiac function in patients with chronic heart failure and Cheyne-Stokes respiration

BACKGROUND AND AIMS: Sleep disordered breathing (SDB), especially Cheyne-Stokes respiration (CSR) is common in patients with chronic heart failure (CHF). Adaptive servoventilation (ASV) was recently introduced to treat CSR in CHF. The aim of this study was to investigate the effects of ASV on CSR and CHF parameters. METHODS: In 29 male patients (63.9+/-9 years, NYHA> or =II, left ventricular ejection fraction [LV-EF]< or =40%), cardiorespiratory polygraphy, cardiopulmonary exercise (CPX) testing, and echocardiography were performed and concentrations of NT-proBNP determined before and after 5.8+/-3.5 months (median 5.7 months) of ASV (AutoSet CS2, ResMed) treatment. All patients also received guideline-driven CHF therapy. RESULTS: Apnoea-hypopnoea-index was reduced from 37.4+/-9.4/h to 3.9+/-4.1/h (p<0.001). Workload during CPX testing increased from 81+/-26 to 100+/-31 W (p=0.005), oxygen uptake (VO2) at the anaerobic threshold from 12.6+/-3 to 15.3+/-4 ml/kg/min (p=0.01) and predicted peak VO2 from 58+/-12% to 69+/-17% (p=0.007). LV-EF increased from 28.2+/-7% to 35.2+/-11% (p=0.001), and NT-proBNP levels decreased significantly (2285+/-2192 pg/ml to 1061+/-1293 pg/ml, p=0.01). CONCLUSIONS: In selected patients with CHF and CSR, addition of ASV to standard heart failure therapy is able to improve SDB, CPX test results, LV-EF and NT-proBNP concentrations.     

Influence of Low-Flow Oxygen Supply on Sleep Architecture in Patients with Severe Heart Failure (NYHA III-IV) and Cheyne-Stokes Respiration

Patients suffering from severe heart failure may develop breathing pattern disorders during sleep, especially in the form of Cheyne-Stokes respiration. Results may be severe disturbances in sleep architecture and worsening of hemodynamics and of prognosis of these patients. Causes of the periodic breathing disorders are probably hypocapnia, hypersensitivity of respiratory control centers, hypoxemia, and prolonged blood circulation time. This study examined the influence of different concentrations of continously administered oxygen during the nighttime on breathing pattern disorders, oxygen saturation, and sleep architecture in 65 patients with severe heart failure (NYHA III–IV). Fifty-two of 65 patients showed an improvement of sleep architecture. Total sleeping time increased significantly (p < 0.01). Fragmentations of sleep by arousals decreased (p < 0.01); time of random eye movement (REM) sleep and non–REM sleep III and IV increased significantly.     

Influence of Orthotopic Heart Transplantation on Breathing Pattern Disorders in Patients with Dilated Cardiomyopathy

Cheyne-Stokes respiration is well-known in patients with congestive heart failure. One of the causes might be a prolonged circulation time or diminished pulmonary gas stores. Improvement of cardiac function by heart transplantation might abolish Cheyne-Stokes respiration. We examined 29 male patients (age 24 to 63 years) with polysomnographically verified Cheyne-Stokes respiration before and 3 to 9 weeks after orthotopic heart transplantation. All patients suffered from congestive heart disease. Left ventricular ejection fraction (LVEF) was between 8 and 19% We analyzed sleep stages, respiratory events, oxygen saturation, and cardiac function (echocardiography and ergometry). Before heart transplantation all patients showed periodic breathing (apnea-hypopnea index [AHI] 13.2–51.6/h). Oxygen saturation dropped to a minimum of 63% Sleep was severely disturbed. After heart transplantation LVEF was significantly higher in all patients (x_mean = 64%). Twenty-three of 29 patients showed no more evidence of periodic breathing. However, even with normalized cardiac function, 6 patients still suffered from Cheyne-Stokes respiration. Cheyne-Stokes respiration is often associated with dilated cardiomyopathy. Our results demonstrate that normalization of cardiac function improves Cheyne-Stokes respiration. Even after normalization of cardiac function, some patients suffer from Cheyne-Stokes respiration further on. We suggest that breathing control centers may be permanently damaged in these patients.     

Cheyne-Stokes Respiration in a 17-Year-Old Boy Awaiting Heart Transplantation

Cheyne-Stokes respiration is a pattern of alternating central apnea and hyperpnea. It is well described in adults with congestive heart failure, but not in children.We report the case of a 17-year-old boy whose systolic heart failure was complicated by Cheyne-Stokes respiration. He was given supportive therapy until heart transplant, after which his Cheyne-Stokes respiration clinically resolved. Clinicians should be aware of this uncommon condition in pediatric and adolescent patients who have advanced heart failure and irregular breathing.     

Effect of cardiac resynchronization therapy on sleep quality,quality of life,and symptomatic depression in patients with chronic heart failure and Cheyne-Stokes respiration

Patients with heart failure (HF) often suffer from sleep-related breathing disorders (SRBD) like Cheyne-Stokes respiration (CSR). Cardiac resynchronization therapy (CRT) improves myocardial function and exercise capacity in patients with HF and conduction disturbances. As CRT has been shown to reduce CSR in patients with HF, it is not clear whether CRT improves quality of life and symptomatic depression by improvement of apnea/hypopnea index (AHI) and sleep quality. Forty-two HF patients with conduction disturbance before CRT were screened for CSR and evaluated for sleep quality [Pittsburgh Sleep Quality Index (PSQI)], quality of life score [36-item short form (SF-36)], depression, and exercise capacity (VO2peak) and ejection fraction (EF). Eighteen patients (three females, age 61±10, body mass index 24±4 kg m⁻², EF 24±4%, QRS complex duration 156±32 ms) presented CSR with an AHI of 18±8 (11 CSR, 7 mixed). Fourteen patients showed no SRBD (PSQI<5,AHI<5). All patients received CRT and were reevaluated after 18±7 weeks. CSR worsen quality of life in seven of eight terms compared to patients without SRBD. Symptomatic depressive symptoms (Beck Depression Inventory>10) were only present in patients with CSR. CRT results in improvement of peakVO2 and EF. There was no difference between patients with CSR and without SRBD on exercise capacity or EF under CRT, whereas CRT led to a significant decrease in AHI (18±8 to 3±2, p<0.0001), PSQI (18±4 to 6±3, p=0.0007), with reduction of depression score (12±3 to 4.8±3, p=0.004). In patients with HF, CSR is associated with symptomatic depressive syndromes and impaired quality of life. CRT reduced CSR with improvement of sleep quality and symptomatic depression.