稳定期心力衰竭中的睡眠呼吸暂停：临床、多导睡眠图及超声心动图特征。
Sleep apnea in stable heart failure: Clinical, polygraphic and echocardiographic characteristics.
文献信息
| PMID | 42744206 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Ferdaous Yangui |
| 作者单位 | University Tunis El Manar, Faculty of Medicine of Tunis, Street Djebel Lakhdhar, La Rabta, Tunis, 2007, Tunisia; Department of Pneumology, Internal Security Forces Hospital, Street Taher Ben Achour, La Marsa, Tunis, 2070, Tunisia; Research Laboratory on Health and Environment for Security Forces LR21INT01, Tunis, Tunisia. Electronic address: ferdaous.yangui@fmt.utm.tn. |
| 期刊 | Respiratory medicine |
| SCI 分区 | Q2 |
| IF | 3.6 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
背景与目的： 睡眠呼吸暂停综合征（SAS）是心力衰竭（HF）患者常见的合并症，可促进疾病进展并导致更差的结局，但仍在很大程度上未被充分诊断。本研究旨在描述稳定期HF患者睡眠呼吸暂停表型的临床、多导睡眠图及超声心动图特征，并探讨不同表型之间心脏结构和功能的差异。
方法： 我们开展了一项横断面研究，纳入80例稳定期HF患者。所有患者均接受经胸超声心动图和夜间呼吸多导睡眠图检查。SAS定义为呼吸暂停低通气指数（AHI）≥5次/小时。选定的描述性指标和效应估计值附有未调整的95%置信区间（CI）。
结果： 66例患者（82.5%）被诊断为SAS，其中47例（58.7%）为阻塞性睡眠呼吸暂停（OSA），19例（23.7%）为中枢性睡眠呼吸暂停（CSA）。AHI中位数为11.8 [6.5-28.3]次/小时，18例患者（27.3%）观察到重度SAS。无SAS组、OSA组和CSA组的中位BMI存在显著差异：分别为25.4（22.3-27.6）、29.3（27.3-31.3）和28.0（26.8-30.7）kg/m2（p = 0.015）。HFrEF（p = 0.008）和HFpEF（p = 0.036）的总体比较均显著，最高比例分别见于CSA组和无SAS组。平均LVEF分别为43.5%（35.2-51.8）、45.4%（41.1-49.8）和32.7%（26.7-38.7）（p = 0.009）；中位TAPSE分别为22.0（17.0-24.0）、19.0（16.0-21.0）和18.5（17.5-20.0）mm（p = 0.044）；中位PASP分别为38.0（36.0-45.0）、35.0（32.0-41.0）和56.0（42.0-72.0）mmHg（p = 0.020）。经Bonferroni校正的Dunn检验显示，BMI（OSA vs 无SAS，p = 0.012）、LVEF（CSA vs OSA，p = 0.006）和PASP（CSA vs OSA，p = 0.018）存在显著的成对差异，但TAPSE无显著差异。
结论： SAS在稳定期HF中高度流行，以OSA为主。在这项探索性、未调整的研究中，不同表型的临床和超声心动图特征存在差异，CSA中观察到最低的LVEF和TAPSE以及最高的PASP。BMI、LVEF和PASP存在显著的成对差异。
英文摘要
BACKGROUND AND OBJECTIVE: Sleep apnea syndrome (SAS) is a frequent comorbidity in patients with heart failure (HF), contributing to disease progression and poorer outcomes, yet remains largely underdiagnosed. This study aimed to characterize the clinical, polygraphic, and echocardiographic features of sleep apnea phenotypes in patients with stable HF and to explore differences in cardiac structure and function across phenotypes.
METHODS: We conducted a cross-sectional study including 80 patients with stable HF. All patients underwent transthoracic echocardiography and overnight respiratory polygraphy. SAS was defined by an apnea-hypopnea index (AHI) ≥5 events/h. Selected descriptive and effect estimates were accompanied by unadjusted 95% confidence intervals (CIs).
RESULTS: SAS was diagnosed in 66 patients (82.5%), including 47 (58.7%) with obstructive sleep apnea (OSA) and 19 (23.7%) with central sleep apnea (CSA). Median AHI was 11.8 [6.5-28.3] events/h, and severe SAS was observed in 18 patients (27.3%). Median BMI differed significantly across the no-SAS, OSA, and CSA groups: 25.4 (22.3-27.6), 29.3 (27.3-31.3), and 28.0 (26.8-30.7) kg/m2, respectively (p = 0.015). Overall comparisons were significant for HFrEF (p = 0.008) and HFpEF (p = 0.036), with the highest proportions observed in the CSA and no-SAS groups, respectively. Mean LVEF was 43.5% (35.2-51.8), 45.4% (41.1-49.8), and 32.7% (26.7-38.7) (p = 0.009); median TAPSE was 22.0 (17.0-24.0), 19.0 (16.0-21.0), and 18.5 (17.5-20.0) mm (p = 0.044); and median PASP was 38.0 (36.0-45.0), 35.0 (32.0-41.0), and 56.0 (42.0-72.0) mmHg (p = 0.020). Bonferroni-adjusted Dunn tests showed significant pairwise differences for BMI (OSA vs no-SAS, p = 0.012), LVEF (CSA vs OSA, p = 0.006), and PASP (CSA vs OSA, p = 0.018), but not TAPSE.
CONCLUSION: SAS was highly prevalent in stable HF, with OSA predominating. In this exploratory, unadjusted study, clinical and echocardiographic characteristics differed across phenotypes, with the lowest LVEF and TAPSE and highest PASP observed in CSA. Significant pairwise differences were found for BMI, LVEF, and PASP.