OBJECTIVE:Sleep-disordered breathing (SDB) is common in congestive heart failure. While isolated diastolic heart failure (DHF) accounts for up to a third of all cases of congestive heart failure, the prevalence of SDB in DHF is unknown. We aim to determine the prevalence and characteristics of SDB in a group of patients with symptomatic DHF.

METHODS:Twenty subjects with symptomatic DHF (New York Heart Association class II or III) and isolated diastolic dysfunction on echocardiography were assessed with lung function tests, modified sleep and health questionnaire, and overnight polysomnography. Significant SDB was defined as an apnea/hypopnea index (AHI) > 10.

RESULTS:Thirteen female and seven male subjects (mean age, 65+/-6.0 years; mean body mass index (BMI), 28+/-3.2) were evaluated, of whom 17 (85%) had a diagnosis of hypertension. Overall sleep quality was poor, with fragmentation and frequent arousals associated with respiratory events. Fifty-five percent of the patients had significant SDB, mainly obstructive apneas. BMI and the prevalence of hypertension were similar in patients with and without SDB. The deceleration time, an index of diastolic dysfunction, was more prolonged in the group with SDB (236+/-40 ms vs 282+/-31 ms; p<0.05). As a group, a lower minimum percentage arterial oxygen saturation during sleep, but not the AHI was associated with more severe degree of diastolic dysfunction on echocardiogram, including a lower ratio between the early peak transmittal flow velocity and the late peak atrial systolic velocity (rho=0.57; p<0.05) and a prolonged isovolumic relaxation time (rho=-0.54; p<0.05).

CONCLUSIONS:SDB is common in patients with DHF. Patients with DHF and SDB may be associated with worse diastolic dysfunction than those without SDB, although a causal relationship remains to be established.

译文

目的 : 睡眠呼吸障碍 (SDB) 在充血性心力衰竭中很常见。虽然孤立的舒张性心力衰竭 (DHF) 占所有充血性心力衰竭病例的三分之一,但DHF中SDB的患病率尚不清楚。我们旨在确定一组有症状的DHF患者中SDB的患病率和特征。
方法 : 通过肺功能测试,改良的睡眠和健康问卷以及过夜多导睡眠图评估了20名有症状的DHF (纽约心脏协会II或III级) 和超声心动图孤立的舒张功能障碍的受试者。显著的SDB定义为呼吸暂停/呼吸不足指数 (AHI)> 10。
结果 : 13名女性和7名男性受试者 (平均年龄65 +/-6.0岁; 平均体重指数 (BMI),评估了28/-3.2),其中17 (85%) 诊断为高血压。总体睡眠质量较差,与呼吸事件相关的碎片和频繁唤醒。5% 的患者有明显的SDB,主要是阻塞性呼吸暂停。有或没有SDB的患者的BMI和高血压患病率相似。SDB组的减速时间 (舒张功能障碍的指标) 更长 (236/-40 ms vs 282/-31 ms; p<0.05)。作为一组,睡眠期间较低的最低动脉血氧饱和度百分比,但AHI与超声心动图更严重的舒张功能障碍相关,包括早期传播峰值流速与晚期心房收缩峰值流速之间的比率较低 (rho = 0.57; p<0.05) 和延长的等容松弛时间 (rho =-0.54; p<0.05)。
结论 :SDB在DHF患者中很常见。DHF和SDB的患者可能比没有SDB的患者舒张功能障碍更差,尽管因果关系尚待确定。

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