南方医科大学学报

南方医科大学学报 ›› 2021, Vol. 41 ›› Issue (9): 1415-1419.doi: 10.12122/j.issn.1673-4254.2021.09.18

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不同射血分数心力衰竭患者的客观睡眠特征及睡眠呼吸暂停的危险因素

韩彬彬，王闪闪，李国华，王学惠，陈志刚，赵国安，陈莹恩，李 猛，李 燕，张 敏，艾思志   

  1. 新乡医学院第一附属医院心内科，心脏中心，河南 卫辉 453100；伦敦国王学院英国心脏基金会卓越研究中心，伦敦 SE59NU
  • 出版日期:2021-09-20 发布日期:2021-09-30

Objective sleep characteristics and risk factors for sleep apnea in heart failure patients with different left ventricular ejection fraction

HAN Binbin, WANG Shanshan, LI Guohua, WANG Xuehui, CHEN Zhigang, ZHAO Guoan, CHEN Yingen, LI Meng, LI Yan, ZHANG Min, AI Sizhi   

  1. Department of Cardiology, Heart Center, First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China; King's College London British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine & Sciences, London SE59NU, UK
  • Online:2021-09-20 Published:2021-09-30

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摘要： 目的 研究不同射血分数心力衰竭患者的客观睡眠特征并探讨影响睡眠呼吸暂停的相关独立危险因素。方法 本研究共纳入2019年4月~2020年10月期间在新乡医学院第一附属医院心血管内科住院治疗的慢性心力衰竭患者共107例。根据心脏 超声左心室射血分数将其分为射血分数减少的心力衰竭患者（HFrEF组，LVEF<40%，35例）、射血分数中间值的心力衰竭患者（HFmrEF组，40%≤LVEF<50%，21例）及射血分数保留的心力衰竭患者（HFpEF组，LVEF≥50%，51例）。收集3组患者入院期间的基线人口学资料，并进行夜间多导睡眠监测，评估其客观睡眠特征，采用Spearman相关分析及多分类Logistic回归模型分析影响心衰患者客观睡眠特征的风险因素。结果 HFpEF组患者的非快速眼动睡眠1期占比及呼吸暂停低通气指数（AHI）水平显著低于HFrEF组患者，且较少表现为中枢性睡眠呼吸暂停（CSA）（P<0.05）。而HFmrEF组患者与其他两组的基线资料及睡眠结构参数方面相比无统计学意义（P>0.05）。Spearman相关分析表明，性别、利尿剂使用、左室射血分数（LVEF）、NT-proBNP及总胆固醇水平与心衰患者的AHI水平及呼吸事件相关（P<0.05）。多分类Logistic回归分析显示年龄、饮酒及LVEF是心衰患者睡眠呼吸暂停发生及严重程度的独立危险因素。结论 3组心衰患者均存在客观睡眠结构的紊乱，以睡眠呼吸暂停为主，但与HFrEF组患者相比，HFpEF组患者发生睡眠呼吸暂停包含CSA的比例较低。高龄、饮酒及低LVEF是心衰患者睡眠呼吸暂停发生及严重程度的独立危险因素。

关键词: 左心室射血分数；心力衰竭；睡眠呼吸暂停；呼吸暂停低通气指数

Abstract: Objective To investigate the objective sleep characteristics and the independent risk factors for sleep apnea in heart failure (HF) patients with different left ventricular ejection fractions (LVEF). Methods A total of 107 patients with chronic HF hospitalized in the Department of Cardiology of our hospital from April, 2019 to October, 2020 were included in this study. According to the LVEF measured by echocardiography, the patients were divided into reduced ejection fraction (HFrEF) group (n=35), mid-range ejection fraction (HFmrEF) group (n=21), and preserved ejection fraction (HFpEF) group (n=51). The baseline demographic and clinical characteristics of the patients were recorded. To assess the objective sleep characteristics, whole night polysomnography was scheduled for all the patients. Spearman correlation and multinomial logistic regression analyses were used to explore the factors affecting objective sleep characteristics. Results The patients in HFpEF group had significantly lower proportion of non-rapid eye movement sleep stage 1, apnea hypopnea index (AHI), and central sleep apnea (CSA) than those in HFrEF group (all P<0.05). The baseline demographic data or sleep structures in HFmrEF group did not differ significantly from those in the other two groups. Spearman correlation analysis revealed significant correlations of the male sex, diuretics use, NT-proBNP, LVEF, and total cholesterol levels with the severity of AHI (all P<0.05). After adjusting for potential confounders, multiple logistics regression analysis showed that age, drinking, and LVEF levels were independently associated with the severity of AHI (all P<0.05). Conclusion Abnormal objective sleep architectures occur in all HF patients, manifested mainly by sleep apnea. The incidences of sleep apnea and CSA are lower in patients with HFpEF than in those with HFrEF. Age, drinking, and LVEF levels are independent risk factors for the occurrence and severity of sleep apnea.

Key words: left ventricular ejection fraction; heart failure; sleep apnea; apnea hypopnea index