Europace：ICD植入患者常合并睡眠呼吸障碍

睡眠呼吸障碍在心衰患者中十分常见，心衰患者阻塞性呼吸暂停的发生率与健康人群相当，而中枢性呼吸暂停的发生率显著高于健康人群，据统计约50%的心衰患者合并中枢性睡眠呼吸暂停，据既往的研究资料，无论是阻塞性呼吸暂停还是中枢性呼吸暂停均明显增加心衰患者的死亡率及再入院率，也明显增加房颤及室颤的发生率，可能与交感神经的兴奋性增加有关。
植入式心脏转复除颤器（Implantable cardioverter-defibrillators，ICD）是目前用于预防室速或室颤导致的心脏性猝死的首选治疗措施，多数植入ICD的患者均为缺血性或非缺血性心脏病导致的心衰患者，既往的研究资料表明，睡眠呼吸障碍可能是预测室速、室颤导致ICD放电次数增多的预测因子，但其是否可增加ICD患者的死亡率目前还不清楚。据此，Grimm W等进行了一项临床研究，旨在探讨睡眠呼吸障碍对ICD植入患者预后的影响。
该研究共入选204例ICD植入患者，所有患者既往无睡眠呼吸障碍及日间嗜睡病史，所有患者均进行睡眠监测，以呼吸暂停-低通气每小时发作5次或以上为诊断睡眠呼吸障碍的依据。结果显示34%的患者无睡眠呼吸障碍，51%的患者存在中枢性睡眠呼吸暂停，14%的患者存在阻塞性睡眠呼吸暂停。平均随访38月，39%的患者因室速、室颤发作而接受了ICD的正确放电，26%的患者死亡。多因素Cox相关分析提示，左室舒张末期内径、ICD用于二级预防、使用过利尿剂、未使用醛固酮拮抗剂是室速室颤发作的独立预测因子，而睡眠呼吸障碍不是。多因素Cox回归分析提示，左室射血分数与年龄是死亡率增加的独立预测因子，但睡眠呼吸障碍不是。
通过该项研究可得出以下结论：ICD植入的患者睡眠呼吸障碍十分常见，而睡眠呼吸暂停并不是ICD植入患者室速、室颤发作的独立危险因素，也不是死亡率增加的独立危险因素。

与呼吸障碍相关的拓展阅读：

• Circulation：睡眠呼吸障碍增加慢性心衰患者致死性室性心律失常的发生 更多信息请点击：有关呼吸障碍更多资讯

Sleep-disordered breathing in patients withimplantable cardioverter-defibrillator
Aims
To assess the prognostic significance of screening for sleep-disordered breathing in patients with implantable cardioverter-defibrillator (ICD) with regard to appropriate ICD therapy and total mortality.
Methods and results
Overnight sleep studies were performed in 204 ICD recipients not known to have sleep apnoea and with no history of daytime sleepiness. Sleep-disordered breathing was diagnosed in the presence of an apnoea–hypopnea index of five or more events per hour. Seventy patients (34%) had no sleep apnoea, 105 patients (51%) had central sleep apnoea, and 29 patients (14%) had obstructive sleep apnoea. During 38 ± 26 months follow-up, 80 patients (39%) received appropriate ICD therapy for ventricular tachycardia (VT) or ventricular fibrillation (VF), and 54 patients (26%) died. On multivariate Cox regression analysis, age, left ventricular (LV) end-diastolic diameter, secondary prevention ICD indication, use of diuretics, and absence of aldosterone antagonist therapy but not sleep apnoea were associatedwith appropriate ICD therapy for VT or VF. In addition, multivariate Cox analysis identified age and LV ejection fraction but not sleep apnoea as predictors of total mortality.
Conclusion
Undiagnosed sleep-disordered breathing is common inICD recipients. The presence and severity of previously unknown sleep apnoea in ICD recipients, however, does not appear to be an independent predictor of appropriate ICD therapy or morality during follow-up.