射血分数保留的打鼾患者中枢性睡眠呼吸暂停与左心房扩大的关系。

IF 3 2区医学 Q2 CLINICAL NEUROLOGY

Nature and Science of Sleep Pub Date : 2025-03-13 eCollection Date: 2025-01-01 DOI:10.2147/NSS.S500562

Xinghe Sun, Yang Wang, Chaoqun Wu, Yinghui Gao

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引用次数: 0

摘要

背景：中枢性睡眠呼吸暂停（CSA）显著影响心血管健康，与射血分数（EF）降低的心力衰竭患者左房扩大、心房颤动和心功能受损有关。然而，对于保留EF的个体，CSA与左房大小之间的关系仍未得到充分探讨。目的：探讨保留心房颤动的鼾症患者左心房大小与CSA的关系。方法：对341例心内科连续打鼾患者进行了观察性研究，这些患者接受了夜间多导睡眠图（PSG）和超声心动图检查。EF低于50%、肺部疾病或神经肌肉疾病的患者被排除在外。CSA被定义为中心呼吸暂停低通气指数（CAHI）每小时5次或更多事件。采用治疗加权逆概率（IPTW）和logistic回归模型评价CSA与左房大小的关系。结果：341例患者中，33例（9.68%）确诊为CSA，男性患病率（10.0%）高于女性（8.91%）。左房增大172例（50.44%），以女性为主（71.29%）。CSA患者呼吸暂停低通气指数（AHI）（49.2/h vs 26.75/h, p < 0.01）和氧去饱和指数（ODI）（44.9 vs 22.85, p < 0.01）显著升高，血氧饱和度< 90%的睡眠时间增多（6.6% vs 2.35%, p = 0.01）。超声心动图评价显示，CSA患者左心房前后径较大（LAD-ap 42.73±13.01 mm vs 38.15±4.58 mm, p < 0.01）， LAE发生率较高（69.7% vs 48.38%, p = 0.02）。患有CSA的男性发生LAE的风险显著增加(OR: 4.54；95% CI: 1.45-14.2)，在有吸烟和血脂异常等危险因素的人群中存在显著相关性。结论：本研究强调了CSA与保留EF的男性左房扩大之间的显著关联，表明CSA可能有助于心房重构，即使没有降低射血分数。

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Association Between Central Sleep Apnea and Left Atrial Enlargement in Snoring Patients with Preserved Ejection Fraction.

Background: Central sleep apnea (CSA) significantly impacts cardiovascular health, linking it to left atrial enlargement, atrial fibrillation, and impaired cardiac function in heart failure patients with reduced ejection fraction (EF). However, the relationship between CSA and left atrial size in individuals with preserved EF remains underexplored.

Objective: This study aims to examine the relationship between left atrial size and CSA in snoring patients with preserved EF.

Methods: An observational study was conducted involving 341 consecutive snoring patients from a cardiology department who underwent overnight polysomnography (PSG) and echocardiography. Patients with EF below 50%, pulmonary diseases or neuromuscular disorders were excluded. CSA was defined as a central apnea-hypopnea index (CAHI) of five or more events per hour. Inverse probability of treatment weighting (IPTW) and logistic regression models were employed to evaluate the relationship between CSA and left atrial size.

Results: Among the 341 patients, 33 (9.68%) were diagnosed with CSA, with a higher prevalence in males (10.0%) than females (8.91%). Left atrial enlargement (LAE) was observed in 172 patients (50.44%), predominantly in females (71.29%). CSA patients demonstrated significantly higher apnea-hypopnea index (AHI) (49.2/h vs 26.75/h, p < 0.01) and oxygen desaturation index (ODI) (44.9 vs 22.85, p < 0.01), alongside more sleep time with oxygen saturation < 90% (6.6% vs 2.35%, p = 0.01). Echocardiographic evaluations revealed that CSA patients had a greater left atrial anterior-posterior diameter(LAD-ap 42.73 ± 13.01 mm vs 38.15 ± 4.58 mm, p < 0.01) and a higher frequency of LAE (69.7% vs 48.38%, p = 0.02). Males with CSA had a significantly increased risk of LAE (OR: 4.54; 95% CI: 1.45-14.2) after IPTW adjustment, with significant associations persisting among those with risk factors such as smoking and dyslipidemia.

Conclusion: This study highlights a significant association between CSA and left atrial enlargement in males with preserved EF, suggesting that CSA may contribute to atrial remodeling even without reduced ejection fraction.

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来源期刊

Nature and Science of Sleep Neuroscience-Behavioral Neuroscience

CiteScore

5.70

自引率

5.90%

发文量

245

审稿时长

16 weeks

期刊介绍： Nature and Science of Sleep is an international, peer-reviewed, open access journal covering all aspects of sleep science and sleep medicine, including the neurophysiology and functions of sleep, the genetics of sleep, sleep and society, biological rhythms, dreaming, sleep disorders and therapy, and strategies to optimize healthy sleep. Specific topics covered in the journal include: The functions of sleep in humans and other animals Physiological and neurophysiological changes with sleep The genetics of sleep and sleep differences The neurotransmitters, receptors and pathways involved in controlling both sleep and wakefulness Behavioral and pharmacological interventions aimed at improving sleep, and improving wakefulness Sleep changes with development and with age Sleep and reproduction (e.g., changes across the menstrual cycle, with pregnancy and menopause) The science and nature of dreams Sleep disorders Impact of sleep and sleep disorders on health, daytime function and quality of life Sleep problems secondary to clinical disorders Interaction of society with sleep (e.g., consequences of shift work, occupational health, public health) The microbiome and sleep Chronotherapy Impact of circadian rhythms on sleep, physiology, cognition and health Mechanisms controlling circadian rhythms, centrally and peripherally Impact of circadian rhythm disruptions (including night shift work, jet lag and social jet lag) on sleep, physiology, cognition and health Behavioral and pharmacological interventions aimed at reducing adverse effects of circadian-related sleep disruption Assessment of technologies and biomarkers for measuring sleep and/or circadian rhythms Epigenetic markers of sleep or circadian disruption.