Relationship between sleep apnoea and mortality in patients with ischaemic heart failure

被引:88
作者
Yumino, D. [2 ,3 ]
Wang, H. [2 ,3 ]
Floras, J. S. [4 ]
Newton, G. E. [4 ]
Mak, S. [4 ]
Ruttanaumpawan, P. [2 ,3 ]
Parker, J. D. [4 ]
Bradley, T. D. [1 ,2 ,3 ]
机构
[1] Univ Toronto, Toronto Gen Hosp, Univ Hlth Network, Toronto, ON M5G 2C4, Canada
[2] Univ Toronto, Toronto Rehabil Inst, Sleep Res Lab, Toronto, ON M5G 2C4, Canada
[3] Univ Toronto, Ctr Sleep Med & Circadian Biol, Toronto, ON M5G 2C4, Canada
[4] Univ Toronto, Dept Med, Mt Sinai Hosp, Toronto, ON M5G 2C4, Canada
关键词
CHEYNE-STOKES RESPIRATION; POSITIVE AIRWAY PRESSURE; LONG-TERM SURVIVAL; VENTRICULAR DYSFUNCTION; SYMPATHETIC ACTIVITY; CARDIOMYOPATHY; PREVALENCE; ETIOLOGY; OUTCOMES; DISEASE;
D O I
10.1136/hrt.2008.160952
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: To determine whether the influence of sleep apnoea (SA) on the risk of death differs in patients with ischaemic and in those with non-ischaemic heart failure (HF). Design: Prospective observational study. Patients: Consecutive patients with HF with left ventricular ejection fraction (<= 45% newly referred to the HF clinic between 1 September 1997 and 1 December 2004. Main outcome measures: Patients underwent sleep studies and were divided into those with moderate to severe SA (apnoea-hypopnoea index >= 15/h of sleep) and those with mild to no SA (apnoea-hypopnoea index <15/h of sleep). They were followed up for a mean of 32 months to determine all-cause mortality rate. Results: Of 193 patients, 34 (18%) died. In the ischaemic group, mortality risk adjusted for confounding factors was significantly higher in those with SA than in those without it (18.9 vs 4.6 deaths/100 patient-years, hazards ratio (HR) = 3.03, 95% CI 1.04 to 8.84, p = 0.043). In contrast, in the non-ischaemic HF group, there was no difference in adjusted mortality risk between those with, and those without, SA (3.9 vs 4.0 deaths/100 patient-years, p = 0.929). Conclusions: In patients with HF, the presence of SA is independently associated with an increased risk of death in those with ischaemic, but not in those with non-ischaemic, aetiology. These findings suggest that patients with ischaemic cardiomyopathy are more susceptible to the adverse haemodynamic, autonomic and inflammatory consequences of SA than are those with non-ischaemic cardiomyopathy.
引用
收藏
页码:819 / 824
页数:6
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