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Abstract：
Background: Although central apneas (CA) and obstructive apneas (OA) are highly prevalent in heart failure (HF), a comparison of apnea prevalence, predictors and clinical correlates in the whole HF spectrum, including HF with reduced ejection fraction (HFrEF), mid-range EF (HFmrEF) and preserved EF (HFpEF) has never been carried out so far. Materials and methods: 700 HF patients were prospectively enrolled and then divided according to left ventricular EF (408 HFrEF, 117 HFmrEF, 175 HFpEF). All patients underwent a thorough evaluation including: 2D echocardiography; 24-h Holter-ECG monitoring; cardiopulmonary exercise testing; neuro-hormonal assessment and 24-h cardiorespiratory monitoring. Results: In the whole population, prevalence of normal breathing (NB), CA and OA at daytime was 40, 51, and 9%, respectively, while at nighttime 15, 55, and 30%, respectively. When stratified according to left ventricular EF, CA prevalence decreased (daytime: 57 vs. 43 vs. 42%, p = 0.001; nighttime: 66 vs. 48 vs. 34%, p < 0.0001) from HFrEF to HFmrEF and HFpEF, while OA prevalence increased (daytime: 5 vs. 8 vs. 18%, p < 0.0001; nighttime 20 vs. 29 vs. 53%, p < 0.0001). In HFrEF, male gender and body mass index (BMI) were independent predictors of both CA and OA at nighttime, while age, New York Heart Association functional class and diastolic dysfunction of daytime CA. In HFmrEF and HFpEF male gender and systolic pulmonary artery pressure were independent predictors of CA at daytime, while hypertension predicted nighttime OA in HFpEF patients; no predictor of nighttime CA was identified. When compared to patients with NB, those with CA had higher neuro-hormonal activation in all HF subgroups. Moreover, in the HFrEF subgroup, patients with CA were older, more comorbid and with greater hemodynamic impairment while, in the HFmrEF and HFpEF subgroups, they had higher left atrial volumes and more severe diastolic dysfunction, respectively. When compared to patients with NB, those with OA were older and more comorbid independently from background EF. Conclusions: Across the whole spectrum of HF, CA prevalence increases and OA decreases as left ventricular systolic dysfunction progresses. Different predictors and specific clinical characteristics might help to identify patients at risk of developing CA or OA in different HF phenotypes.
摘要：
背景：虽然中枢性呼吸暂停（CA）和阻塞性呼吸暂停（OA）在心力衰竭（HF）中非常普遍，呼吸暂停患病率的比较，整个HF频谱中的预测因子和临床相关性，包括射血分数降低的HF（HFrEF），迄今为止，从未进行过中程EF（HFmrEF）和保留EF（HFpEF）。材料和方法：前瞻性纳入700例HF患者，然后根据左心室EF（408HFrEF，117HFmrEF，175HFpEF）。所有患者均接受了全面评估，包括：2D超声心动图；24小时动态心电图监测；心肺运动测试；神经激素评估和24小时心肺监测。结果:在整个人群中,正常呼吸（NB）的患病率，白天CA和OA分别为40％、51％和9％，分别,而在夜间15、55和30%，分别。当根据左心室EF分层时，CA患病率下降（白天：57vs.43vs.42%,p=0.001；夜间：66vs.48vs.34%,p<0.0001)从HFrEF到HFmrEF和HFpEF，而OA患病率增加(白天：5vs.8vs.18%,p<0.0001;夜间20vs.29vs.53%,p<0.0001)。在HFrEF,男性性别和体重指数（BMI）是夜间CA和OA的独立预测因子，而年龄,纽约心脏协会功能分类和白天CA的舒张功能障碍。在HFmrEF和HFpEF中，男性和收缩压是白天CA的独立预测因子，而高血压可预测HFpEF患者的夜间OA；没有确定夜间CA的预测因子。与NB患者相比，在所有HF亚组中,CA患者的神经激素激活均较高.此外，在HFrEF亚组中，CA患者年龄较大，更合并症，血液动力学损害更大，而，在HFmrEF和HFpEF亚组中，他们有更高的左心房容积和更严重的舒张功能障碍，分别。与NB患者相比，OA患者年龄较大,合并疾病较多,与EF背景无关.结论：在整个HF频谱中，随着左心室收缩功能障碍的进展，CA患病率增加，OA减少。不同的预测因子和特定的临床特征可能有助于确定在不同HF表型中存在发生CA或OA风险的患者。
