Abstract：
Background Central apneas (CA) are a frequent comorbidity in patients with heart failure (HF) and are associated with worse prognosis. The clinical and prognostic relevance of CA in each sex is unknown. Methods and Results Consecutive outpatients with HF with either reduced or mildly reduced left ventricular ejection fraction (n=550, age 65±12 years, left ventricular ejection fraction 32%±9%, 21% women) underwent a 24-hour ambulatory polygraphy to evaluate CA burden and were followed up for the composite end point of cardiac death, appropriate implantable cardioverter-defibrillator shock, or first HF hospitalization. Compared with men, women were younger, had higher left ventricular ejection fraction, had lower prevalence of ischemic etiology and of atrial fibrillation, and showed lower apnea-hypopnea index (expressed as median [interquartile range]) at daytime (3 [0-9] versus 10 [3-20] events/hour) and nighttime (10 [3-21] versus 23 [11-36] events/hour) (all P<0.001), despite similar neurohormonal activation and HF therapy. Increased chemoreflex sensitivity to either hypoxia or hypercapnia (evaluated in 356 patients, 65%, by a rebreathing test) was less frequent in women (P<0.001), but chemoreflex sensitivity to hypercapnia was a predictor of apnea-hypopnea index in both sexes. At adjusted survival analysis, daytime apnea-hypopnea index ≥15 events/hour (hazard ratio [HR], 2.70; 95% CI, 1.06-7.34; P=0.037), nighttime apnea-hypopnea index ≥15 events/hour (HR, 2.84; 95% CI, 1.28-6.32; P=0.010), and nighttime CA index ≥10 events/hour (HR, 5.01; 95% CI, 1.88-13.4; P=0.001) were independent predictors of the primary end point in women but not in men (all P>0.05), also after matching women and men for possible confounders. Conclusions In chronic HF, CA are associated with a greater risk of adverse events in women than in men.
摘要：
背景中枢神经性呼吸暂停（CA）是心力衰竭（HF）患者的常见合并症，并与预后较差有关。CA在每个性别中的临床和预后相关性尚不清楚。方法和结果连续门诊患者左心室射血分数降低或轻度降低（n=550，年龄65±12岁，左心室射血分数32%±9%,21％的女性）进行了24小时动态测谎仪以评估CA负担，并对心脏死亡的复合终点进行了随访，适当的植入式心脏复律除颤器休克,或首次HF住院。和男人相比,女人更年轻，左心室射血分数较高，缺血性病因和心房颤动的患病率较低，并且在白天（3[0-9]对10[3-20]事件/小时）和夜间（10[3-21]对23[11-36]事件/小时）显示较低的呼吸暂停低通气指数（以中位数[四分位距]表示）（所有P<0.001），尽管类似的神经激素激活和HF治疗。对缺氧或高碳酸血症的化学反射敏感性增加（在356名患者中进行了评估，65%,通过再呼吸测试）在女性中频率较低（P<0.001），但对高碳酸血症的化学反射敏感性是男女呼吸暂停低通气指数的预测指标.在调整后的生存分析中，日间呼吸暂停低通气指数≥15次/小时(风险比[HR]，2.70；95%CI，1.06-7.34；P=0.037），夜间呼吸暂停低通气指数≥15次/小时(HR，2.84；95%CI，1.28-6.32；P=0.010），和夜间CA指数≥10个事件/小时(HR，5.01;95%CI,1.88-13.4;P=0.001)是女性主要终点的独立预测因子,而不是男性(均P>0.05),在匹配男女可能的混淆因素之后。结论慢性HF,女性与男性相比，CA与更大的不良事件风险相关。
