自适应支持通气(ASV)是针对中枢性睡眠呼吸暂停(CSA)的建议治疗选择。尽管ASV的有效性尚不清楚,一些研究报道了在射血分数保留的心力衰竭(HfpEF)患者中使用ASV的良好结果.为了说明对无法识别症状的老年人进行怀疑和诊断睡眠呼吸紊乱(SDB)的重要性,我们讨论了一个病例,其中ASV对CSA和HfpEF患者有效,基于动态心电图(ECG)的变化。
2021年4月19日,一名82岁的男子因呕吐来到我们医院。入院前大约10年,他被诊断患有1型糖尿病,最近由于认知功能障碍,他的妻子需要全力支持他的日常活动。入院前两天,由于血糖水平过高,他的妻子无法服用胰岛素,在患者的血糖仪上显示为“高”;因此,我们诊断患者患有糖尿病酮症酸中毒。恢复后,我们启动了强化胰岛素治疗以控制血糖.然而,患者表现出白天过度嗜睡,尽管没有低血糖,但在他的心电图监护仪上观察到许多室性早搏.当我们怀疑睡眠呼吸紊乱(SDB)时,我们进行了便携式多导睡眠图(PSG),这揭示了CSA。由于呼吸暂停低通气指数为37.6,PSG显示为中枢型呼吸暂停和低通气。此外,病人白天嗜睡;因此,我们诊断他患有CSA.我们进行了ASV,并使用便携式PSG和HolterECG观察了其效果。他的呼吸暂停和呼吸不足发作得到了解决,通过动态心电图证实明显改善。
医务人员应仔细监测成人SDB的体征或危险因素,以防止严重并发症。未来ASV的研究应集中于老年心律失常患者,由于CSA的患病率在该人群中可能被低估,并且确定了ASV在HfpEF患者中的有效性,尤其是老年人。
Adaptive support ventilation (ASV) is a proposed treatment option for central sleep apnea (CSA). Although the effectiveness of ASV remains unclear, some studies have reported promising results regarding the use of ASV in patients with heart failure with preserved ejection fraction (HfpEF). To illustrate the importance of suspecting and diagnosing sleep-disordered breathing (SDB) in older adults unable to recognize symptoms, we discuss a
case in which ASV was effective in a patient with CSA and HfpEF, based on changes in the Holter electrocardiogram (ECG).
An 82-year-old man presented to our hospital with vomiting on April 19, 2021. Approximately 10 years before admission, he was diagnosed with type 1 diabetes mellitus and recently required full support from his wife for daily activities due to cognitive dysfunction. Two days before admission, his wife was unable to administer insulin due to excessively high glucose levels, which were displayed as \"high\" on the patient\'s glucose meter; therefore, we diagnosed the patient with diabetic ketoacidosis. After recovery, we initiated intensive insulin therapy for glycemic control. However, the patient exhibited excessive daytime sleepiness, and numerous premature ventricular contractions were observed on his ECG monitor despite the absence of hypoglycemia. As we suspected sleep-disordered breathing (SDB), we performed portable polysomnography (PSG), which revealed CSA. PSG revealed a central type of apnea and hypopnea due to an apnea-hypopnea index of 37.6, which was > 5. Moreover, the patient had daytime sleepiness; thus, we diagnosed him with CSA. We performed ASV and observed its effect using portable PSG and Holter ECG. His episodes of apnea and hypopnea were resolved, and an apparent improvement was confirmed through Holter ECG.
Medical staff should carefully monitor adult adults for signs of or risk factors for SDB to prevent serious complications. Future studies on ASV should focus on older patients with arrhythmia, as the prevalence of CSA may be underreported in this population and determine the effectiveness of ASV in patients with HfpEF, especially in older adults.