目的分析扩张性心肌病(DCM)合并重度OSAHS的患者的临床特征,探讨持续气道正压通气(CPAP)的疗效。
方法报道1例表现为DCM致肺动脉高压的重度OSAHS患者,结合文献进行分析。以"阻塞性睡眠呼吸暂停"或"OSA"或"OSAHS"和"扩张性心肌病"或"扩心病"或"DCM"为关键词,通过万方数据和中国知网数据库对1990年1月至2016年5月的中文文献进行检索;以"Obstructive sleep apnea"或"OSA"或"OSAHS"和"dilated cardiomyopathy"或"DCM"为关键词,通过PubMed数据库检索2016年5月前的英文文献。
结果患者男,54岁,因"活动后气促1年,加重2周"于2015年10月19日入院,经降低心脏负荷、营养心肌、改善代谢、增加心肌收缩力及抗凝等常规治疗,症状无明显好转,行多导睡眠呼吸监测(PSG)确诊为重度OSAHS,联合CPAP辅助通气后症状好转出院。半年后随访,B超检查结果显示左心房及左心室腔有所缩小,气促等症状未复发。共检索到中文文献39篇,英文文献22篇,阅读排除中枢性睡眠呼吸暂停综合征相关报道,最终保留OSAHS和DCM相关报道10篇,其中中文文献6篇,综述、专家笔谈及论著各1篇,病例报告3篇;英文文献4篇,均为论著。10篇文献共报道74例OSAHS合并DCM病例,其中男46例,女11例,年龄29~69岁,平均(50±10)岁,17例患者采用了CPAP治疗,治疗后相关临床症状和指标均有所改善。
结论DCM患者合并OSAHS,若伴肥胖、睡眠打鼾、白天嗜睡及晨起口干等相关症状,应考虑合并OSAHS的可能,经PSG确诊给予CPAP治疗可能改善患者相关临床症状和预后。
ObjectiveTo study the relationship between dilated cardiomyopathy and obstructive sleep apnea-hypopnea syndrome (OSAHS) and to evaluate the curative effects of continuous positive airway pressure (CPAP) in OSAHS complicated with dilated cardiomyopathy.
MethodsWe reported one case with the symptom of exertional dyspnea for 1 year and aggravating for 1 month. The patient finally was diagnosed with severe OSAHS complicated with dilated cardiomyopathy leading to pulmonary hypertension. A systematic literature review was performed for similar published cases in Pubmed, Wanfang and CNKI database, using the keywords (obstructive sleep apnea) OR(OSA) OR(OSAHS) AND(dilated cardiomyopathy OR DCM)from January 1990 to May 2016.
ResultsOur patient had no significant improvement after receiving initial treatments, including reducing cardiac preload, improving myocardial metabolism, increasing myocardial contractility, and anticoagulants. After the patient was diagnosed as having severe OSAHS by polysomnography(PSG) and treated with CPAP, his symptoms improved remarkably. The enlarged heart became smaller and the patient had no repeated dyspnea at follow-up examination. By literature review, we found 4 English original articles and 6 Chinese articles (1 review article, 1 expert note, 1 original article and 3 case reports) on OSAHS complicated by DCM.Four Chinese and 1 English articles reported that the symptoms and parameters of OSAHS with DCM was improved remarkably after treatment with CPAP.
ConclusionFor patients with dilated cardiomyopathy which fails to conventional therapy, especially those accompanied by obesity, snoring, daytime sleepiness, morning dry mouth and other related symptoms, PSG should be carried out. Early CPAP therapy could improve symptoms and prognosis of OSAHS associated with DCM.
陈日垦,洪城,周圆明,等. 重度睡眠呼吸暂停低通气综合征表现为扩张性心肌病致肺动脉高压一例并文献复习[J]. 中华结核和呼吸杂志,2017,40(1):46-51.
DOI:10.3760/cma.j.issn.1001-0939.2017.01.010版权归中华医学会所有。
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