论著
ENGLISH ABSTRACT
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
陈日垦
洪城
周圆明
邝爱玲
张贻涛
卿思敏
刘春丽
张挪富
作者及单位信息
·
DOI: 10.3760/cma.j.issn.1001-0939.2017.01.010
Severe obstructive sleep apnea-hypopnea syndrome with dilated cardiomyopathy leading to pulmonary hypertension: case report and literature review
Chen Riken
Hong Cheng
Zhou Yuanming
Kuang Ailing
Zhang Yitao
Qing Simin
Liu Chunli
Zhang Nuofu
Authors Info & Affiliations
Chen Riken
State Key Laboratory of Respiratory Diseases, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Diseases, National Research Center of Clinical Medicine, Guangzhou 510120, China
Hong Cheng
Zhou Yuanming
Kuang Ailing
Zhang Yitao
Qing Simin
Liu Chunli
Zhang Nuofu
·
DOI: 10.3760/cma.j.issn.1001-0939.2017.01.010
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摘要

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。

睡眠呼吸暂停,阻塞性;心肌病,扩张型;高血压,肺性;持续气道正压通气
ABSTRACT

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.

Sleep apnea syndrome, obstructive;Cardiomyopathy, dilated;Hypertension, pulmonary;Continuous positive airway pressure
Zhang Nuofu, Email: mocdef.3ab61driggnahzfn
Natural Science Foundation of Guangdong Province(2014A030313501)
引用本文

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

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*以上评分为匿名评价
OSAHS是一种由于睡眠状态下气道塌陷导致反复呼吸暂停和低通气,引起低氧和高碳酸血症,进而引发一系列病理生理改变的多系统综合征,可导致糖尿病、高血压、冠心病及心力衰竭等,成年人患病率约为4% [ 1 ],未经治疗的OSAHS也是心血管疾病患者病死率增加的独立危险因素之一 [ 2 ]。扩张性心肌病(dilated cardiomyopathy,DCM)是以左心室或双心室腔扩大、心肌收缩功能障碍为主要特征的心肌疾病,诊断需排除引起心肌损伤的其他疾病,如冠状动脉粥样硬化性心脏病、高血压、肺源性脏心病、风湿性心脏病、先天性心脏病及神经肌肉性疾病等。现将广州呼吸疾病研究所收治的1例以DCM肺动脉高压为首发表现的OSAHS病例报道如下,并复习相关国内外文献,探讨DCM合并OSAHS的相关治疗。
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备注信息
A
张挪富,Email: mocdef.3ab61driggnahzfn
B
广东省自然科学基金项目 (2014A030313501)
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