移植后生存者的改善:一些证据表明与常规治疗相比,CPAP通过降低AHI,能够明显改善CHF合并CSA患者的LVEF和生存质量。 基于治疗预后的评估,CPAP与常规治疗相比不能使生存者获益。{0} [33]Arzt M, Floras JS, Logan AG, et al. Suppression of central sleep apnea by continuous positive airway pressure and transplant-free survival in heart failure. Circulation. 2007;115:3173-3180.http://circ.ahajournals.org/content/115/25/3173.fullhttp://www.ncbi.nlm.nih.gov/pubmed/17562959?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
移植后生存者的改善:一些证据表明与常规治疗相比,CPAP通过降低AHI,能够明显改善CHF合并CSA患者的LVEF和生存质量。 基于治疗预后的评估,CPAP与常规治疗相比不能使生存者获益。{0} [33]Arzt M, Floras JS, Logan AG, et al. Suppression of central sleep apnea by continuous positive airway pressure and transplant-free survival in heart failure. Circulation. 2007;115:3173-3180.http://circ.ahajournals.org/content/115/25/3173.fullhttp://www.ncbi.nlm.nih.gov/pubmed/17562959?tool=bestpractice.com
改善觉醒、心功能、AHI:中等证据支持氧疗可以减少但不能完全消除(50%-70%)AHI,而对觉醒和心功能的影响无一致意见;远期疗效不明。[48]Hanly PJ, Millar TW, Steljes DG, et al. The effect of oxygen on respiration and sleep in patients with congestive heart failure. Ann Intern Med. 1989;111:777-782.http://www.ncbi.nlm.nih.gov/pubmed/2817624?tool=bestpractice.com[49]Javaheri S. Treatment of central sleep apnea in heart failure. Sleep. 2000;23(suppl 4):S224-S227.http://www.ncbi.nlm.nih.gov/pubmed/10893108?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
改善觉醒、心功能、AHI:中等证据支持氧疗可以减少但不能完全消除(50%-70%)AHI,而对觉醒和心功能的影响无一致意见;远期疗效不明。[48]Hanly PJ, Millar TW, Steljes DG, et al. The effect of oxygen on respiration and sleep in patients with congestive heart failure. Ann Intern Med. 1989;111:777-782.http://www.ncbi.nlm.nih.gov/pubmed/2817624?tool=bestpractice.com[49]Javaheri S. Treatment of central sleep apnea in heart failure. Sleep. 2000;23(suppl 4):S224-S227.http://www.ncbi.nlm.nih.gov/pubmed/10893108?tool=bestpractice.com
改善周期性呼吸、主观睡眠质量、急性高原反应、AHI:中等证据表明,高海拔周期性呼吸患者进行氧疗可以减轻周期性呼吸和AHI,改善主观睡眠质量,减少急性高山反应。[50]Luks AM, van Melick H, Batarse RR, et al. Room oxygen enrichment improves sleep and subsequent day-time performance at high altitude. Respir Physiol. 1998;113:247-258.http://www.ncbi.nlm.nih.gov/pubmed/9840334?tool=bestpractice.com[51]McElroy MK, Gerard A, Powell FL, et al. Nocturnal O2 enrichment of room air at high altitude increases daytime O2 saturation without changing control of ventilation. High Alt Med Biol. 2000;1:197-206.http://www.ncbi.nlm.nih.gov/pubmed/11254229?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
改善周期性呼吸、主观睡眠质量、急性高原反应、AHI:中等证据表明,高海拔周期性呼吸患者进行氧疗可以减轻周期性呼吸和AHI,改善主观睡眠质量,减少急性高山反应。[50]Luks AM, van Melick H, Batarse RR, et al. Room oxygen enrichment improves sleep and subsequent day-time performance at high altitude. Respir Physiol. 1998;113:247-258.http://www.ncbi.nlm.nih.gov/pubmed/9840334?tool=bestpractice.com[51]McElroy MK, Gerard A, Powell FL, et al. Nocturnal O2 enrichment of room air at high altitude increases daytime O2 saturation without changing control of ventilation. High Alt Med Biol. 2000;1:197-206.http://www.ncbi.nlm.nih.gov/pubmed/11254229?tool=bestpractice.com
控制AHI,改善左室射血分数、SF-36生存质量问卷:低等级证据表明稳定期心衰并睡眠呼吸暂停患者进行ASV治疗6个月AHI得到控制,与对照组的LVEF下降4%相比,ASV使LVEF降低7%。 SF-36生存质量问卷结果随着ASV的使用而改善,但无对照数据。 其他变量与对照相比无明显改善。[31]Hastings PC, Vazir A, Meadows GE, et al. Adaptive servo-ventilation in heart failure patients with sleep apnea: a real world study. Int J Cardiol. 2010;139:17-24.http://www.ncbi.nlm.nih.gov/pubmed/18805598?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
控制AHI,改善左室射血分数、SF-36生存质量问卷:低等级证据表明稳定期心衰并睡眠呼吸暂停患者进行ASV治疗6个月AHI得到控制,与对照组的LVEF下降4%相比,ASV使LVEF降低7%。 SF-36生存质量问卷结果随着ASV的使用而改善,但无对照数据。 其他变量与对照相比无明显改善。[31]Hastings PC, Vazir A, Meadows GE, et al. Adaptive servo-ventilation in heart failure patients with sleep apnea: a real world study. Int J Cardiol. 2010;139:17-24.http://www.ncbi.nlm.nih.gov/pubmed/18805598?tool=bestpractice.com
降低觉醒指数(原发性CSA):没有充分证据表明氧疗可以降低原发性CSA的觉醒指数,[44]Franklin KA, Eriksson P, Sahlin C, et al. Reversal of central sleep apnea with oxygen. Chest. 1997;111:163-169.http://journal.publications.chestnet.org/data/Journals/CHEST/21742/163.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/8996011?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
降低觉醒指数(原发性CSA):没有充分证据表明氧疗可以降低原发性CSA的觉醒指数,[44]Franklin KA, Eriksson P, Sahlin C, et al. Reversal of central sleep apnea with oxygen. Chest. 1997;111:163-169.http://journal.publications.chestnet.org/data/Journals/CHEST/21742/163.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/8996011?tool=bestpractice.com
药物导致的CSA患者改善AHI:没有一致的证据表明停用或调整相关药物剂量能改善AHI。[1]American Academy of Sleep Medicine. International classification of sleep disorders: diagnostic and coding manual. 3rd ed. Darien, IL: American Academy of Sleep Medicine; 2014.[2]Eckert DJ, Jordan AS, Merchia P, et al. Central sleep apnea: pathophysiology and treatment. Chest. 2007;131:595-607.http://journal.publications.chestnet.org/article.aspx?articleid=1084978http://www.ncbi.nlm.nih.gov/pubmed/17296668?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
药物导致的CSA患者改善AHI:没有一致的证据表明停用或调整相关药物剂量能改善AHI。[1]American Academy of Sleep Medicine. International classification of sleep disorders: diagnostic and coding manual. 3rd ed. Darien, IL: American Academy of Sleep Medicine; 2014.[2]Eckert DJ, Jordan AS, Merchia P, et al. Central sleep apnea: pathophysiology and treatment. Chest. 2007;131:595-607.http://journal.publications.chestnet.org/article.aspx?articleid=1084978http://www.ncbi.nlm.nih.gov/pubmed/17296668?tool=bestpractice.com
改善AHI:仅有的几个小型病例研究表明改善心脏情况可以改善AHI。[62]Baylor P, Tayloe D, Owen D, et al. Cardiac failure presenting as sleep apnea. Elimination of apnea following medical management of cardiac failure. Chest. 1988;94:1298-1300.http://journal.publications.chestnet.org/data/Journals/CHEST/21586/1298.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/3191774?tool=bestpractice.com[63]Dark DS, Pingleton SK, Kerby GR, et al. Breathing pattern abnormalities and arterial oxygen desaturation during sleep in the congestive heart failure syndrome. Improvement following medical therapy. Chest. 1987;91:833-836.http://journal.publications.chestnet.org/data/Journals/CHEST/21561/833.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/3581932?tool=bestpractice.com[64]Solin P, Bergin P, Richardson M, et al. Influence of pulmonary capillary wedge pressure on central apnea in heart failure. Circulation. 1999;99:1574-1579.http://www.ncbi.nlm.nih.gov/pubmed/10096933?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
改善AHI:仅有的几个小型病例研究表明改善心脏情况可以改善AHI。[62]Baylor P, Tayloe D, Owen D, et al. Cardiac failure presenting as sleep apnea. Elimination of apnea following medical management of cardiac failure. Chest. 1988;94:1298-1300.http://journal.publications.chestnet.org/data/Journals/CHEST/21586/1298.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/3191774?tool=bestpractice.com[63]Dark DS, Pingleton SK, Kerby GR, et al. Breathing pattern abnormalities and arterial oxygen desaturation during sleep in the congestive heart failure syndrome. Improvement following medical therapy. Chest. 1987;91:833-836.http://journal.publications.chestnet.org/data/Journals/CHEST/21561/833.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/3581932?tool=bestpractice.com[64]Solin P, Bergin P, Richardson M, et al. Influence of pulmonary capillary wedge pressure on central apnea in heart failure. Circulation. 1999;99:1574-1579.http://www.ncbi.nlm.nih.gov/pubmed/10096933?tool=bestpractice.com
改善AHI:没有充分证据表明CO2治疗可以改善AHI,同样对于睡眠片段化和患者耐受性以及远期安全性数据也乏善可陈。[75]Xie A, Rankin F, Rutherford R, et al. Effects of inhaled CO2 and added dead space on idiopathic central sleep apnea. J Appl Physiol. 1997;82:918-926.http://jap.physiology.org/content/82/3/918http://www.ncbi.nlm.nih.gov/pubmed/9074983?tool=bestpractice.com[76]Lorenzi-Filho G, Rankin F, Bies I, et al. Effects of inhaled carbon dioxide and oxygen on Cheyne-Stokes respiration in patients with heart failure. Am J Respir Crit Care Med. 1999;159:1490-1498.http://www.atsjournals.org/doi/pdf/10.1164/ajrccm.159.5.9810040http://www.ncbi.nlm.nih.gov/pubmed/10228116?tool=bestpractice.com[77]Khayat RN, Xie A, Patel AK, et al. Cardiorespiratory effects of added dead space in patients with heart failure and central sleep apnea. Chest. 2003;123:1551-1560.http://journal.publications.chestnet.org/article.aspx?articleid=1081577http://www.ncbi.nlm.nih.gov/pubmed/12740273?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
改善AHI:没有充分证据表明CO2治疗可以改善AHI,同样对于睡眠片段化和患者耐受性以及远期安全性数据也乏善可陈。[75]Xie A, Rankin F, Rutherford R, et al. Effects of inhaled CO2 and added dead space on idiopathic central sleep apnea. J Appl Physiol. 1997;82:918-926.http://jap.physiology.org/content/82/3/918http://www.ncbi.nlm.nih.gov/pubmed/9074983?tool=bestpractice.com[76]Lorenzi-Filho G, Rankin F, Bies I, et al. Effects of inhaled carbon dioxide and oxygen on Cheyne-Stokes respiration in patients with heart failure. Am J Respir Crit Care Med. 1999;159:1490-1498.http://www.atsjournals.org/doi/pdf/10.1164/ajrccm.159.5.9810040http://www.ncbi.nlm.nih.gov/pubmed/10228116?tool=bestpractice.com[77]Khayat RN, Xie A, Patel AK, et al. Cardiorespiratory effects of added dead space in patients with heart failure and central sleep apnea. Chest. 2003;123:1551-1560.http://journal.publications.chestnet.org/article.aspx?articleid=1081577http://www.ncbi.nlm.nih.gov/pubmed/12740273?tool=bestpractice.com