有心脏病,就应查睡眠呼吸暂停!亚太共识

2022-08-02 中国循环杂志 网络

近期,亚太心脏病学会工作组发布了亚太地区心血管病患者阻塞性睡眠呼吸暂停综合征的管理共识,共识有11条建议。

在亚洲人群中,18 岁以上成年人群中的阻塞性睡眠呼吸暂停综合征总体患病率达到了8.5%。

而在冠心病、中风、心衰和心律失常患者中,睡眠呼吸暂停患病率分别高达65%、75%、55%和50%。接受冠脉介入治疗或搭桥手术的亚洲患者中,睡眠呼吸暂停的患病率也高达45%~50%。

近期,亚太心脏病学会工作组发布了亚太地区心血管病患者阻塞性睡眠呼吸暂停综合征的管理共识,共识有11条建议。

建议1:对于有高血压、2型糖尿病、肥胖、冠心病、心衰、卒中、心律失常的患者,都应督促临床医生筛查睡眠呼吸暂停。(证据级别:很低)

建议2:对于心血管病的患者,建议询问睡眠呼吸暂停的症状并使用筛查量表(如STOP Bang)。(证据级别:低)

建议3:顽固性高血压、需要心脏复律/消融的房颤、原因不明的肺动脉高压患者,应进行睡眠监测。(证据级别:中等)

建议4:对于患有严重心肺疾病(心衰、先心病或复杂瓣膜病)的疑似睡眠呼吸暂停患者,应进行I型多导睡眠图检查。由于临床情况的复杂性,不应使用III型和IV型家庭睡眠监测,这可能导致误诊。(证据级别:很低)

建议5:对于无明显心肺疾病或卒中的中重度睡眠呼吸暂停可能性较高的患者,可使用家庭睡眠监测(III型/IV型)或多导睡眠图进行筛查(I型/II型)。(证据级别:中等)

有研究发现,在心内科病房可以采用Ⅳ型设备进行疑似睡眠呼吸暂停患者的诊断和病情复查。

建议6:心血管病患者的睡眠监测结果应经专业人员进行评估。(证据级别:很低)

建议7:所有接受睡眠呼吸暂停治疗的患者也应接受生活方式的干预以及针对性的患者教育和行为干预,超重或肥胖者应减重。(证据级别:很低)

建议8:治疗睡眠呼吸暂停可改善白天嗜睡和认知功能。在观察性研究中,持续气道正压通气治疗与不良心血管事件的发生率降低密切相关。(证据级别:低)

持续气道正压通气(CPAP)治疗的益处尚未在 RCT 中得到证实。一项针对多导睡眠图诊断为 OSA 和任何心血管病的成年患者的9项RCT(n=3,314)的Meta分析发现,主要结局(即全因死亡、心血管死亡、急性心肌梗死、卒中和任何主要心血管事件)在接受CPAP治疗的患者未发现有显著降低。

主要原因可能是对CPAP治疗的依从性低、包括症状不严重的患者或具有不同疾病表型和动脉氧饱和度下降的异质性,以及潜在的缺乏疗效的 CPAP 治疗。

建议9:合并心衰的睡眠呼吸暂停患者接受持续气道正压通气治疗,可改善心室功能、症状和生活质量。(证据级别:中等)

建议10:节律控制的房颤的房颤患者合并中重度睡眠呼吸暂停,持续气道正压通气治疗可降低房颤复发的风险。(证据级别:低)

建议11:合并心血管病的睡眠呼吸暂停患者,在治疗后仍持续存在睡眠呼吸暂停治疗,应寻求睡眠专科医生诊治。(证据级别:很低)

来源

[1]Asian Pacific Society of Cardiology Consensus Statements on the Diagnosis and Management of Obstructive Sleep Apnoea in Patients with Cardiovascular Disease. Eur Cardiol. 2022 Jun 20;17:e16.
[2] 黄楷壮, 王玲, 黄志华, 等. Ⅳ型便携式睡眠监测设备在心内科的应用.2022, 37(1): 82-88. DOI:10.3969/j.issn.1000-3614.2022.01.013.

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