The Effect Of Central Sleep Breathing Disorder On The Nocturnal Urinary VMA Concentration And Other Factors In Patients With Chronic Congestive Heart Failure

Objective To investigate the incidence and influence of central sleep apnea C Cheyne-Stokes Respiration(CSR)) and To explore the effect of CSR on the nocturnal urinary VMA concentration and other factors in patients with chronic congestive heart failure. Methods 58 cases of patients with chronic congestive heart failure(HI~IVgrade in the classification of NYHA)were monitored by Sleep Screen(SC20 Breas Sweden).They were divided into two groups. Control group had AHI (apnea-hyopnea index,) less than 15 .Study group had AHI≥15. Results The Control group (n=24,41.38%), AHI varied from 5.1 to 14.8 ,mean and standard deviation 10.30?.01 .The study group, AHI varied from 17.3 to 59.8 and 37.26?1.25.The lowest arterial oxygen saturation, oxygen desaturation index(ODI) during sleep had significantly difference between the control group and the study group ( M:81.50 (P25:80.00, P75:84.00,M:77.00 (P25:73.75, P75:80.50), respectively,P=0.001; 19.55?12.5, 39.28?2.45, respectively,p<0.0001) .There were no difference in levels of PH, PO2, PaCO2 HCO3,between two groups in the daytimearterial blood gas analysis.Doppler echocardiography showed left atria and pulmonary artery significantly increased in the study group (39.17?6.16mm, 49.03?12.00mm,respectively,p<0.0001;21.61?.21mm,25.48?4.74mm,respectively,p<0.01).The concentration of nocturnal urinary VMA in the study group was remarkable highened compared with that of control group M:1.34 (P25:0.94,P75:1.95), M:2.83 (P25:1.98, P75:3.76), respectively, P=0.001). Conclusions The incidence of central sleep apnea is rather frequent in patients with chronic congestive heart failure .The episodes of sleep breathing disorder may lead to aggravate the nocturnal hypoxemia. In patients with CHF, CSR is associated with elevated sympathoneural activity.Severe untreated sleep breathing disorder may impair myocardium and could contribute to death in patients with congestive heart failure.Meanwhile patients with CHF, CSR have larger left artria and pulmonary artery.