睡眠呼吸暂停与心力衰竭吴彦.pptVIP

C://Desktop/ACCP Meeting 2004 Fellows Lecture 2 * C://Desktop/ACCP Meeting 2004 Fellows Lecture 2 * C://Desktop/ACCP Meeting 2004 Fellows Lecture 2 * C://Desktop/ACCP Meeting 2004 Fellows Lecture 2 * Figure 2. Effects of continuous positive airway pressure (CPAP) on obstructive sleep apnea (OSA) in a patient with heart failure. Abolition of obstructive apneas by CPAP prevents dips in oxygen saturation (SaO2), dampens negative intrathoracic pressure (ie, esophageal pressure; Pes), swings and lowers blood pressure (BP).The combination of the latter two causes a marked reduction in left ventricular transmural pressure, an important determinant of afterload. EEG indicates electroencephalogram; EMGsm, submental electromyogram; and VT, tidal volume. Reprinted with permission Tkacova R, Rankin F, Fitzgerald FS, et al. Effects of continuous positive airway pressure on obstructive sleep apnea and left ventricular afterload in patients with heart failure. Circulation. 1998;98:2269–2275.69 C://Desktop/ACCP Meeting 2004 Fellows Lecture 2 * C://Desktop/ACCP Meeting 2004 Fellows Lecture 2 * Figure 1 Progress of the Cohort Through the Study * * C://Desktop/ACCP Meeting 2004 Fellows Lecture 2 * C://Desktop/ACCP Meeting 2004 Fellows Lecture 2 * C://Desktop/ACCP Meeting 2004 Fellows Lecture 2 * This pt is 80 years old M/H: HTN, Heart surgery in 1993 AHI = 69/hr Lowest oxygen = 87% D O T= 11/21/04 C://Desktop/ACCP Meeting 2004 Fellows Lecture 2 * HF leads to increased left ventricular (LV) filling pressure The resulting pulmonary congestion activates lung vagal irritant receptors, which stimulate hyperventilation and hypocapnia. Superimposed arousals cause further abrupt increases in ventilation and drive PaCO2 below the threshold for ventilation, triggering a central apnea. Central sleep apneas are sustained by recurrent arousals resulting from apnea-induced hypoxia and the increased effort to breathe during the ventilatory phase because of pulmonary congestion and reduced lung com