心不全に伴う睡眠呼吸障害の治療戦略
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概要
- 論文の詳細を見る
心不全の進行は,心疾患のリスクだけが存在するステージAから,治療抵抗性心不全のステージDまでに分類されている.ステージAでは,閉塞性睡眠時無呼吸(obstructive sleep apnea;OSA)が循環器疾患のリスクとのエビデンスが数多く出てきており,OSA治療が動脈硬化性心疾患の予防などを通じて心不全の予防に重要である.すでになんらかの心疾患があるが,心不全はないステージBでは,ステージAと同様にOSAの治療が重要であるが,この段階で多く認められている拡張障害はOSAにより悪化する一方,拡張障害による左房圧の上昇は中枢性睡眠時無呼吸(central sleep apnea;CSA)の原因となることが示唆されている.すでに心不全状態であるステージC以降では,CSAの合併が30%以上となることや心機能の程度に応じてCSA合併率が高いこと,また,心機能の改善でCSAが減少することが示されている.心不全に合併するCSAを治療することの意義を検討したCANPAP研究では,予後改善は示されなかった.この原因として,無呼吸の除去が不完全であった可能性や,不全心を持つ患者の胸腔に陽圧をかけること自体が,心機能の悪化を招いたことなどが考えられる.患者の呼吸状態に応じて,より完全に無呼吸を取り除くことが可能であるadaptive servo ventilationが,心不全に伴う睡眠呼吸障害の改善のみならず,心不全そのものの改善に有効との報告が増えており,予後を含めた今後の詳細な検討が重要である.
著者
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安藤 真一
福岡県済生会二日市病院循環器科
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Andoh Shinichi
Division Of Cardiology Saiseikai Futsukaichi Hospital
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Ando Shin-ichi
九州大学医学部附属心臓血管研究施設
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安藤 真一
Division Of Cardiology Saiseikai Futsukaichi Hospital
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Ando Shinnichi
Research Institute Of Angiocardiology And Cardiovascular Clinic Faculty Of Medicine Kyushu Universit
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Ando Shinnichi
Research Institute Of Angiocardiology And Cardiovascular Clinic Faculty Of Medicine Kyushu Universit
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Ando Shin-ichi
Sleep Apnea Center Kyushu University Hospital
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