利尿剂可改善心衰患者的睡眠呼吸暂停
Chest 2007;132:440-446.Diuretics Improve Sleep Apnea in Heart Failure Patients
NEW YORK (Reuters Health) Aug 20 - Use of diuretics in obese patients with diastolic heart failure appears to reduce sleep-disordered breathing, Italian researchers report in the August issue of Chest.
Dr. Caterina B. Bucca and colleagues at the University of Turin note that upper airway edema might contribute to pharyngeal collapsibility and account for the high prevalence of obstructive sleep apnea (OSA) in such patients.
To investigate whether "intensive unloading" with the use of diuretics might help in this situation, the researchers conducted an in-hospital study of 15 patients with severe OSA, hypertension, and diastolic heart failure. They received IV furosemide 20 mg and spironolactone 100 mg twice daily for 3 days.
This diuretic treatment led to a significant reduction in weight (from 111.5 to 109.0 kg), in blood pressure, and apnea-hypopnea index or AHI (from 74.89 to 57.17 events per hour). There also was a significant improvement in the area of the oropharyngeal junction.
In addition, there was a significant increase in measures of upper airway patency, such as forced midinspiratory flow. Weight loss was significantly related to these improvements and to the decrease in AHI.
"These findings," the investigators conclude, "suggest that diuretics may have a beneficial effect in the pharmacologic treatment of sleep apnea" in such patients.
However, they add that "the short-term nature of the observation and the intensive fluid unloading do not warrant definite therapeutic recommendations," and they call for longer-term studies including patients with milder OSA. 转贴
利尿剂可改善心衰患者的睡眠呼吸暂停
路透社健康新闻8月20日纽约报道，意大利研究人员在《Chest》杂志八月刊上报告称，对于舒张期心衰肥胖患者使用利尿剂似乎能减少睡眠呼吸障碍，同时研究人员认为研究中所观察到短期效果及强效的利尿消肿作用还不足以使该法成为明确的推荐治疗方案，因此需要对包括症状较轻患者在内的OSA患者进行更长时间的研究来确定疗效。
都灵大学的Caterina B. Bucca博士及其同事称上呼吸道水肿可能会引起咽部塌陷，并导致这类患者梗塞性睡眠呼吸暂停(OSA)的高发。为了研究利尿剂的“强效利尿”作用是否能有助于缓解这种情况，研究人员对15名患严重OSA、高血压及舒张期心衰的患者进行了一项医院内研究。这些患者静注速尿20 mg及螺内酯100 mg每天两次，静注3天。
结果发现该利尿疗法导致体重明显下降（从111.5到109.0 kg），血压及呼吸暂停-呼吸不足指数或AHI (从每小时74.89次到57.17次)也明显下降。对于口咽接合部位也有明显的改善作用。另外，上呼吸道开放状态明显增多，用力吸气中期流速增加。而体重减轻与这些改善及AHI下降间存在明显相关性。 感谢分享，辛苦了 [s:60]
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