持续气道正压通气联合药物优化管理对射血分数降低型心衰合并OSA患者的疗效评价

Evaluation of the Efficacy of Continuous Positive Airway Pressure Combined with Optimized Pharmacotherapy in Heart Failure with Reduced Ejection Fraction Patients with Obstructive Sleep Apnea

摘要: 目的：评价持续气道正压通气(CPAP)联合药物优化管理(GDMT)对射血分数降低型心力衰竭(HFrEF)合并阻塞性睡眠呼吸暂停综合征(OSA)患者的疗效。方法：选择2024年1月~2024年12月在新疆生产建设兵团十三师红星医院住院并以心力衰竭为主要诊断的住院患者43例，分为CPAP + GDMT组和单纯GDMT组，对患者预后进行随访，比较两组临床特征差异及预后。结果：CPAP + GDMT组与非GDMT组比较，年龄、性别，BMI、吸烟史、收缩压、舒张压、糖尿病、高血压、NT-proBNP、左室舒张末期内径、左室射血分数均无统计学差异(P > 0.05)。CPAP + GDMT组呼吸暂停低通气指数(AHI)显著降低，最低血氧饱和度升高(P < 0.05)，LVEF较高，LVEDD、NT-proBNP较小，差异具有统计学意义(P < 0.05)，CPAP + GDMT组发生心血管不良事件较少，差异具有统计学意义(P < 0.05)。结论：CPAP联合GDMT可显著改善HFrEF合并OSA患者的心功能，降低心血管主要不良事件发生率。

Abstract: Objective: This paper aims to evaluate the efficacy of continuous positive airway pressure (CPAP) combined with pharmacological optimization management (GDMT) in patients with heart failure with reduced ejection fraction (HFrEF) and obstructive sleep apnea (OSA). Methods: A total of 43 hospitalized patients diagnosed primarily with heart failure from January 2024 to December 2024 at 13th Division Hongxing Hospital of Xinjiang Production and Construction Corps were selected and divided into the CPAP + GDMT group and the GDMT-only group. Prognosis was followed up, and clinical characteristics and prognostic factors were compared between the two groups. Results: Compared with the non-GDMT group, there were no statistically significant differences in age, gender, BMI, smoking history, systolic blood pressure, diastolic blood pressure, diabetes, hypertension, NT-proBNP, left ventricular end-diastolic diameter, and left ventricular ejection fraction between the CPAP + GDMT group and the non-GDMT group (P > 0.05). The CPAP + GDMT group demonstrated significantly reduced apnea-hypopnea index and elevated minimum oxygen saturation (P < 0.05), along with higher LVEF, smaller LVEDD, and lower NT-proBNP (P < 0.05). This group also showed fewer cardiovascular adverse events (P < 0.05). Conclusion: CPAP combined with GDMT can significantly improve cardiac function in HFrEF patients with OSA and reduce the incidence of major cardiovascular adverse events.