수면정신생리 (Sleep Medicine and Psychophysiology)

  • 제24권2호
  • /
  • Pages.118-123
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  • 2017
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  • 1225-7354(pISSN)
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  • 2713-8631(eISSN)
대한수면의학회 (KOREAN ACADEMY OF SLEEP MEDICINE)
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중추성 수면 무호흡이 동반된 심부전 환자에서 지속적 상기도 양압술 적용 1례

A Case of Continuous Positive Airway Pressure Therapy in a Patient with Central Sleep Apnea and Heart Failure

  • 안지영 (가톨릭대학교 의과대학 성바오로병원 내과학교실) ;
  • 김신범 (가톨릭대학교 의과대학 성바오로병원 내과학교실) ;
  • 강현희 (가톨릭대학교 의과대학 성바오로병원 내과학교실)
  • An, Jee Young (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Kim, Shin Bum (Department of Internal Medicine, College of Medicine, The Catholic University of Korea) ;
  • Kang, Hyeon Hui (Department of Internal Medicine, College of Medicine, The Catholic University of Korea)
  • 투고 : 2017.10.02
  • 심사 : 2017.10.26
  • 발행 : 2017.12.31
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초록

일반적으로 폐쇄성 수면 무호흡이 중추성 수면 무호흡보다 발생 비율이 높지만 심부전 환자에서는 체인-스토크스 호흡이 동반된 중추성 수면 무호흡이 흔하며, 실제로 심부전 환자에서 25~40%까지 중추성 수면 무호흡이 발생한다고 한다. 저자들은 호흡곤란으로 내원하여 심부전으로 진단된 환자가 관상동맥 중재술을 시행하고 난 이후 추적 시행한 심초음파 결과에 비해 주관적인 호흡곤란이 해결되지 않은 경우, 의료진의 자세한 병력 청취를 통해 환자가 평소 코골이와 수면 무호흡이 심하다는 소견을 바탕으로 조기에 수면 다원검사를 시행했다. 환자는 체인-스토크스 호흡을 동반한 중추성 수면 무호흡으로 진단 되어 지속적 상기도 양압술을 적용 후 호흡곤란 및 주간 졸림증이 호전 되었다. 심부전 환자에서 중추성 수면 무호흡이 동반된 경우, 피로감, 주간 졸림증 등과 같은 수면 무호흡의 일반적인 증상이 심부전 자체로 인한 증상으로 오인되어 중추성 수면 무호흡의 진단이 늦어 질 수 있으며, 이 경우 환자의 예후에 나쁜 영향을 끼칠 수 있다. 본 증례의 경우와 같이 심부전 환자의 치료 시 수면 무호흡을 의심할 만한 증상이 있는 경우 중추성 수면 무호흡의 동반 가능성을 염두해 두고 수면다원검사를 통해 중추성 수면 무호흡을 조기에 진단하는 것이 증상 호전 및 예후에 긍정적인 영향을 끼치는 것을 경험하였기에 보고하는 바이다.

Central sleep apnea (CSA) is a highly prevalent comorbidity in patients with heart failure and may present in 25 to 40 percent of heart failure patients. Continuous positive airway pressure (CPAP) is the primary therapeutic option and effective in treatment of obstructive sleep apnea (OSA). In heart failure patients with CSA, several trials of CPAP showed a number of positive effects in heart failure treatment. A 58-year-old male visited the hospital because of dyspnea and he was diagnosed as heart failure with ischemic heart disease. He underwent coronary angiography and received percutaneous coronary intervention due to stenosis at the middle of left anterior descending coronary artery. However, dyspnea was not completely improved after treatment with percutaneous coronary intervention. The patient also experienced snoring and sleep apnea which worsened with symptom of dyspnea in the recent year. We suspected CSA and the patient underwent polysomnography to confirm whether sleep apnea was present. During the polysomnography, CSA with Cheyne-Stokes respiration (CSR) was observed and apnea-hypopnea index was 45.9/hr. The patient was treated with CPAP. After CPAP treatment, hypoxemia and CSA were resolved and dyspnea was improved with reducing NYHA class. We report a case successfully treated with clinical improvement by presuming CSA in a patient with heart failure.

키워드

참고문헌

  1. Bradley TD, Floras JS. Sleep apnea and heart failure: Part II: central sleep apnea. Circulation 2003;107:1822-1866. https://doi.org/10.1161/01.CIR.0000061758.05044.64
  2. Bradley TD, Logan AG, Kimoff RJ, Series F, Morrison D, Ferguson K, et al. Continuous positive airway pressure for central sleep apnea and heart failure. N Engl J Med 2005;353:2015-2033.
  3. Cho YJ. Sleep-onset central apnea. J Kor Sleep Soc 2009;6:42-49. https://doi.org/10.13078/jksrs.09009
  4. Costanzo MR, Khayat R, Ponikowski P, Augostini R, Stellbrink C, Mianulli M, et al. Mechanisms and clinical consequences of untreated central sleep apnea in heart failure. J Am Coll Cardiol 2015;65:72-84. https://doi.org/10.1016/j.jacc.2014.10.025
  5. Hall MJ, Xie A. Rutherford R. Ando S, Floras JS. Bradley TD. Cyclic length of periodic breathing in patients with and without heart failure. Am J Respir Crit Care Med 1996;154:376-381. https://doi.org/10.1164/ajrccm.154.2.8756809
  6. Javaheri S. CPAP should not be used for central sleep apnea in congestive heart failure. J Clin Sleep Med 2006;2:399-402.
  7. Javaheri S, Parker TJ, Liming JD, Corbett WS, Nishiyama H, Wexler L, et al. Sleep apnea in 81 ambulatory male patients with stable heart failure. Types and their prevalences, consequences, and presentation. Circulation 1998;97:2154-2159. https://doi.org/10.1161/01.CIR.97.21.2154
  8. Khayat RN, Abrahan WT. Current treatment approaches and trials in central sleep apnea. Int J Cardiol 2016;206:S22-S27. https://doi.org/10.1016/j.ijcard.2016.02.126
  9. Kim WS. Cardiovascular impacts of sleep-disordered breathing, Tuberc Respir Dis 2009;66:173-177. https://doi.org/10.4046/trd.2009.66.3.173
  10. Naughton MT, Benard DC, Rutherford R, Bradley TD. Effect of continuous positive airway pressure on central sleep apnea and nocturnal PCO2 in heart failure. Am J Respir Crit Care Med 1994;150:1598-1604. https://doi.org/10.1164/ajrccm.150.6.7952621
  11. Naughton MT, Rahman MA, Hara K, Floras JS, Bradley TD. Effect of continuous positive airway pressure on intrathoracic and left ventricular transmural pressure in patients with congestive heart failure. Circulation 1995;91:1725-1731. https://doi.org/10.1161/01.CIR.91.6.1725
  12. Rowley JA, Badr MS. Central sleep apnea in patients with congestive heart failure. Sleep Med Clin 2017;12:221-227. https://doi.org/10.1016/j.jsmc.2017.03.001
  13. Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest 2014;146:1387-1394. https://doi.org/10.1378/chest.14-0970
  14. Sin DD, Fitzgerald F, Parker JD, Newton G, Floras JS, Bradley TD. Risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure. Am J Respir Crit Care Med 1999;160:1101-1106. https://doi.org/10.1164/ajrccm.160.4.9903020
  15. White LH, Bradley TD. Role of nocturnal rostal fluid shift in the pathogenesis of obstructive and central sleep apnea. J Physiol 2013;591:1179-1193. https://doi.org/10.1113/jphysiol.2012.245159
  16. Yu J, Zhou Z, McEvoy RD, Anderson CS, Rodgers A, Perkovic V, et al. Association of positive airway pressure with cardiovascular events and death in adults with sleep apnea: A systematic review and meta-analysis. JAMA 2017;318:156-166. https://doi.org/10.1001/jama.2017.7967