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
利尿剂可改善心衰患者的睡眠呼吸暂停
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.
纽约（路透社健康新闻）8月20日－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。
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.
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。
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.
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。
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.
该利尿疗法导致体重明显下降（从111.5到109.0 kg），导致血压及呼吸暂停-呼吸不足指数或AHI (从每小时74.89次到57.17次)明显下降。对于口咽接合部位也有明显的改善作用。
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.
另外，上呼吸道开放状态明显增多，比如用力吸气中期流速增强。体重减轻与这些改善及AHI下降明显相关。
\"These findings,\" the investigators conclude, \"suggest that diuretics may have a beneficial effect in the pharmacologic treatment of sleep apnea\" in such patients.
研究人员总结说，“这些结果，说明对于这类患者的睡眠呼吸暂停，采用利尿剂进行药物治疗可能有一定帮助”。
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.
然而，他们补充说，“所观察到的短期作用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”，因此他们认为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以确定疗效。