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1、11-慢性心衰中的中枢性睡眠呼吸暂停（11- central sleep apnea in chronic heart failure）Central sleep apnea in chronic heart failureLi Wei, (90405130), Li Mingjia (90405134), Huang Xiantao (904-5133), Wang Kang (904-5135), Zhang heavy (90405138)Disease physiology experiment 04 groups, 04 basic classesKeywords CHF, CSA,
2、 BNPChronic heart failure (Chronic, heart, failure, CHF) is a heart failure caused by cardiovascular or other multisystem disorders. Heart failure is still a cardiovascular disease with a high morbidity and mortality, and is the leading cause of hospitalization in people over the age of 65. Central
3、sleep apnea (Central sleep, apnea, CSA) is sleep disordered breathing (Sleep disordered, breathing, SDB) a loss generated during the suction process due to the failure of the short central respiratory rhythm, obstructive sleep disorder and expiratory pause (OSA) on the contrary. CSA and OSA are comm
4、on in patients with severe chronic heart failure, and studies have shown that CSA is associated with a significant prognosis for heart failure, whereas OSA is not. CSA and CHF are reciprocal causation, a vicious cycle, which seriously affects the prognosis of patients.This review summarizes the mech
5、anisms of action of CSA and CHF, the clinical symptomatic treatment of CSA, and the new guiding role of BNP in the diagnosis of CHF associated with CSA.Mechanisms of action of 1.CSA and CHF:It includes two aspects: CHF produces and aggravates CSA; CSA aggravates CHF and affects prognosis.Pathogenesi
6、s of 1.1.CSA:The control of respiratory rhythm in 1.1.1. normal body includes two points: the control of the autonomic nervous metabolism system, the control of respiratory rhythm, and the control of the respiratory rhythm by the waking state.The autonomic nervous metabolic system controls respirato
7、ry rhythms, i.e., chemical signals such as changes in CO2 and H+ concentrations that regulate respiration, which is the most sensitive and rapid regulation of respiratory movements.The control of respiratory rhythm in waking state. The human body in the awake state, awakening system located in the b
8、rainstem reticular system by stimulating signal transduction, activation of neurons to activate the upper pons discharge, the respiratory center also located in the brainstem, thereby maintaining the normal respiratory rhythm.In the sleep after the start, reduce the neurotransmitter activity in the
9、respiratory arousal system, thus inhibited the respiratory rate and pulmonary ventilation volume decreased, when the blood Pco2 decreased to a certain value (apnea threshold) below, will stop breathing. Under normal circumstances, the body will be through the negative feedback regulation of autonomi
10、c nervous system metabolism, blood Pco2 increased, thus maintaining normal breathing; and in pathological conditions, sleep at the beginning of the Pco2 in the blood did not increase, more easily reduced to below the threshold, resulting in CSA.1.1.2.CHF acts on the autonomic nervous metabolism syst
11、em and leads to the CSA mechanism:CHF affects many systems and organs, and their combined effect is to cause hyperventilation and reduce Pco2 in the blood and cause CSA.First of all, the compensatory body in patients with CHF due to the increased sympathetic activity, increase catecholamine release,
12、 and catecholamine hormone levels will improve the peripheral chemoreceptor sensitivity increased, leading to ventilation gain respiratory center to increase CO2, lead to excessive ventilation. Hyperventilation results in lower levels of Pco2. When sleep begins, it is easier to fall below the apnea
13、threshold and trigger CSA.Second, CHF leads to decreased cardiac output, blood circulation slows, blood Pco2 changes caused by negative feedback regulation becomes delay, declining respiratory center can not be timely aware Pco2, respiratory control system over the role of hyperventilation, apnea th
14、reshold level of Pco2 dropped to below, causing CSA.Third, CHF with pulmonary edema leading to lung tissue distraction, J receptor and C activation of vagus nerve fiber sensors; at the same time, lung congestion and oxygen diffusion dysfunction, which will increase the ventilation on respiratory ref
15、lect, causing excessive ventilation, the Pco2 below the apnea threshold caused by CSA.The effect of 1.1.3. micro arousal on apnea:Sleep is segmented, such as sleep, sleep in four stages (especially REM sleep), as well as the awakening of central and central segments between each dominant breathing d
16、ifferent sensitivity to chemical stimuli. The apnea and arousal threshold threshold in Pco2 is similar to that of lower end low ventilation caused extreme decline of oxygen saturation will cause arousal, reaction of respiratory center of CO2 increased, triggering hyperventilation, and Pco2 overexpression decreased, triggering another apnea, so as to produce periodic breathing cycle.1.2. CSA worsens CHF:Repeat
