持続気道陽圧が有効であったチェーン・ストークス呼吸を伴う高齢者うっ血性心不全の1例

Successful Continuous Positive Airway Pressure Treatment in an Aged Patient with Congestive Heart Failure Presenting with Cheyne-Stokes Respiration

　洞不全症候群で心臓ペースメーカ（VVI）を埋め込まれた93歳の男性において，息切れと下腿のむくみが出現し，うつ血性心不全（CHF）と診断された．外来で薬物治療中，激しいいびきを伴う窒息感を訴えた．睡眠ポリグラフィでは，中枢型無呼吸・低呼吸を伴うチェーン・ストークス呼吸（CSR）が認められた．4cmH²Oの低圧で持続気道陽圧（CPAP）を3カ月間行ったところ，CSRは消失し，臨床症状と睡眠の質が改善した．同時に，循環系検査の改善（心エコーの左室駆出分画上昇，心房性・脳性利尿ペプチド低下，心胸郭比低下など）が認められた．CPAPは，睡眠呼吸障害の治療として有効であるばかりか，心機能を向上させCHFの治療としても有効と思われた．

A 93-year-old man with an implanted VVI pace-maker complained of dyspnea with edematous lowerextremities, and was diagnosed as having congestiveheart failure (CHF).After seemingly successful phar-macological treatment for two months, he then com-plained of nocturnal choking with heavy snoring.Subse-quent polysomnography revealed Cheyne-Stokes respi-ration (CSR) with central sleep apnea/hypopnea.Withcontinuous positive airway pressure (CPAP) of 4cmH²Ofor three months,the symptoms and CSR disappeared.Moreover,the echocardiographic and serum cardiacparameters were significantly improved.Our observa-tions suggest that CPAP can enhance cardiac functionthrough abolishing CSR and improving sleep qualityeven in an aged patient with CHF.