체인-스토크스 호흡이 신경계 중환자의 예후에 미치는 영향
Cheyne-Stokes Respiration and Prognosis in Neurocritical Patients
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Objectives: Cheyne-Stokes respiration (CSR) is frequently found in critically ill patients and is associated with poor prognosis. However, CSR has not been evaluated in neurocritical patients. This study investigated the frequency and prognostic impact of CSR in neurocritical patients using biosignal big data obtained from intensive care units. Methods: This study included all patients who received neurocritical care at the tertiary hospital from January 2018 to December 2019. Clinical information and biosignal data of intensive care units were used and analyzed. The respiratory curve was visually assessed to determine whether CSR and obstructive sleep apnea (OSA) were present, and a heart rate variability (HRV) was obtained from the electrocardiogram. Results: CSR was confirmed in 166 of 406 patients (40.9%). Patients with CSR were older, had a higher frequency of cardiovascular risk factors as well as heart failure, and had a poor outcome (modified Rankin scale ≥4). As a result of multiple regression analysis adjusted for other variables, CSR was significantly associated with poor outcome with an odds ratio of 2.27 times higher (95% confidence interval 1.25–4.14, p=0.007). HRV analysis demonstrated that CSR and OSA had distinct autonomic characteristics. Conclusions: This study first revealed the substantial frequency of CSR in neurocritical patients and suggests that it can be used as a predictor of poor prognosis in neurocritical care.
Abstract
Objectives: Cheyne-Stokes respiration (CSR) is frequently found in critically ill patients and is associated with poor prognosis. However, CSR has not been evaluated in neurocritical patients. This study investigated the frequency and prognostic impact of CSR in neurocritical patients using biosignal big data obtained from intensive care units. Methods: This study included all patients who received neurocritical care at the tertiary hospital from January 2018 to December 2019. Clinical information and biosignal data of intensive care units were used and analyzed. The respiratory curve was visually assessed to determine whether CSR and obstructive sleep apnea (OSA) were present, and a heart rate variability (HRV) was obtained from the electrocardiogram. Results: CSR was confirmed in 166 of 406 patients (40.9%). Patients with CSR were older, had a higher frequency of cardiovascular risk factors as well as heart failure, and had a poor outcome (modified Rankin scale ≥4). As a result of multiple regression analysis adjusted for other variables, CSR was significantly associated with poor outcome with an odds ratio of 2.27 times higher (95% confidence interval 1.25–4.14, p=0.007). HRV analysis demonstrated that CSR and OSA had distinct autonomic characteristics. Conclusions: This study first revealed the substantial frequency of CSR in neurocritical patients and suggests that it can be used as a predictor of poor prognosis in neurocritical care.
참고문헌 (37)
- AlDabal L, "Cheyne-Stokes respiration in patients with heart failure", Lung, 188, pp.5~14 (2010)
- Javaheri S, "Central sleep apnea", Compr Physiol, 3, pp.141~163 (2013)
- Flinta I, "Relationship between central sleep apnea and Cheyne-Stokes respiration", Int J Cardiol, 206(SupplSuppl), pp.S8~S12 (2016)
- Herkenrath SD, "More than heart failure : central sleep apnea and sleep-related hypoventilation", Respiration, 98, pp.95~110 (2019)
- Brack T, "Daytime Cheyne-Stokes respiration in ambulatory patients with severe congestive heart failure is associated with increased mortality", Chest, 132, pp.1463~1471 (2007)
- Cowie MR, "Adaptive servo-ventilation for central sleep apnea in systolic heart failure", N Engl J Med, 373, pp.1095~1105 (2015)
- Magalang UJ, "Adaptive servo-ventilation for central sleep apnea in heart failure", N Engl J Med, 374, pp.691~ (2016)
- Javaheri S, "CON : persistent central sleep apnea", hunter-Cheyne-Stokes breathing, despite best guideline-based therapy of heart failure with reduced ejection fraction, is not a compensatory mechanism and should be suppressed, 2018, pp.14, 915~921
- Naughton MT, "PRO : persistent central sleep apnea", hunter-Cheyne-Stokes breathing, despite best guideline-based therapy of heart failure with reduced ejection fraction, is a compensatory mechanism and should not be suppressed, 2018, pp.14, 909~914
- Naughton MT, "Cheyne-Stokes respiration: friend or foe?", Thorax, 67, pp.357~360 (2012)
- Richards KC, "Sleep-related breathing disorders in patients who are critically ill", J Cardiovasc Nurs, 17, pp.42~55 (2002)
- Van den Broecke S, "Very early screening for sleep-disordered breathing in acute coronary syndrome in patients without acute heart failure", Sleep Med, 15, pp.1539~1546 (2014)
- Tinoco A, "ECG derived Cheyne-Stokes respiration and periodic breathing are associated with cardiorespiratory arrest in intensive care unit patients", Heart Lung, 48, pp.114~120 (2019)
- Siccoli MM, "Central periodic breathing during sleep in 74 patients with acute ischemic stroke–Neurogenic and cardiogenic factors", J Neurol, 255, pp.1687~1692 (2008)
- 김유나, "Factors Associated with Cheyne-Stokes Respiration in Acute Ischemic Stroke", Journal of Clinical Neurology, 14(4), pp.542~548 (2018), 대한신경과학회[DOI]
- Vilella L, "Postconvulsive central apnea as a biomarker for sudden unexpected death in epilepsy(SUDEP)", Neurology, 92, pp.e171~e182 (2019)
- 윤덕용, "System for Collecting Biosignal Data from Multiple Patient Monitoring Systems", Healthcare Informatics Research, 23(4), pp.333~337 (2017), 대한의료정보학회[DOI]
- Berry RB, "The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, version 2.6", American Academy of Sleep Medicine, ~ (2020)
- Sadr N, "Comparing ECG derived respiratory signals and chest respiratory signal for the detection of obstructive sleep apnoea", 2016Computing in Cardiology Conference (CinC) (2016)
- Janbakhshi P, "Sleep apnea detection from single-lead ECG using features based on ECG-derived respiration(EDR)signals", IRBM, 39, pp.206~218 (2018)
- Varon C, "A comparative study of ECG-derived respiration in ambulatory monitoring using the single-lead ECG", Sci Rep, 10, pp.5704~ (2020)
- Szollosi I, "Sleep apnea in heart failure increases heart rate variability and sympathetic dominance", Sleep, 30, pp.1509~1514 (2007)
- 박기종, "심박변이에 대한 평가방법", Annals of Clinical Neurophysiology, 16(2), pp.49~54 (2014), 대한임상신경생리학회[DOI]
- Donovan LM, "Prevalence and characteristics of central compared to obstructive sleep apnea : analyses from the Sleep Heart Health Study cohort", Sleep, 39, pp.1353~1359 (2016)
- Johnson KG, "Frequency of sleep apnea in stroke and TIA patients : a meta-analysis", J Clin Sleep Med, 6, pp.131~137 (2010)
- 한수현, "체인스토크스 호흡과 급성 뇌경색의 예후", Journal of sleep medicine, 16(2), pp.81~87 (2019), 대한수면연구학회[DOI]
- Hanly PJ, "Increased mortality associated with Cheyne-Stokes respiration in patients with congestive heart failure", Am J Respir Crit Care Med, 153, pp.272~276 (1996)
- Lanfranchi PA, "Prognostic value of nocturnal Cheyne-Stokes respiration in chronic heart failure", Circulation, 99, pp.1435~1440 (1999)
- Rowat AM, "Central periodic breathing observed on hospital admission is associated with an adverse prognosis in conscious acute stroke patients", Cerebrovasc Dis, 21, pp.340~347 (2006)
- Andrews P, "Year in review in intensive care medicine, 2004. III. Outcome, ICU organisation, scoring, quality of life, ethics, psychological problems and communication in the ICU, immunity and hemodynamics during sepsis, pediatric and neonatal critical care, experimental studies", Intensive Care Med, 31, pp.356~372 (2005)
- Bento L, "Autonomic nervous system monitoring in intensive care as a prognostic tool. Systematic review", Rev Bras Ter Intensiva, 29, pp.481~489 (2017)
- Mortara A, "Abnormal awake respiratory patterns are common in chronic heart failure and may prevent evaluation of autonomic tone by measures of heart rate variability", Circulation, 96, pp.246~252 (1997)
- Ponikowski P, "Oscillatory breathing patterns during wakefulness in patients with chronic heart failure : clinical implications and role of augmented peripheral chemosensitivity", Circulation, 100, pp.2418~2424 (1999)
- Rupprecht S, "Central sleep apnea indicates autonomic dysfunction in asymptomatic carotid stenosis : a potential marker of cerebrovascular and cardiovascular risk", Sleep, 33, pp.327~333 (2010)
- Mortara A, "Association between hemodynamic impairment and Cheyne-Stokes respiration and periodic breathing in chronic stable congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy", Am J Cardiol, 84, pp.900~904 (1999)
- Lucreziotti S, "Five-minute recording of heart rate variability in severe chronic heart failure : correlates with right ventricular function and prognostic implications", Am Heart J, 139, pp.1088~1095 (2000)
- Maier C, "Central sleep apnea detection from ECG-derived respiratory signals. Application of multivariate recurrence plot analysis", Methods Inf Med, 49, pp.462~466 (2010)