目的 探讨心率变异性(HRV)及心率减速力(DC)与阻塞性睡眠呼吸暂停低通气综合征(OSAHS)诊断指标的相关性。方法 收集在我院就诊的以白日嗜睡或夜间睡眠打鼾为主诉的101例患者,根据紊乱指数(AHI)分为:对照组(AHI<5)、轻中度组(5≤AHI≤30)、重度组(AHI>30),均进行呼吸睡眠监测(PSG)及24小时动态心电图(HCG)检查,记录PSG参数及HRV指标、DC值,并进行统计学分析。结果 AHI、氧减指数(ODI)、血氧低于90%以下的总时间占睡眠总时间的百分比(T90)、最低氧饱和度(SaO
2min)、全部窦性心搏RR间期的标准差(SDNN)、低频功率(LF)、高频功率(HF)及LF/HF在对照组、轻中度组及重度组间比较差异均具有统计学意义(
P<0.05);SDANN、rMSSD、PNN50在重度组与轻中度组、重度组与对照组之间差异具有统计学意义(
P<0.05);在OSAHS组中SDNN、LF/HF与AHI、ODI、T90具有相关性(
P<0.05),DC值与AHI呈负相关(
P<0.05)。结论 HRV指标尤其是LF/HF及DC值对OSAHS的初筛及预后评估有重要意义。
Abstract
Objective: To discuss the correlation between heart rate variability(HRV) and deceleration (DC) in obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: The subjects of 101 patients with daytime somnolence or night sleep snoring in our hospital were included and were categorized into three groups according to apnea-hypopnea index (AHI): AHI<5 as control group, 5≤AHI≤30 as mild-to-moderate OSAHS group, AHI>30 as severe OSAHS group.Polysomnography (PSG) test and 24-hour dynamic electrocardiagraphic (DCG) monitoring in all patients were done and PSG parameters, HRV index and DC were recorded and analyzed. Results: Statistically significant differences were found in HRV index, such as SDNN, LF, LF and LF/HF and PSG parameters, such as AHI, ODI, T90 and SaO
2min in between groups. SDANN, rMSSD and PNN50 results revealed significant difference between control group, mild-to-moderate OSAHS group and severe OSAHS group.In the OSAHS group, SDNN and LF/HF were positively linked to AHI, ODI and T90 while DC and AHI were negatively related. Conclusion: HRV index especially LF/HF and DC are important for assessing the prognosis and detecting OSAHS.
关键词
OSAHS/动态心电图/心率变异性
Key words
OSAHS/dynamic electrocardiagraphic (DCG) monitoring/HRV
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 中华医学会呼吸病学分会睡眠呼吸障碍学组.阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011年修订版)[J].中华结核和呼吸杂志,2012,35(1):9-12.
[2] Sharma SK, Vasudev C, Sinha S, et al. Validation of the modified Berlin questionnaire to identify patients at risk for the obstructive sleep apnoea syndrome[J]. Indian J Med Res, 2006,124(3): 281-290.
[3] Zinchuk AV, Gentry MJ, Concato J, et al. Phenotypes in obstructive sleep apnea: A definition, examples and evolution of approaches[J]. Sleep Med Rev,2017,35: 113-123.
[4] Nagayoshi M, Punjabi NM, Selvin E, et al. Obstructive sleep apnea and incident type 2 diabetes[J]. Sleep Med, 2016,25: 156-161.
[5] Park DH, Shin CJ, Hong SC, et al. Correlation between the severity of obstructive sleep apnea and heart rate variability indices[J]. Journal of Korean Medical Science, 2008, 23 (2):226-231.
[6] Ewing DJ, Campbell IW, Clarke BF, et al.The natural history of diabetic autonomic neuropathy[J]. The Quarterly Journal of Medicine,1980, 49(193):95-108.
[7] Tascilar E, Yokusoglu M, Dundaroz R, et al. Cardiac autonomic imbalance in children with allergic rhinitis[J]. The Tohoku Journal of Experimental Medicine, 2009, 219(3):187-191.
[8] Guilleminault C, Connolly S, Winkle R, et al. Cyclical variation of the heart rate in sleep apnoea syndrome, mechanisms, and usefulness of 24 h electrocardiography as a screening technique[J]. Lancet, 1984, 8369(1):126-131.
[9] Fletcher E, Miller J, Schaaf J, et al.Urinary catecholamines before and after tracheostomy in patients with obstructive sleep apnea and hypertension[J]. Sleep, 1987, 10(1):35-44.
[10] Marrone O, Riccobono L, Salvaggio A, et al.Catecholamines and blood pressure in obstructive sleep apnea syndrome[J]. Chest Journal, 1993, 103(3):722-725.
[11] Grimm W, Koehler U.Cardiac arrhythmias and sleep-disordered breathing in patients with heart failure[J]. Int J Mol Sci, 2014,15(10): 693-705.
[12] Karasulu L, Dalar L, Sökücü S, et al. Heart rate variability analysis of single-channel electrocardiogram can help to differentiate high-risk patients with obstructive sleep apnea syndrome: a study on diagnostic accuracy[J].Anadolu Kardiyol Derg, 2012, 12: 331-338.
[13] Aydin M, Altin R, Ozeren A, et al. Cardiac autonomic activity inobstructive sleepapnea[J].Tex Heart Inst J,2004,31(2):132.
[14] Mehra R, Stone KL, Varosy PD, et al. Nocturnal Arrhythmias across a spectrum of obstructive and central sleep-disordered breathing in older men: outcomes of sleep disorders in older men (MrOS sleep) study[J]. Arch Intern Med, 2009,169 (12): 1147-1155.
[15] 温华之.阻塞性睡眠呼吸暂停综合征患者心律失常的发生与心率变异性分析[C]//中国睡眠研究会.中国睡眠研究会第十一届全国学术年会论文汇编.北京:中国睡眠研究会,2019:1.
[16] Gula LJ, Krahn AD, Skanes A, et al. Heart rate variability in obstructive sleep apnea: a prospective study and frequency-domain analysis[J]. Ann Noninvasive Electrocardiol, 2003, 8: 144-149.