阻塞性睡眠呼吸暂停低通气综合征与心律失常相关性及持续正压通气疗效探讨

Relationship between sleep apnea syndrome and arrhythmias and the effect of continuous positive airway pressure on arrhythmia

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与心律失常的关系及经鼻持续正压通气(nCPAP)治疗OSAS所致心律失常的疗效。方法:对82例睡眠打鼾者同步进行夜间7h以上多导睡眠图(PSG)及24h动态心电图监测,根据PSG结果分为OSAS组64例和对照组(单纯鼾症组)18例,比较组间最长呼吸暂停时间(LAT)、平均呼吸暂停时间(MAT)、呼吸暂停低通气指数(AHI)、最低动脉血氧饱和度(mSaO2)、心律失常发生率及发生类型;对18例中重度OSAS伴心律失常患者行nCPAP治疗,比较治疗前后监测资料。结果:OSAS组LAT、MAT长于对照组,AHI高于对照组,mSaO2低于对照组(均P<0.01),OSAS组心律失常发生率显著高于对照组(P<0.01);并且随着病情加重而升高(P<0.05)。nCPAP治疗后,AHI下降,mSaO2上升,平均每小时心律失常发生次数较治疗前显著减少(均P<0.01)。结论:OSAS与心律失常之间存在显著相关性,OS-AS患者夜间心律失常与低氧血症密切相关,nCPAP可有效减少心律失常的发生。

Objective:To explore the relationship between obstructive sleep apnea syndrome(OSAS)and arrhythmia and the effect of nasal continuous positive airway pressure(nCPAP)on arrhythmia induced by OSAS.Method:Eighty-two snorers were recruited to undergo more than 7 hours nocturnal polysomnography(PSG)and dynamic electrocardiogram(DCG)monitoring,shorers were divided into OSAS group(n=64)and control group(simple snoring group,n=18)based on the results of PSG monitoring.The following parameters were compared:longest apnea time(LAT);mean apnea time(MAT);apnea hypopnea index(AHI);minimum arterial oxygen saturation(mSaO2);arrhythmia frequency and types.18 moderate and severe OSAS patients accompanied by arrhythmia were treated with nCPAP and their parameters were compared before and after treatment.Result:OSAS group had longer LAT and MAT than control group,also larger AHI,while lower in mSaO2(P<0.001).The frequency of cardiac arrhythmia was significant higher in OSAS group than in control group(P<0.01)and was increased with the severity of OSAS(P<0.01).After nCPAP therapy,AHI decreased and mSaO2 increased obviously,the number of cardiac arrhythmia per hour decreased obviously(P<0.001).Conclusion:It suggest that OSAS and arrhythmia significant relationship.During sleep the occurrence of cardiac arrhythmia in OSAS patients is closely related with nocturnal hypoxemia.nCPAP could effectively decrease the occurrence of arrhythmia.