应用心率变异性时域和频域指标初筛阻塞性睡眠呼吸暂停综合征

Screening of obstructive sleep apnea syndrome from time-domain analysis and frequency-domain analysis of heart rate variability

目的 以多导睡眠分析仪 (PSG)作为金标准,比较心率变异性 (HRV)的时域和频域指标初筛阻塞性睡眠呼吸暂停综合征 (OSAS)的可行性。方法 2003年 7月至 2003年 12月对在我院睡眠中心进行整夜PSG睡眠监测的患者同步进行动态心电图检查,由睡眠中心提供连续 48例OSAS(阳性 )患者作为试验组, 47例OSAS(阴性 )患者作为对照组。动态心电图分析者在不知道患者临床情况和PSG结果的情况下独立作出OSAS(阳性 )与OSAS(阴性 )的诊断,并比较HRV时域指标与频域指标初筛OSAS的可行性。结果 试验组的平均年龄、男女比值、体重指数、高血压和糖尿病的患病率均明显高于对照组 (P<0 .05);HRV时域指标中,试验组SDNN昼 夜、SDNN指数昼 夜、PNN50夜与对照组相比差异有统计学意义 (P<0. 05);频域指标中,与对照组相比,试验组在总功率夜、总功率昼 夜、VLF夜、VLF昼 夜、LF夜、LF昼 夜等频域指标差异均有统计学意义 (P<0 05 )。而LF/HF这一频域指标,无论是昼、夜,还是昼夜差值,与对照组相比差异均有统计学意义 (P<0 .05 )。其他指标中,试验组仅室性心律失常明显多于对照组 (P<0 .05)。当动态心电图睡眠窒息危险评分 >4为阳性标准时,初筛诊断OSAS的敏感性为 81 .25%,特异性为 46 .81%,诊断符合率 64 21%。

Objective To evaluate the feasibility of screening obstructive sleep apnea syndrome ((OSAS)) from time-domain analysis and frequency-domain analysis of heart rate variability (HRV) via ambulatory electrocardiogram monitoring. Methods The overnight sleep investigation was administered to 95 subjects by polysomnogram (PSG) and 24 hours ambulatory electrocardiogram monitoring simultaneously during July through December, 2003. Forty-eight OSAS positive patients and 47 OSAS negative patients provided by sleep center of this hospital were enrolled into study group and control group,separately. However, the two electrocardiogram analyzers did not know the PSG results at all. They were asked to give the apnea scores by heart rate variability analysis. Results The average age, male gender, body mass index, history of hypertension and diabetes were higher in the study group than those of the control group. The PNN50 (night)、SDNN (day-night) and SDNNI (day-night) among time-domain analysis were more sensitive than other parameters. In frequency-domain analysis of HRV during nocturnal sleep, the mean nighttime Total Power, nighttime VLF Power, nighttime LF Power as well as their difference between day and night in study group were significanly higher than those of control group. The LF to HF ratio was significanly higher than that of control group whatever in daytime, nighttime and difference between day and night (P<0.05). When sleep apnea risk score>4, the sensitivity of screening diagnose of (OSAS) was 81.25%, with the specificity of 46.81%, and the positive predictive value of 64.21%. Whereas, when sleep apnea risk score >5,>6 or >7 respectively, the specificity became gradually higher and the sensitivity and the positive predicting value pretty lower. Conclusion Time-domain analysis and frequency-domain analysis of HRV are helpful to screen the suspicious OSAS patients, and frequency-domain analysis is much more sensitive than time-domain analysis. Ambulatory electrocardiogram monitoring is a simple shortcut useful tool as a non-invasive means for screening OSAS.