心房起搏对老年睡眠呼吸暂停综合征作用的影响

Effect of atrial pacing on the sleep apnea syndrome in elderly patients

目的:探讨老年睡眠呼吸暂停综合征(sleep apnea syndrome,SAS)患者睡眠时用心房起搏方式增加心率的治疗作用。方法:因症状性心动过缓行心房心室同步起搏的中枢型或阻塞型老年SAS患者16例,每例患者连续3晚经多导睡眠图检查等监测,第1晚所有患者进行基础评估后随机分组,第2晚一组自身心律模式、另一组心房超速起搏模式(夜间基础平均窦性心率基础上增加15次/min)下评估,第3晚两组监测模式互换,分析比较两种不同模式总的睡眠呼吸暂停和低通气事件。结果:基础评估24h自身平均窦性心率为(55±9)次/min,较心房超速起搏模式频率[(72±4)次/min]差异有统计学意义(P<0.05);自身节律模式时总的睡眠时间为(322±48)min,与心房超速起搏模式[(330±52)min]比较差异无统计学意义(P>0.05);低通气指数从自身节律模式时的9±3减少到心房超速起搏模式时的3±3(P<0.01);呼吸暂停/低通气指数从自身节律模式时的28±21减少到心房超速起搏模式时的10±13(P<0.01)。结论:心房超速起搏可明显降低中枢性与阻塞性老年SAS患者睡眠呼吸暂停事件的发生,而不减少总的睡眠时间。

Objective To evaluate the efficacy of atrial pacing to increase the heart rate during sleep in elderly patients with sleep apnea syndrome. Methods Sixteen elderly patients with central type or obstructive type sleep apnea received permanent atrial-synchronous ventricular pacemakers for symptomatic sinus bradycardia were analysed in this study. All patients received polysomnographic evaluations for 3 consecutive nights. All patients were evaluated at the base-line, and then were randomly divided into 2 groups at the first night. In the following 2 nights, one group was monitored in spontaneous rhythm model and the other in dual-chamber pacing model with atrial overdrive （ increasing by 15 beats per minute on the basic rate of the mean nocturnal sinus ） , and then the two groups were switched at the third night. The total duration and number of episodes of sleep apnea or hypopnea were analyzed, and compared between the two models. Results The mean 24 h sinus rate in the spontaneous rhythm mode was 55 ±9 beats per minute at the base line, as compared in the 72±4 beats per minute in the atrial overdrive pacing model. There was statistic significant difference between the 2 models （ P 〈 0.05 ）. There was no difference in the total duration of sleep between spontaneous rhythm model and atrial overdrive pacing model [ （322±48 ） minutes vs （330±52 ） minutes, P 〉 0. 05 ]. The hypopnea index reduced from 9±3 in the spontaneous rhythm model to3 ± 3 in the atrial overdrive pacing model （ P 〈 0.01 ）. The index of apnea and hypopnea was 28 ±21 in the spontaneous rhythm model, as compared with 10±13 in the atrial overdrive pacing model （ P 〈 0.01 ）. Conclusion Atrial overdrive pacing can significantly reduce the number of episodes of central type or obstructive type sleep apnea, but doesn＇t decrease the total sleep time in elderly patients with sleep apnea syndrome.