AUTO-CPAP治疗对老年阻塞性睡眠呼吸暂停低通气综合征患者心率变异性的影响

Effects of AUTO-CPAP on heart rate variability in elderly patients with obstructive sleep apnea/hypopnea syndrome

目的研究老年阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者心率变异性(HRV)的改变,探讨自动调节持续气道正压通气(AUTO-CPAP)治疗对其的影响。方法根据睡眠呼吸暂停低通气指数(AHI),选取老年轻度(5<AHI≤20)、中重度(AHI>20)OSAHS患者及对照组共3组,每组各20例进行多导睡眠图(PSG)及动态心电图监测,采用时域分析法定量分析HRV,测定全程记录中每5 min窦性心搏R-R(NN)间期标准差的平均值(ASDNN)、所有的窦性心搏RR间期的标准差(SDNN)、全程记录中每5 min NN间期平均值的标准差(SDANN)及相邻NN间期差值的均方根(RMSSD)。其中20例老年中重度OSAHS患者行AUTO-CPAP治疗3月后复查PSG及HRV。结果(1)老年轻度及中重度OSAHS组与对照组比较,SDNN、SDANN的差异均有显著性(P<0.05或P<0.01)。老年中重度OSAHS组与对照组比较,RMSSD的差异也有显著性(P<0.05)。(2)老年中重度OS-AHS组治疗后与治疗前比较,AHI、夜间最低动脉血氧饱和度(SaO2)及SDNN、SDANN、RMSSD的差异均有显著性(P<0.05或P<0.01)。结论老年OSAHS患者的HRV出现异常,AUTO-CPAP治疗可显著改善老年中重度OSAHS患者的HRV。

Objective To study the variations of heart rate variability （HRV） in elderly patients with obstructive sleep apnea/hypopnea syndrome （ OSAHS ） , and to analyze the effects of treatment with auto-continuous positive airways pressure （AUTO-CPAP）. Methods According to apnea hypopnea index（AHI） , 3 groups of subjects were enrolled：eld- erly patients with slight OSAHS （ 5 〈 AHI ≤ 20 ）, patients with moderate and severe OSAHS （ AHI 〉 20 ） and control group, and each group included 20 cases. All subjects were involved in the detection of polysomography （PSG） and HRV. Mean standard deviation of all NN intervals for all 5 min segments of 24 h（ASDNN） , standard deviation of all normal RR intervals （SDNN） , standard deviation of all mean 5 min RR intervals （ SDANN ） and the root mean square successive differences （RMSSD） were recorded. Twenty patients with moderate or severe OSAHS were treated by AUTO-CPAP for 3 months and had PSG and HRV detection repeated. Results ①Compared with control group,the variations of SDNN and SDANN were significantly decreased （P 〈 0. 05 or P 〈 0. 01 ） in patients with OSAHS. Compared with control group, the variations of RMSSD were significantly decreased （P 〈 0. 05 ） in patients with moderate or severe OSAHS. ②After the treatment of AUTO-CPAP, the variations of AHI, SaO2 , SDNN, SDANN and RMSSD of 20 patients with moderate or severe OSAHS were significantly increased （P 〈 0.05）. Conclusions There is an obvious abnormality of HRV in elderly patients with OSAHS,and the treatment of AUTO-CPAP can significantly modify the HRV in elderly patients with moderate or severe OSAHS.