摘要
目的研究阻塞性睡眠呼吸暂停（ＯＳＡ）患者夜间睡眠时自主神经功能的状态，以及有效的持续正压通气治疗对自主神经张力的影响。方法对５６例重度ＯＳＡ患者持续正压通气（ＣＰＡＰ）治疗前和治疗中进行夜间７小时多导睡眠图（ＰＳＧ）及动态心电图监测，另择３０名正常受试者作为对照。采用心率功率谱分析法（ＨＲＰＳＡ）定量分析ＯＳＡ患者治疗前后夜间自主神经功能的变化。结果ＯＳＡ组夜间睡眠时伴随着反复的呼吸暂停和低氧血症，低频（ＬＦ）及高频（ＨＦ）值逐渐增高，与对照组比较差异有显著性（ＬＦ为１３８３±３０５∶１２５±６４，Ｐ＜０．００１；ＨＦ为６６２±１９０∶１６３±７８，Ｐ＜０．００１），表明交感神经和副交感神经张力均明显增高。夜间平均ＬＦ／ＨＦ比率在较高水平（２１１±１０１），与对照组（０８７±０６４）比较差异有显著性（Ｐ＜０．０５），说明以交感神经张力增加更为显著。经过有效的ＣＰＡＰ治疗，ＯＳＡ患者ＬＦ（２２１±８１）、ＨＦ（２２１±１０８）明显降低（Ｐ＜０．００１）。结论ＯＳＡ患者夜间有自主神经功能紊乱。
Objective Heart rate power spectral analysis (HRPSA) can provide information of sympathetic and vagus activities. The aim of the study was to investigate nocturnal variations of autonomic nervous system (ANS) before and during continuous positive airway pressure (CPAP) treatment in patients with OSA. Method 56 subjects with severe OSA were recruited to undergo 7hour nocturnal polysomnography and ECG monitoring in sleep lab before and during CPAP treatment. 30 subjects without OSA were included as controls. Subjects were excluded if they were receiving medications known to influence ANS activities. ANS was evaluated by HRPSA. Result In addition to repeated sleep apneas and oxygen desaturations, mean areas of LF (1 383±305) and HF (662±190) in OSA subjects were significantly higher than those in the controls (LF 125±64, P<0.001; HF 163±78, P<0.001). With effective CPAP treatment, LF (221±81) and HF (221±108) decreased remarkably (P<0.001, separately) and reached the levels of controls (P>0.05, separately). Conclusion The results suggested that nocturnal ANS activities are abnormal in patients with OSA, especially the enhancement of sympathetic nervous activity. Fluctuation of ANS induced by apnea and oxygen desaturation may explain the association between OSA and cardiovascular diseases. CPAP treatment is effective in improving ANS activities by way of eliminating apnea and reversing hypoxemia.
出处
《中华结核和呼吸杂志》
CSCD
北大核心
1998年第8期480-483,共4页
Chinese Journal of Tuberculosis and Respiratory Diseases
