动态心电图对阻塞性睡眠呼吸暂停综合征严重程度的预测价值

The predictive value of Holter recordings to detect moderate-severe obstructive sleep apnea syndrome

目的评价动态心电图（Hoher）预测阻塞性睡眠呼吸暂停综合征（OSAHS）严重程度的价值。方法选择2008年1月至2009年7月在我院老年科就诊经多导睡眠分析仪（PSG）检查确诊为OSAHS患者76例，并于1个月内行Hoher榆杏。其中，28例呼吸暂停低通气指数（AHI）≤20诊断为轻度OSAHS，48例AHI〉20诊断为中、蕈度OSAHS。根据Hoher心率变异性分析对13项睡眠窒息危险指标进行评分，总和为睡眠窒息危险总分。将体质指数（BMI）及13项睡眠窒息危险指标各项得分进行logistic二元回归分析，评估Hoher预测OSAHS严重程度的价值。结果轻度OSAHS和中、重度OSAHS患者的性别、年龄，合并高血压、冠心病、糖尿病、高脂血症及服用B受体阻滞剂的临床特征无显著性芹异。严霞程度不同的OSAHS患者Hoher睡眠窒息危险评分总分差异无统计学意义（分别为5．64±2．33和6．42±2．22，P〉0．05）。极低频／总功率百分比〉70％和△白天／夜晚低频功率差异〈-70以及BMI与中、重度OSAHS相关，OR值分别为3．98（1．087～14．596），3．69（1．106～12．285）和1．28（1．062～1．544）（P〈0．05）。结论应用Hoher心率变异性分析指标中的极低频／总功率订分比和△F1天／夜晚低频功率差异以及BMI有助于早期识别中、重度OSAHS患者。

Objective To evaluate the predictive value of Holter ECG recordings for patients with moderate-severe obstructive sleep apnea and hypopnea syndrome （OSAHS）. Methods Holter recordings was performed in 76 patients who were diagnosed OSAHS by po]ysomnography（PSG） within one month from Jail. 2008 to July 2009 in our hospital. Twenty-eight patients were identified as mild OSAHS （AHI~〈20） and forty-eight patients were moderate-to-severe OSAHS （ AHI 〉 20）. The indexes of heart rate variability （HRV） , total scores of thirteen sleep apnea risk indexes of Holter recordings and BMI were analyzed by bivariate Logistic regression analysis. Results Clinical features （eg. Gender, age, complicated with hypertension,coronary heart disease, diabetes mellitus, hyperglycemia, and taken [3-blocker） , total scores, the sum of thirteen sleep apnea risk scores collected by Hoher recordings （5.64 _＋ 2. 33 vs. 6.42 ＋ 2. 22, respectively,P 〉 0. 05 ） were similar between patients with mild OSAHS and moderate-to-severity OSAHS. VLF/Total Power 〉 70% ,the difference of daytime/nighttimeLF Power 〈 - 70 and BMI were independent predictors of moderate-to-severe OSAHS with OR 3.98 （ 1. 087 - 14. 596 ） , 3.69 （ 1. 106 - 12. 285 ） and 1.28 （ 1. 062 - 1. 544） ,respectively （ all P 〈 0. 05 ）. Conclusions VLF/Total Power and the difference of daytime/nighttime LF Power and BM1 could be used as screening parameters to recognize patients with moderate-to-severe OSAHS.