睡眠呼吸暂停综合征所致的心脏传导阻滞6例报告

Heart block resulted from sleep apnea syndrome: a report of 6 cases

目的 报告６ 例睡眠呼吸暂停（ＳＡ）引起的心脏传导阻滞， 探讨其发生机制及诊疗特点。方法 ６ 例患者均无心血管疾病史， 均经日间心电图检查。在ＢｉＰＡＰ 呼吸机治疗前及治疗过程中按国际标准方法应用多导生理记录仪（ＰＳＧ）同步监测口鼻气流、胸部及腹部呼吸运动、血氧饱和度（ＳａＯ２）、脑电图、眼动图、肌电图及Ⅱ导心电图。结果 ６ 例患者均符合阻塞型睡眠呼吸暂停综合征（ＯＳＡＳ） 的诊断， 日间心电图（ＥＫＧ） 正常。ＰＳＧ 睡眠呼吸监测发现４ 例睡眠时存在Ⅱ～Ⅲ度房室传导阻滞（ＡＶＢ） ，１ 例窦性停搏伴交界逸搏，１ 例Ⅱ度窦房阻滞（ 莫氏型） ， 最长Ｒ－ Ｒ间期２－５（２－０ ～２－８）ｓ。心脏传导阻滞多发生在睡眠呼吸暂停即将结束时， 与最长呼吸暂停及最低ＳａＯ２ 的出现相关， 经鼻应用ＢｉＰＡＰ呼吸机治疗彻底去除ＳＡ后， 心脏传导阻滞也随之消失。１ 例行悬雍垂咽软腭成形术（ＵＰＰＰ），３ 例应用正压通气机长期家庭治疗， 随诊１～４ 年， 效果良好。结论 ＳＡ引起的缺氧及迷走神经张力增高是发生心脏传导阻滞的主要机制， 心电Ｈｏｌｔｅｒ 监测可以发现较多的心律失常， 提供诊断线索，ＰＳＧ 睡眠呼吸监测是确诊睡眠呼吸暂停综合征、明确心律失常原?

Objective To explore the mechanisms, diagnosis and treatment of the heart block resulted from sleep apnea syndrome(SAS).Methods Six male patients, with no history of heart disease and normal daytime EKG, had standard polysomonography(PSG) test before and during BiPAP ventilation.Three of them also had Holter monitoring during sleep studies.Results The PSG study showed that four of the patients had Ⅱ degree or Ⅲ degree atrial-ventricular block, one had sinoatrial block, one had sinus arrest, and the occurrence of heart block was closely related to the occurrence of sleep apnea and the subsequent hypoxemia.With the reversal of sleep apnea by BiPAP ventilation, the heart block disappeared .In the long-term follow-up of the four patients, who have had UPPP or regular positive airway pressure ventilation, no heart block recurred.Conclusion The heart block of sleep apnea resulted from the combined effect of cessation of breathing plus hypoxemia.It can be diagnosed by PSG sleep study, and treated with continuous positive airway pressure.