阻塞性睡眠呼吸暂停综合征患者心脏自主神经调节功能改变与心律失常的关系

Relationship of cardiac autonomic nervous dysfunction and cardiac arrhythmia in patients with obstructive sleep apnea syndromes

目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)患者心脏自主神经调节功能改变与心律失常的关系。方法 118例主诉打鼾患者经多导睡眠呼吸监测仪(PSG)行整夜睡眠监测,并同步监测24-h动态心电图。根据呼吸暂停低通气指数(AHI)将118例患者分为重度OSAS组(A组,46例,AHI>40)、轻中度OSAS组(B组,45例,5≤AHI≤40)和单纯鼾症组(C组,27例,AHI<5)。结果 A组时域指标SDNN、SDANN指数均显著低于B组和C组,心率变异性频域指标LF显著高于B组和C组(P<0.05)。相关分析显示,氧减指数(ODI)、血氧低于90%的时间比(T90)、最低血氧饱和度(LSaO2)与SDNN、SDANN指数和LF显著相关(P<0.05)。A组心律失常发生率为71.7%,明显高于B组的48.9%和C组的29.6%(P<0.05)。结论 OSAS患者心率变异性变化与间歇低氧血症相关,心脏自主神经调节功能改变可能是OSAS导致心律失常的重要机制之一。

Objective To investigate the association between cardiac autonomic nervous dysfunction and cardiac arrhythmia in patients with obstructive sleep apnea syndrome （OSAS）. Methods A total of 118 patients with snoring problem underwent an overnight polysomnographic study and the dynamic ECG by Holter at the same time. Based on the results of apnea-hypopnea index （AHI） assessment,the patients were divided into three groups of A（46 cases with AHI〉40）,B （45 cases with 5≤AHI≤40） and C（27 cases with AHI〈5）. Results Compared with groups of C and B, SDNN, SDANN indexes were decreased and LF of heart rate variability（HRV） was increased in group A（P〈0. 05）. There was a significant correlation between the changes of SDNN, SDANN indexes and LF with the changes of oxygen desaturation index, percentage of SaO2〈90% to total sleep time and the lowest SaO2 （P〈0. 05）. The incidence rate of cardiac arrhythmia in group A was 71.7%, which was higher than 48.9% in group B and 29.6% in group C（P〈0. 05）. Conclusion The change of HRV in patients with OSAS is related with nocturnal hypoxemia. Cardiac autonomic nervous dysfunction plays a potential role in cardiac arrhythmia of OSAS patients.