无创正压通气对睡眠呼吸暂停综合征合并心律失常的影响

Effects of noninvasive positive pressure ventilation on patients with arrhythmia complicated by sleep apnea syndrome

目的 探讨睡眠呼吸暂停综合征（SAS） 合并心律失常患者在常规应用心血管药物基础上联合无创正压通气（NPPV）治疗的意义。 方法 选择多导睡眠监测（PSG）及心电图或动态心电图确诊为中、重度SAS合并心律失常患者135例，按照随机方法分为NPPV组（69例）和对照组（66例）,对照组单纯行心内科常规药物治疗，NPPV组在常规药物治疗基础上加用NPPV, 治疗3个月后复查相关指标。 结果 （1）NPPV组治疗前后比较，ESS评分、呼吸暂停低通气指数（AHI）、微觉醒指数均明显下降，分别是8.25±5.41 和4.08±3.43、39.95±7.32和4.71±1.80、39.69±4.40和15.20±2.05，P均〈0.05；Ⅲ期及快速动眼期睡眠时间明显增加最低血氧饱和度升高，分别是（4.53±2.10）% 和（16.78±2.59）% 、（8.37±1.380）% 和（15.25±1.41）%、（77.15±6.72）%和（93.35±2.03）%，P均〈0.01。（2）NPPV组治疗前后比较，窦性心动过缓、窦性心动过速、窦性停搏、房性早搏、室性早搏、短阵性房性心动过速、短阵性室性心动过速、心房颤动、二～三度房室传导阻滞、无症状ST-T段改变发生率由57.4%、44.4%、7.4%、20.4%、13.0%、36.5%、12.0%、8.3%、37.0%、53.7%下降为4.6%、1.9%、0.0%、3.7%、2.8%、7.0%、0.9%、0.0%、1.9%、4.6%，P均〈0.05。夜间各种心律失常发生的总次数明显减少（P均〈0.01），HRV各指标均升高（P〈0.01）。夜间心律失常总次数与AHI呈正相关，与最低血氧饱和度呈负相关（P均〈0.01）。 结论 对SAS合并心律失常患者，在常规应用心血管药物治疗基础上积极采用NPPV治疗，能降低心律失常发生率，显著减少夜间心律失常发生次数，疗效优于单纯药物治疗。

Objective To investigate the clinical efficacy of noninvasive positive pressure ventilation （NPPV） in treatment of patients with arrhythmia complicated by sleep apnea syndrome （SAS）. Methods One hundred and thirty-five arrhythmia patients with polysomnography diagnosed SAS were randomly divided into NPPV group （69 cases） and control group （66 cases ） , the NPPV group was treated with standard medications and NPPV, and the control group was treated with standard medications. SAS related parameters were compared between the groups after 3 months therapy. Results （ 1 ） Epworth sleepiness scale （ ESS ） score, apnea-hypopnea index （ AHI ） and arousal index were significantly lower （8.25±5.41 vs. 4.08±3.43, 39.95±7.32 vs. 4.71±1.80 and 39.69±4.40 vs. 15.20±2.05, P〈 0. 01 ） while not rapid eye movement （NREM） Ⅲ and rapid eye movement stage of sleep time and lowest pulse oxygen saturation （ LSaO2 ） were significantly higher in NPPV group than in control group [ （ 4. 53 ± 2.10）% vs. （16.78 ±2.59）%,（8.37 ± 1.380）% vs. （15.25 ± 1.41）%, （77.15 ±6.72）% vs. （93.35 ± 2.03 ）% , P 〈 0. 01 ] after 3 months therapy. （2） Incidence of Sinus bradyeardia, sinus tachycardia, sinus arrest, atrial premature beats, ventricular premature beats, paroxysmal atrial tachycardia, paroxysmal ventricular tachycardia, atrial fibrillation, Ⅱ - Ⅲ degree atrioventricular block, ST-T segment changes were reduced from 57.4% , 44. 4% , 7.4% , 20. 4% , 13.0% , 36. 5% , 12. 0% , 8.3% , 37.0% ,53.7% to 4. 6%,1.9%,0.0%,3.7%,2.8%,7.0%,0.9%,0.0%,1.9%,4.6% （all P〈0.05） and the total number of arrhythmias happened at night were significantly lower （ all P 〈 0. 05） while the heart rate variability （HRV） were significantly higher （P 〈 0. 01 ） in NPPV group than in control group; AHI was positively while LSaO2 was negatively correlated with the total night arrhythmia number （P 〈 0. 01 ）. Conclusion Noninvasive positive pressure ventilation is an effective therapy strategy for treating patients with arrhythmia eomplieated by sleep apnea syndrome.