阻塞性睡眠呼吸暂停综合征患者夜间心律失常的临床特征

Nocturnal heart rhythm disorder in patients with obstructive sleep apnea syndrome

目的 探讨阻塞性睡眠呼吸暂停综合征（OSAS）患者夜间心律失常的临床特征.方法 调查分析2010年9月至201 1年8月就诊于河北医科大学第三医院呼吸睡眠科门诊的446例OSAS患者夜间心律失常的发生率、高危因素及发生类型与OSAS严重度之间的相关性.446例患者均接受整夜多导睡眠监测、同步心电监测,根据呼吸暂停低通气指数（AHI）分成轻度（5≤AHI＜ 15次/h）、中度（15≤AHI＜ 40次/h）、重度（AHI≥40次/h）3组,观察并分析3组患者夜间发生心律失常的例数及类型.结果 在446例患者中,心律失常的发生率为24.4％（109/446）.心律失常的发生与OSAS的严重程度和年龄呈正相关（r=1.857,P=0.043和r=1.030,P=0.003）.心律失常以窦性心动过缓（79.8％,87/109）和偶发室性早搏（54.1％,59/109）多见（均P＜0.01）.中度和重度OSAS患者中窦性心动过缓、频发房性早搏、合并2种以上心律失常、心房颤动、房室传导阻滞的发生率分别为50.0％、0、42.9％、7.1％、0和90.9％、14.8％、57.9％、4.5％、5.7％,均显著高于轻度患者（均为0）（均P＜0.05）.结论 OSAS患者夜间心律失常的发生率与其严重度和年龄呈正相关,类型以窦性心动过缓和室性早搏常见;中、重度OSAS患者窦性心动过缓、频发房性早搏、合并2种以上心律失常、心房颤动、房室传导阻滞比轻度患者更多见.

Objective To explore the clinical characteristics of patients with obstructive sleep apnea syndrome （OSAS） and nocturnal arrhythmia.Methods During September 2010 to August 2011,a total of 446 subjects were recruited from Department of Sleep Breathing Disorder,Third Hospital,Hebei Medical University to receive polysomnography examination and electrocardiogram monitoring.According to the results,they were classified as mild （5 ≤ AHI 〈 15/h） or moderate （15 ≤ AHI 〈 40/h） or severe （AHI ≥ 40/h） OSAS.Then the incidence of different types of arrhythmias,risk factors and the relationship with OSAS severity were examined.Results Among 446 patients,the incidence of arrhythmia was 24.4% （109/446）.The severity of OSAS （r =1.857,P =0.043） and age （r =1.030,P =0.003） had a positive relationship with the incidence of arrhythmias.Sinus bradycardia （79.8%,87/109） and accidental ventricular premature beat （54.1%,59/109） were most likely to occur than other types of arrhythmias （P 〈 0.01）.In moderate and severity OSAS patients,the incidence of sinus bradycardia,frequent atrial premature beat,combined over two kinds of arrhythmias,atrial fibrillation and atrioventricular block were 50.0%,0,42.9%,7.1%,0 and 90.9%,14.8%,57.9%,4.5%,5.7% respectively.And they were significantly higher than those of mild patients （all =0） （all P 〈 0.05）.Conclusions Age and severity of OSAS have a positive relationship with the incidence of nocturnal arrhythmias.Sinus bradycardia and ventricular premature beat are the most likely to occur in OSAS patients.In moderate and severe group,sinus bradycardia,frequent atrial premature beat,combined over two kinds of arrhythmias,atrial fibrillation and atrioventricular block are more commonly encountered.