心力衰竭并阻塞性睡眠呼吸暂停低通气综合征患者心率变异性变化及其对预后的影响研究

Change of Heart Rate Variability of Heart Failure Patients Complicated with Obstructive Sleep Apnea Hypopnea Syndrome and the Impact on Prognosis

目的探究心力衰竭并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者心率变异性(HRV)变化及其对预后的影响。方法选取2012年1月—2015年5月秦皇岛市第二医院收治的初发心力衰竭患者364例作为观察组,并根据OSAHS发生情况将患者分为心力衰竭并OSAHS组(A组)219例与心力衰竭无OSAHS组(B组)145例;另选取同期在秦皇岛市第二医院体检健康者180例作为正常对照组。比较A、B两组患者临床资料及预后,3组受检者HRV指标。结果 A、B组患者吸烟史阳性率、疾病类型、美国纽约心脏病学会(NYHA)分级、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、高血压和糖尿病及高脂血症发生率比较,差异无统计学意义(P>0.05)。A、B组患者24 h窦性R-R间期总体标准差(SDNN)、24 h每5 min平均窦性R-R间期标准差(SDANN)、相邻窦性R-R间期差值的均方根(r MSSD)、相邻R-R间期差值>50 ms百分比(PNN50)、总功率(TP)、极低频(VLF)、低频(LF)、高频(HF)低于正常对照组,A组患者SDNN、SDANN、r MSSD、PNN50、TP、VLF、LF、HF低于B组(P<0.05)。A组患者心律失常、心源性猝死发生率及再次入院率高于B组(P<0.05)。结论心力衰竭并OSAHS患者HRV指标低于单纯心力衰竭患者,预后较差。

Objective To explore the change of heart rate variability （HRV） of heart failure patients complicated with obstructive sleep apnea hypopnea syndrome （ OSAHS）, to investigate the impact on prognosis. Methods A total of 364 patients with primary attack of heart failure were selected as observation group in the Second Hospital of Qinhuangdao from January 2012 to May 2015, and they were divided into A group （complicated with OSAHS, n =219） and B group （did not complicate with OSAHS, n = 145 ） according to the complication of OSAHS; a total of 180 healthy people admitted to this hospital for physical examination were selected as control group at the same time. Clinical data and prognosis were compared between A group and B group, and index of HRV were compared among the three groups. Results No statistically significant differences of positive rate of smoking history, categories of disease, NYHA grading, LVEF, LVEDD, incidence of hypertension, diabetes or hyperlipidaemia was found between A group and B group （P 〉 0. 05）. SDNN, SDANN, rMSSD, PNN50, TP, VLF, LF and HF of A group and B group were statistically significantly lower than those of control group, meanwhile SDNN, SDANN, rMSSD, PNN50, TP, VLF, LF and HF of A group were statistically significantly lower than those of B group （P 〈 0. 05）. The incidence of arrhythmia and sudden cardiac death, and hospital readmission rate of A group were statistically significantly lower than those of B group （P 〈 0. 05）. Conclusion Compared with isolated heart failure patients, HRV of heart failure patients complicated with OSAHS is lower, and the prognosis is worse.