阻塞性睡眠呼吸暂停相关性高血压与心律失常的研究

Cardiac arrhythmia in patients with obstructive sleep apnoea-related hypertension

目的 探讨阻塞性睡眠呼吸暂停相关性高血压（OSA-RH）患者心律失常的发生,并通过心率变异性（HRV）研究以探讨其自主神经机制.方法 选取2013年5月至2015年3月就诊于大连医科大学附属第一医院心内科高血压患者150例,所有患者均行多导睡眠监测（PSG）、同步24 h动态心电图和24 h动态血压监测（ABPM）.根据PSG的睡眠呼吸紊乱指数（AHI）将患者分为原发性高血压组（EHT）55例、OSA-RH组95例,对OSA-RH组分为轻度组16例（5≤AHI〈15）、中度组23例（15≤AHI〈30）及重度组56例（AHI≥30）3组.应用t检验进行2组间一般资料的比较,包括身高、体重、性别、年龄、超敏C反应蛋白（hs-CRP）,红细胞计数（RBC）,尿微量白蛋白/肌酐（MA/Cre）,血脂,空腹血糖,肌酐,左心房及左心室内径等）,使用χ2检验比较2组间各指标的差异.结果 OSA-RH组与EHT组心律失常的发生率分别为69.5％、20.0％,OSA-RH组（95例）轻、中、重度3个亚组心律失常的发生率分别为37.5％、52.2％、85.7％.阻塞性睡眠呼吸暂停综合征（OSAS）引起的窦性心动过缓（49.5％）、偶发室性早搏（41.1％）多见,OSA-RH组与EHT组MA/Cre差异有统计学意义（P〈0.05）,2组体质指数（BMI）、左心房及左心室内径差异有统计学意义（P〈0.01）,空腹血糖、血脂、肌酐、年龄、性别、RBC、hs-CRP差异无统计学意义（P〉0.05）;OSA-RH组与EHT组相比,心率变异性（HRV）的指标所有心搏RR间期的标准差（SDNN）、低频（LF）及LF/HF（高频）均明显升高,差异具有统计学意义（P〈0.01）;反映血压变异性的指标24 h收缩压标准差（24 hSSD）、白天收缩压标准差（dSSD）、夜间收缩压标准差（nSSD）明显升高,差异有统计学意义（P〈0.01）;结论 OSA-RH患者较单纯高血压患者更易发生心律失常,且心律失常的发生与OSAS严重程度呈正相关.在OSAS引起的心律失常类型中,以窦性心动过缓及室性早搏多见,与轻度和中度OSAS患者相比,重度OSAS患者缓慢性心律失常及快速性心律失常发生率均明显升高.HRV反映的自主神经功能紊乱可能是促发心律失常的重要因素.

Objective The purpose of this study was to investigate the incidence of arrhythmia in obstructive sleep apnoea-related hypertension （ OSA-RH ） , and to evaluatesits possible mechanisms of autonomic nerve function. Methods We assessed 150 patients with hypertension who were admitted to hypertension ward.All patients with hypertension were evaluated by completed polysomnography（PSG）,24-hour ambulatory blood pressure monitoring （ ABPM ） and 24-hour dynamic electrocardiogram. According to apnea hypopnea index （ AHI ） , these patients were divided into two groups：OSA-RH group （ n=95 ） and essental hypertension（EHT）group（n=55）.And OSA-RH group were subdivided into three groups according to the severity of the esverity of obstructive sleep apnea（ OSAS） ,the mild group（ n=16） ,moderate group（ n=23）,and severe group（n=56）.The test was used for the data comparison between the 2 groups（hight,wight, gender,age, Hypersensitive c-reactive protein （ hs-CRP ） . red blood cell, left atrial diameter, left ventricular diameter）.χ2 test was used to evaluate the difference between indicators from two groups. Results The incidence of arrhythmias in OSA-RH groups and EHT groups was 69. 5% and 20. 0% respectively.Besides,the incidence of arrhythmias among OSA-RH groups was different,37. 5%in mild group accounts,52. 2% in moderate group and 85. 7% in severe group.The common types of arrhythmias in patients with OSAS were sinus bradycardia（49. 5%） and ventricular premature beats （ 41. 1%） . Glucose （ GLU ） , Total cholesterol （ TC ） , Triglycerides （ TG ） , High density lipoprotein（HDL-C）,Low density lipoprotein（LDL-C）,Hypersensitive c-reactive protein（hs-CRP）,red blood cell,gender,age between the two groups showed no difference.But the Body mass index（BMI）,left atrial diameter,left ventricular diameter and MA/Cre were significant differences（P〈0. 01 and P〈0. 05）.SDNN,LF, LF/HF were increased significantly in OSA-RH group（P〈0. 01）.24 hSSD,dSSD,nSSD were raised obviously in OSA-RH group（P〈0. 01）.Conclusion The incidence of arrhythmias in OSA-RH group was much higher than in EHT group.Furthermore,cardiac arrhythmias were positively correlated with OSA severity. The common types of arrhythmias in patients with OSAS were sinus bradycardia and occasional ventricular premature beat. Compared with mild and moderate group patients,severe group patients had higher incidence of bradyarrhythmias and rapid-arrhythmia.The autonomic nerve dysfunction in OSAS may be a crucial factor that contributes to cardiac arrhythmias.