阻塞性睡眠呼吸暂停综合征患者心律失常的发生与心率变异性分析

The incidence of arrhythmia in patients with obstructive sleep apnea syndrome and its correlation with heart rate variability

目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)患者心律失常的发生,与心率变异性(HRV)分析。方法收集OSAS患者共212例,根据呼吸暂停低通气指数(AHI)将患者分为三组:AHI <5作为对照组,5≤AHI<30作为轻-中度组,AHI≥30作为重度组。收集患者睡眠呼吸监测指标和动态心电图指标。比较各组心律失常的发生情况及HRV参数。结果重度组房性心动过速、窦性心动过缓发生率高于轻中度组(13.3%vs 3.28%;12.50%vs 4.91%,P<0.05)。重度组短阵房性心动过速发作频率>100阵的比例显著高于对照组和轻中度组(11.67%vs 0;11.67%vs 1.64%,P<0.05)。重度组与对照组比较RR间期标准差的平均值(SDNN)差异有显著性。平均血氧饱和度、最低血氧饱和度、氧减指数(ODI)、血氧低于90%以下的总时间占睡眠总时间的百分比(T90)在重度组与轻中度组之间比较有显著性差异(P<0.05)。重度组与对照组比较最低血氧饱和度、ODI有显著性差异(P<0.05)。OSAS患者的低频、高频(HF)与AHI呈正相关(P<0.05或<0.01),T90与SDNN及HF呈正相关(P<0.05或<0.01)。结论 OSAS患者更易发生心律失常,重度组比轻中度组发生率更高,OSAS患者夜间反复发作的低氧血症与自主神经功能紊乱可能是导致心律失常发生的重要因素。

Objective To investigate the occurrence of arrhythmia in patients with obstructive sleep apnea syndrome(OSAS)and to analyze its correlation with heart rate variability(HRV). Methods A total of 212 suspected OSAS patients were enrolled from January 2016 to December 2017.According to the apneahypopnea index(AHI),the patients were divided into three groups:AHI<5 as a control group,5≤ AHI<30 as a mild-moderate group,AHI≥ 30 as a severe group.Collected the PSG and HRV parameters.The incidence of arrhythmia in each group was compared,as well as the differences between the PSG and HRV parameters. Results The incidence of atrial arrhythmiaand sinus bradycardia in the severe group was higher than that in the mild to moderate group.The proportion oftheparoxysmal atrial tachycardia frequency <10 array in the mild to moderate group and the severe group was significantly higher than that in the control group.The difference of SDNN between the severe group and the control group was significant(P<0.05).The average time of total oxygen saturation,minimum oxygen saturation,oxygen deprivation index(ODI),and blood oxygen less than 90% of total sleep time(T90)were statistically significant among the three groups and the difference between the severe group and the mild to moderate group was also significant(P<0.05),and the difference of minimum oxygen saturation and ODI between the severe group and the control group were significant(P<0.05).In the correlation analysis,the low frequency(LF)and the high frequency(HF)of OSAS patients were positively correlated with AHI(P<0.05 or 0.01),and T90 was positively correlated with SDNN and HF(P<0.05 or<0.01). Conclusion OSAS patients are more prone to arrhythmia,Severe group has a higher incidence than mild to moderate group.Recurrent hypoxemia and autonomic nerve dysfunction in OSAS patients may be important factors of occurance of arrhythmia.