老年人阻塞性睡眠呼吸暂停综合征与心律失常关系的探讨

Relationship between arrhythmia and obstructive sleep apnea syndrome of the elderly

目的 探讨老年人阻塞性睡眠呼吸暂停综合征 (OSAS)与心律失常发生、发展的关系。 方法 选择拟诊老年OSAS患者 12 0例和健康对照组 4 0例进行多导睡眠图或脉搏血氧监测和动态心电图 (holter)监测分析。 结果 OSAS组中 ,睡眠呼吸暂停 低通气指数 (AHI)、动脉血氧饱和度(SaO2 )降低大于 0 0 4的总次数、SaO2 低于 0 9的时间明显高于健康对照组 (均为P <0 0 0 1) ;睡眠中SaO2 最低值、平均值均低于对照组 (均为P <0 0 0 1) ;在轻、中、重度组间两两比较上述指标也有显著性意义 (均为P <0 0 0 1)。轻、中、重度OSAS患者心律失常的发生率分别为 6 3%、78%、94 % ;与对照组 (34% )相比 ,轻度组差异无显著性 (P >0 0 5 ) ,中、重度组的心律失常发生率则显著升高 (P <0 0 5 ,P <0 0 1) ;在轻、中、重度组间两两比较 ,心律失常发生的总次数和每小时的发生次数差异也有显著性 (均为P <0 0 1)。 结论 OSAS病情越严重 ,睡眠时SaO2 降低的程度越显著 ,低氧血症也越明显 ,心律失常的发生与睡眠时相和SaO2 降低的程度显著相关 ,OSAS患者心律失常的发生可能与低氧血症有关。

Objective To study the relationship between obstructive sleep apnea syndrome(OSAS) in the elderly and the occurrence and development of arrhythmia. Methods A total of 120 OSAS patients and 40 normal controls were selected and their polysomnography(PSG) or dynamic blood oxygen and analyzed holter were monitored. Results The total number of the reduction in apnta hypopnea index (AHI) and arterial orygen saturation (SaO 2) over 0.04 and the lasted period during SaO 2<0.9 in the OSAS group are obviously higher than those of the control group(P<0.001); the lowest and mean values of SaO 2 during sleeping are lower than the control group(P<0.001). The above indexes also showed notable significance vs controls among mild, intermediate and serious groups(P<0.001). The incidences of arrhythmia in the mild, intermediate and serious OSAS patients were 63%, 78% and 94% respectively. Compared with the control group (34%), the incidence of the mild group showed no significance(P>0.05), while the incidences of the intermediate and serious groups significantly increased(P<0.05, P<0.01); in contrast, between mild and intermediate, mild and serious, and intermediate and serious groups, the total occurring number and the number occurring per hour of arrhythmia showed significance(P<0.01). Conclusions The more serious the OSAS, the more significant the reduction degree of SaO 2 during sleeping and the more obvious hypoxemia. The occurrence of arrhythmia significantly related with the sleeping stages and the reduction degree of SaO 2 during sleeping. The occurrence of arrhythmia in OSAS patients may be related with hypoxemia.