心率变异性与阻塞性睡眠呼吸暂停患者脑小血管病的相关性

Correlation between heart rate variability and cerebral small vessel disease in patients with obstructive sleep apnea

目的探讨心率变异性(heart rate variability,HRV)与阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)患者脑小血管病(cerebral small vessels disease,CSVD)的相关性。方法连续收集2019年7月至2020年7月在威海市立医院接受多导睡眠监测和颅脑MRI检查的OSA患者为研究对象进行横断面分析。分析患者睡前清醒状态下5 min HRV。根据CSVD总体负担将患者分为CSVD组和非CSVD组,比较两组患者人口统计学数据、临床资料、多导睡眠监测参数以及HRV时域和频域参数。应用多变量logistic回归分析确定OSA患者HRV参数与CSVD的相关性。结果共纳入100例OSA患者,男性79例(79.0%),年龄(52.36±8.66)岁,呼吸暂停低通气指数(apnea-hypopnea index,AHI)(38.70±24.65)次/h。CSVD组46例(46.0%),非CSVD组54例(54.0%)。单变量分析显示,CSVD组年龄、AHI、氧减指数(oxygen desaturation index,ODI)、血氧饱和度<90%时间占总睡眠时间百分比(T90)、相邻RR间期差值均方根(square root of the mean of the sum of the squares of the difference between adjacent RR intervals,RMSSD)、高频功率(power in high frequency range,HF)、低频(power in low frequency range,LF)与HF比值(LF/HF)与非CSVD组差异有统计学意义(P均<0.05)。多变量logistic分析显示,在校正年龄、体重指数、收缩压、AHI、ODI和T90后,RMSSD(优势比0.625,95%置信区间0.389~0.981;P=0.041)和LF/HF比值(优势比1.429,95%置信区间1.011~2.020;P=0.043)是OSA患者CSVD的独立影响因素。结论OSA合并CSVD患者的LF/HF升高且RMSSD下降,提示交感神经兴奋性增高和迷走神经功能下降,这可能是OSA患者发生CSVD的病理生理学机制之一。

Objective To investigate the correlation between heart rate variability(HRV)and cerebral small vessel disease(CSVD)in patients with obstructive sleep apnea(OSA).Methods Patients with OSA received polysomnography and brain MRI examination in Weihai Municipal Hospital from July 2019 to July 2020 were consecutively collected for cross-sectional analysis.The 5 min HRV before sleep(awake state)was analyzed.The patients were divided into CSVD group and non-CSVD group according to the overall burden of CSVD.The demographic data,clinical data,polysomnography parameters and HRV time domain and frequency domain parameters were compared between the two groups.Multivariate logistic regression analysis was used to determine the correlation between the HRV parameters and CSVD in patients with OSA.Results A total of 100 patients with OSA were enrolled,including 79 males(79.0%),aged 52.36±8.66 years,apnea hypopnea index(AHI)38.70±24.65/h.There were 46 patients(46.0%)in the CSVD group and 54(54.0%)in the non-CSVD group.Univariate analysis showed that there were significant differences in age,AHI,oxygen desaturation index(ODI),percentage of blood oxygen saturation<90%in total sleep time(T90),square root of the mean of the sum of the squares of the difference between adjacent RR intervals(RMSSD),power in high frequency range(HF),power in low frequency range(LF)to HF ratio(LF/HF)between the CSVD group and the non-CSVD group(all P<0.05).Multivariate logistic regression analysis showed that after adjusting for age,body mass index,systolic blood pressure,AHI,ODI,and T90,RMSSD(odds ratio 0.625,95%confidence interval 0.389-0.981;P=0.041)and LF/HF ratio(odds ratio 1.429,95%confidence interval 1.011-2.020;P=0.043)were the independent influencing factors of CSVD in patients with OSA.Conclusion Increased LF/HF and decreased RMSSD in OSA patients with CSVD suggest that the increased sympathetic excitability and decreased vagus function,which may be one of the pathophysiological mechanisms of occurring CSVD in patients with OSA.