阻塞性睡眠呼吸暂停低通气综合征患者昼夜心室复极参数变化研究

A Study on the Diurnal Variation of Ventricular Repolarization Parameters in Patients with Obstructive Sleep Apnea

背景阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是一种常见的睡眠呼吸疾病,越来越多的研究表明OSAHS与心血管疾病具有显著相关性,是心律失常、高血压、冠心病等心血管疾病的独立危险因素,但其具体机制仍未完全阐明。相关证据表明,Tp-e间期、QT间期和Tp-e/QT等心室复极参数可能与心律失常甚至心源性猝死有关。然而截止到目前,对OSAHS相关心律失常及心电参数变化的研究相对较少。目的研究OSAHS患者昼夜心室复极参数变化。方法选取2020年6月至2021年7月在郑州大学第一附属医院接受多导睡眠监测、符合纳入及排除标准的OSAHS患者159例,并根据疾病的严重程度进一步分为轻-中度OSAHS组(78例)与重度OSAHS组(81例);选取51例未患疾病的健康者为对照组。测量并计算所有参与者的日间和夜间Tp-e间期、QT间期、Tp-e/QT。结果对照组与轻-中度OSAHS组、重度OSAHS组之间的日间Tp-e间期、夜间Tp-e间期、日间Tp-e/QT、夜间Tp-e/QT比较,差异均有统计学意义(P<0.05)。日间Tp-e间期、夜间Tp-e间期、日间Tp-e/QT、夜间Tp-e/QT在三组间有逐渐延长的趋势(P<0.05);三组日间及夜间QT间期比较,差异无统计学意义(P>0.05)。OSAHS患者日间静息状态及夜间阻塞性呼吸暂停期的Tp-e间期、QT间期、Tp-e/QT比较,差异均有统计学意义(P<0.05);夜间阻塞性呼吸暂停期的Tp-e间期、QT间期、Tp-e/QT均较日间静息状态有所延长,差异有统计学意义(P<0.05)。OSAHS患者夜间Tp-e间期(r_(s)=0.221,P=0.005)、夜间Tp-e/QT(r_(s)=0.298,P<0.001)均与AHI呈正相关。结论OSAHS患者夜间阻塞性呼吸暂停期心室复极参数较日间静息状态下延长,昼夜变化显著,为今后OSAHS合并心律失常的研究提供了新的思路。

Background Obstructive sleep apnea hypopnea syndrome(OSAHS)is a common sleep breathing disorder.More and more studies have shown that OSAHS has a significant correlation with cardiovascular disease.It is an independent risk factor for arrhythmia,hypertension,coronary heart disease and other cardiovascular diseases,but the specific mechanism is still not completely clear.Relevant evidence indicates that ventricular repolarization parameters such as Tp-e interval,QT interval and Tp-e/QT ratio may be related to arrhythmia and even sudden cardiac death.However,up to now,there are relatively few studies on OSAHS-related arrhythmias and changes in cardiac electrical parameters.Objective To study the diurnal variation of ventricular repolarization parameters in patients with obstructive sleep apnea.Method A total of 159 OSAHS patients who met the inclusion criteria and received polysomnography monitoring in the First Affiliated Hospital of Zhengzhou University from June 2020 to July 2021 were selected as the observation group,further divided into mild-moderate OSAHS group(n=78)and severe OSAHS group(n=81)according to the severity.Fifty-one healthy people without disease were selected as the control group.Daytime and nocturnal Tp-e interval,QT interval,Tp-e/QT ratio were measured and calculated for all participants.Results There were significant differences in daytime Tp-e interval,nocturnal Tp-e interval,daytime Tp-e/QT ratio,nocturnal Tp-e/QT ratio among the control group、the mild-moderate OSAHS group and the severe OSAHS group(P<0.001).In addition,the daytime Tp-e interval,nocturnal Tp-e interval,daytime Tp-e/QT ratio and nocturnal Tp-e/QT ratio have a gradually increasing trend among the three groups(P<0.05).There were no significant differences in daytime QT interval and nocturnal QT interval among the three groups(P>0.05).Tp-e interval,QT interval,Tp-e/QT ratiosin the observation group were statistically different between daytime resting state and nocturnal obstructive state(P<0.05);The Tp-e interval,QT interval,and Tp-e/QT ratio in nocturnal obstructive state were significantly longer than those in daytime resting state(P<0.05).The nocturnal Tp-e interval(r_(s)=0.221,P=0.005)and nocturnal Tp-e/QT(r_(s)=0.298,P<0.001)of OSAHS patients were positively correlated with AHI.Conclusion Ventricular repolarization parameters in OSAHS patients during nocturnal obstructive apnea are longer than those in daytime resting state,and the diurnal variation is significant,which provides a new idea for the future study of OSAHS with arrhythmia.