脉氧下降率和心率波动率与阻塞性睡眠呼吸暂停低通气综合征患者发生心律失常的关系研究

Relationship between Pulse Oxygen Desaturation Rate and Heart Rate Fluctuation Rate and Arrhythmias in Patients with Obstructive Sleep Apnea Hypopnea Syndrome

背景心律失常是阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的常见并发症,然而OSAHS患者心律失常的发生及严重程度与其疾病本身严重程度并不完全一致。本研究团队前期研究发现脉氧下降率(ODR)是OSAHS患者发生高血压的独立预测因素,推测呼吸暂停事件相关的ODR和心率波动率(HRFR)可能预测OSAHS患者心律失常的发生。目的探讨ODR及HRFR与OSAHS患者发生心律失常的相关性,ODR及HRFR对心律失常发生的预测价值。方法2021年1—6月对在南京医科大学第一附属医院睡眠呼吸障碍专病门诊就诊的36例患者行多导睡眠监测和动态心电图监测,同时收集患者基本临床资料信息。以心律失常事件数的中位数为截断值,把患者分为少发心律失常组(心律失常事件数<105次)和多发心律失常组(心律失常事件数≥105次)各18例。采用Spearman秩相关分析探究ODR、HRFR与心律失常发生的相关性,采用多因素Logistic回归分析探讨OSAHS患者发生心律失常的影响因素。结果多发心律失常组患者ODR和HRFR高于少发心律失常组(P<0.05)。相关性分析显示,总心律失常事件数与年龄、ODR、单位时间心率变化幅度(ΔHR)、HRFR呈正相关(r_(s)=0.472、0.719、0.360、0.393,P<0.05);多因素Logistic回归分析显示ODR〔OR=77.849,95%CI(5.250,1154.301),P<0.05〕和HRFR〔OR=9.981,95%CI(1.000,105.600),P=0.05〕是OSAHS患者心律失常发生的影响因素。ODR和HRFR预测多发心律失常的受试者工作特征曲线下面积(AUC)分别为0.932〔95%CI(0.830,0.941)〕和0.753〔95%CI(0.590,0.916)〕。结论ODR和HRFR与OSAHS患者心律失常的发生具有相关性,能够预测OSAHS患者心律失常的发生。

Background Arrhythmias are common complications in patients with obstructive sleep apnea hypopnea syndrome(OSAHS),however their occurrence and severity are not completely consistent with the severity of their disease per se.Our previous study found that pulse oxygen desaturation rate(ODR)was an independent predictor of the development of hypertension in OSAHS patients.We hypothesized that sleep apnea related ODR and heart rate fluctuation rate(HRFR)may predict the occurrence of arrhythmias in OSAHS patients.Objective To observe the correlation between ODR,HRFR and the occurrence of arrhythmias,and to explore the predictive value of ORD and HRFR on the occurrence of arrhythmias.Methods Polysomnography and Holter monitoring were performed on 36 patients who visited the sleep disordered breathing specialized outpatient clinic of the First Affiliated Hospital of Nanjing Medical University between January and June 2021,while basic clinical information of the patients was collected.Taking the median number of arrhythmic events as the cutoff value,the patients were divided into two groups:the patients with low incidence of arrhythmia group(<105 events)and with high incidence of arrhythmias group(≥105 events).ODR and HRFR were analyzed for correlation with arrhythmias and Logistic regression was performed for analysing the predictors of arrhythmia.Results Compared with low incidence of arrhythmia group,the patients with high incidence of arrhythmias had higher ODR and HRFR(P<0.05).Correlation analysis showed that the number of total arrhythmic events was positively correlated with ODR,mean heart rate fluctuation value,and HRFR(r_(s)=0.472,0.719,0.360,and 0.393,respectively,P<0.05).Multivariate Logistic regression analysis showed that ODR〔OR=77.849,95%CI(5.250,1154.301),P<0.05〕and HRFR〔OR=9.981,95%CI(1.000,105.600),P=0.05〕were independent risk factors for arrhythmic events.The area under the receiver operator characteristic(AUC)of ODR and HRFR for predicting multiple arrhythmias were 0.932〔95%CI(0.830,0.941)〕and 0.753〔95%CI(0.590,0.916),respectively.Conclusion ODR and HRFR are associated with the occurrence of arrhythmias and can be used for predicting the occurrence of arrhythmic events in patients with OSAHS.