心率变异性对不同年龄阻塞性睡眠呼吸暂停综合征患者自主神经功能的评估价值

Value of heart rate variability in evaluating autonomic nerve function of patients with obstructive sleep apnea syndrome at different ages

目的探讨不同年龄的阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)患者自主神经功能的变化特征。方法选择158例OSAS患者,并按照不同年龄分别纳入青年组(<40岁,38例)、中年组(40~70岁,56例)、老年组(>70岁,64例)。选择同期住院且无OSAS的患者40例作为对照组。各组患者均进行24 h动态心电图监测,记录心率变异性(heart rate variability,HRV)时域指标,包括昼夜正常RR间期标准差(SDNN_(Day)、SDNN_(Nigh)t)、昼夜连续5 min正常RR间期标准差(SDANN_(Day)、SDANN_(Night))、昼夜相邻RR间期差值均方根(rMSSD_(Day)、rMSSD_(Night)),以及HRV频域指标,包括昼夜低频功率(LF_(Day)、LF_(Night))、昼夜高频功率(HF_(Day)、HF_(Night))、昼夜低频功率与高频功率之比(LF_(Day)/HF_(Day)、LF_(Night)/HF_(Night))。结果老年组的颈围及体重指数显著高于其他各组(P<0.05);青年组呼吸暂停低通气指数(apnea hypopnea index,AHI)显著高于对照组,中年组AHI显著高于对照组和青年组,老年组AHI显著高于其他各组(P<0.05);青年组、中年组和老年组SDNN_(Day)、SDNN_(Nigh)t、SDANN_(Day)、SDANN_(Night)、LF_(Day)、LF_(Night)、HF_(Day)、LF_(Day)/HF_(Day)、LF_(Night)/HF_(Night)显著高于对照组,rMSSD_(Day)、rMSSD_(Night)、HF_(Night)显著低于对照组(P<0.05);中年组和老年组SDNN_(Day)、SDNN_(Nigh)t、SDANN_(Day)、SDANN_(Night)、LF_(Day)、LF_(Night)、HF_(Day)、LF_(Day)/HF_(Day)、LF_(Night)/HF_(Night)显著高于青年组,rMSSD_(Day)、rMSSD_(Night)、HF_(Night)显著低于青年组(P<0.05);老年组LF_(Day)显著高于中年组,HF_(Night)显著低于中年组(P<0.05);中年组和老年组心律失常发生率显著高于青年组,老年组心律失常发生率显著高于中年组(P<0.05)。Pearson相关性分析显示,OSAS患者年龄与SDNN_(Day)、SDNN_(Nigh)t、SDANN_(Day)、SDANN_(Night)、LF_(Day)、LF_(Night)、HF_(Day)呈正相关,与rMSSD_(Day)、rMSSD_(Night)、HF_(Night)呈负相关。结论随着年龄的增长,OSAS患者交感神经活性增高且迷走神经活性降低,交感神经与迷走神经之间的失衡现象更加明显。动态心电图监测HRV对心血管并发症的防治具有指导意义。

Objective To explore the characteristics of autonomic nerve function changes in patients with obstructive sleep apnea syndrome(OSAS)at different ages.Methods A total of 158 OSAS patients were selected,and divided into the young group(<40 years old,38 cases),the middle-aged group(40-70 years old,56 cases),and the elderly group(>70 years old,64 cases)according to different ages.We selected 40 patients without OSAS who had been hospitalized during the same period as the control group.Patients in each group performed 24-hour ambulatory electrocardiography(AECG)monitoring.We recorded heart rate variability(HRV)time-domain indexes[standard deviation of all normal to normal RR intervals(SDNN_(Day),SDNN_(Nigh)t),standard deviation of all 5-minute normal RR intervals(SDANN_(Day),SDANN_(Night))and root mean square of successive differences in RR interval(rMSSD_(Day),rMSSD_(Night))],and HRV frequency-domain indexes[low frequency power(LF_(Day),LF_(Night)),high frequency power(HF_(Day),HF_(Night))and ratio of low frequency power to high frequency power(LF_(Day)/HF_(Day),LF_(Night)/HF_(Night))].Results Neck circumference and body mass index in the elderly group are significantly higher than those in other groups(P<0.05).Apnea hypopnea index(AHI)in the young group is significantly higher than that in the control group;AHI in the middle-aged group is significantly higher than that in the control group and the young group;AHI in the elderly group is significantly higher than that in other groups(P<0.05).SDNN_(Day),SDNN_(Nigh)t,SDANN_(Day),SDANN_(Night),LF_(Day),LF_(Night),HF_(Day),LF_(Day)/HF_(Day) and LF_(Night)/HF_(Night) in the young,the middle-aged and the elderly group are significantly higher than those in the control group while rMSSD_(Day),rMSSD_(Night) and HF_(Night) are significantly lower than those in the control group(P<0.05).SDNN_(Day),SDNN_(Nigh)t,SDANN_(Day),SDANN_(Night),LF_(Day),LF_(Night),HF_(Day),LF_(Day)/HF_(Day),LF_(Night)/HF_(Night) in the middle-aged group and the elderly group are significantly higher than those in the young group while rMSSD_(Day),rMSSD_(Night) and HF_(Night) are significantly lower than those in the young group(P<0.05).LF_(Day) in the elderly group is significantly higher than that in the middle-aged group while HF_(Night) is significantly lower than that in the middleaged group(P<0.05).The incidence of arrhythmia in the middle-aged group and the elderly group is significantly higher than that in the young group while the incidence of arrhythmia in the elderly group is significantly higher than that in the middle-aged group(P<0.05).Pearson correlation analysis shows that the age of OSAS patients is positively correlated with SDNN_(Day),SDNN_(Nigh)t,SDANN_(Day),SDANN_(Night),LF_(Day),LF_(Night) and HF_(Day),and is negatively correlated with rMSSD_(Day),rMSSD_(Night) and HF_(Night).Conclusion The sympathetic nerve activity increases and the vagus nerve activity decreases among OSAS patients with age,and the imbalance between the sympathetic nerve and the vagus nerve becomes more obvious.AECG monitoring of HRV has guiding significance for the prevention and treatment of cardiovascular complications.