阻塞性睡眠呼吸暂停低通气综合征患者心率变异性与低氧程度的相关性分析

Correlation analysis between heart rate variability and degree of hypoxia in patients with obstructive sleep apnea hypopnea syndrome

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者心率变异性(HRV)与低氧程度的相关性。方法选取2021年1月至2023年6月经复旦大学附属中山医院厦门医院睡眠中心初筛为OSAHS患者165例为研究对象,根据夜间最低脉搏血氧饱和度(SpO_(2))将患者分为无低氧组、轻度低氧组、中度低氧组、重度低氧组。收集患者基本资料、多导睡眠图(PSG)监测结果、动态心电图监测结果。采用单因素方差分析比较不同低氧程度组间的一般临床特征;相关性分析比较HRV与PSG参数的相关性;多元线性回归分析HRV与PSG参数之间的关系。结果随着患者低氧程度加重,24 h内全部正常心动周期的标准差(SDNN)、每5 min的RR间期平均值的标准差(SDANN)、清醒期及睡眠期SDNN均逐渐降低(P<0.05)。调整年龄后行相关性分析显示,SDNN、SDANN、清醒期SDNN与PSG参数存在相关性(P<0.05)。进一步行多元线性回归分析发现,年龄、夜间SpO_(2)<90%的睡眠时间占比(T90)、平均SpO_(2)、最低SpO_(2)均影响OSAHS患者的HRV(P<0.05)。结论HRV有识别OSAHS患者中不同低氧程度个体的能力,其可能有独立预测心血管事件的作用。

Objective To explore the relationship between heart rate variability(HRV)and hypoxia in patients with obstructive sleep apnea hypopnea syndrome(OSAHS).Methods A total of 165 patients with OSAHS admitted to Zhongshan Hospital(Xiamen Branch),Fudan University from January 2021 to June 2023 were selected and divided into four groups based on the minimum pulse oxygen saturation(SpO_(2))at night:non-hypoxic group,mild hypoxic group,moderate hypoxic group and severe hypoxic group.All patients completed the general data collection,polysomnography(PSG)and Holter.One-way analysis of variance was used to compare the general clinical characteristics among different groups with hypoxia.Correlation analysis was used to compare the correlation between HRV and PSG parameters.The multiple linear regression analysis was applied to explore the correlation between HRV and PSG parameters.Results With the increase of hypoxia,standard deviation of all normal to normal RR intervals(SDNN),standard deviation of all 5-minute RR intervals(SDANN),SDNN during waking and SDNN during sleeping decreased(P<0.05).Correlation analysis showed that after adjusting the age,there was a relationship between SDNN,SDANN,SDNN during waking and PSG parameters(P<0.05).The multiple linear regression analysis showed that the age,percentage of sleep time spent with oxygen saturation<90%(T90),the average SpO_(2)and the lowest SpO_(2)were correlated with the HRV of OSAHS patients(P<0.05).Conclusions HRV shows the ability to identify the individuals with different levels of hypoxia in the OSAHS patients,which may play an independent role in predicting cardiovascular events.