OSAHS对老年高血压患者心率变异性的影响

Effect of OSAHS on heart rate variability in elderly patients with hypertension

目的探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)对老年高血压患者的心率变异性影响。方法 2015年3月—2016年9月选择杭州市萧山区第三人民医院80例老年高血压患者根据是否合并OSAHS,将其分成2组,OSAHS组38例,非OSAHS 42例;另外选择30例体检的健康志愿者作为健康对照组。对3组进行24小时动态心电图检查,获取HRV时域指标数据和频域指标数据。结果①非OSAHS组患者SDNN、SDANN、rMSSD指标分别为(118.15±15.64)ms、(121.55±16.55)ms、(27.98±10.29)ms,均低于对照组各相应指标(P<0.05);OSAHS组患者SDNN、SDANN、rMSSD指标分别为(89.19±13.95)ms、(86.64±17.34)ms、(21.44±7.27)ms,均低于非OSAHS患者各相应指标(均P<0.05)。②3组LF指标分别为(20.01±7.99)Hz、(21.56±8.96)Hz、(21.63±9.33)Hz(P>0.05)。非OSAHS组患者HF指标为(11.32±4.56)Hz,低于对照组(14.75±5.19)Hz(P<0.05);OSAHS组患者HF指标为(9.14±3.82)Hz,低于非OSAHS组(P<0.05)。非OSAHS组患者L/H指标为(1.96±0.34)Hz,高于对照组(1.45±0.38)Hz(P<0.05);OSAHS组患者L/H指标为(2.23±0.32)Hz,高于非OSAHS组(P<0.05)。结论 OSAHS能够降低老年高血压患者HRV指标,加重老年高血压患者交感与副交感失衡程度,增加其交感神经张力,加重其不良预后。

Objective To investigate the effect of obstructive sleep apnea-hypopnea syndrome(OSAHS) on heart rate variability in elderly patients with hypertension. Methods Eighty elderly patients with hypertension in our hospital from March 2015 to September 2016 were divided into two groups, OSAHS group(38 cases) and non-OSAHS group(42 cases). Another 30 healthy volunteers were selected as healthy control group. Three groups were examined by 24-hour dynamic electrocardiogram to obtain HRV time-domain index data and frequency-domain index data. Results ① The indexes of SDNN, SDANN and rMSSD in non-OSAHS group were(118.15±15.64) ms,(121.55±16.55) ms,(27.98±10.29) ms, respectively, lower than those in control group(all P<0.05);the indexes of SDNN, SDANN and rMSSD in OSAHS group were(89.19±13.95) ms,(86.64±17.34) ms,(21.44±7.27) ms, respectively, which were lower than those in non-OSAHS group(all P<0.05). ② The LF indices of the three groups were(20.01±7.99) Hz,(21.56±8.96) Hz,(21.63±9.33) Hz(P>0.05). The HF index of non-OSAHS group was(11.32±4.56) Hz, lower than that of control group [(14.75±5.19) Hz], P<0.05;the HF index of OSAHS group was(9.14±3.82) Hz, lower than that of non-OSAHS group(P<0.05). The L/H index of non-OSAHS group was(1.96±0.34) Hz, higher than that of control group [(1.45±0.38) Hz], P<0.05;the L/H index of OSAHS group was(2.23±0.32) Hz, higher than that of non-OSAHS group(P<0.05). Conclusion OSAHS can reduce the HRV index of elderly patients with hypertension, aggravate the degree of sympathetic and parasympathetic imbalance, increase the sympathetic nerve tension, and aggravate the adverse prognosis of elderly patients with hypertension.