Yang A, Schäfer H, Manka R, Andrié R, Schwab J O, Lewalter T, Lüderitz B, Tasci S
Department of Medicine II, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.
Basic Res Cardiol. 2005 Sep;100(5):439-45. doi: 10.1007/s00395-005-0536-5. Epub 2005 Jun 10.
Patients with obstructive sleep apnea (OSA) are at increased risk for cardiovascular disease. Increased sympathetic drive is considered as one of the underlying mechanisms. Both heart rate turbulence (HRT) and heart rate variability (HRV) are parameters to describe autonomic regulation. We investigated the influence of sleep-disordered breathing (SDB) on HRT and HRV in patients with OSA.
Sixty-five patients underwent overnight polysomnography for clinically suspected SDB and simultaneous Holter monitoring (11 p.m.-6 a.m.). Patients with diabetes mellitus, a history of cardiac disease, left ventricular dysfunction, periodic breathing pattern, and those on beta-blockers or theophylline were excluded. According to the apnea-hypopnea index (AHI), the patients were assigned to group A (AHI <20, n = 31) or group B (AHI > or =20, n = 34). HRV (time domain, frequency domain) and HRT (onset, slope) were then related to the severity of SDB.
Nighttime turbulence slope (TS) correlated inversely with the AHI (r = -0.45, p = 0.01) and was significantly lower in group B (8.9 +/- 1.6 ms/R-R interval) compared with that in group A (19.8 +/- 4.0 ms/R-R interval, P = 0.01). This relationship remained stable after adjusting TS for the number of ventricular premature contractions. No significant differences in turbulence onset or parameters of nighttime HRV were observed.
Alterations in nighttime HRT correlate with the severity of SDB, indicating abnormalities in cardiac autonomic activity in moderate-to-severe OSA even in the absence of overt cardiac disease. These changes may be associated with the subsequent development of cardiovascular disease.
阻塞性睡眠呼吸暂停（OSA）患者患心血管疾病的风险增加。交感神经驱动力增加被认为是潜在机制之一。心率震荡（HRT）和心率变异性（HRV）都是描述自主神经调节的参数。我们研究了睡眠呼吸紊乱（SDB）对OSA患者HRT和HRV的影响。
65例临床怀疑有SDB的患者接受了整夜多导睡眠图检查，并同时进行动态心电图监测（晚上11点至早上6点）。排除患有糖尿病、有心脏病史、左心室功能不全、周期性呼吸模式的患者，以及正在服用β受体阻滞剂或茶碱的患者。根据呼吸暂停低通气指数（AHI），将患者分为A组（AHI<20，n=31）或B组（AHI≥20，n=34）。然后将HRV（时域、频域）和HRT（起始、斜率）与SDB的严重程度相关联。
夜间震荡斜率（TS）与AHI呈负相关（r=-0.45，p=0.01），B组（8.9±1.6毫秒/R-R间期）明显低于A组（19.8±4.0毫秒/R-R间期，P=0.01）。在对室性早搏数量校正TS后，这种关系仍然稳定。未观察到震荡起始或夜间HRV参数的显著差异。
夜间HRT的改变与SDB的严重程度相关，表明即使在没有明显心脏病时，中重度OSA患者的心脏自主神经活动也存在异常。这些变化可能与随后心血管疾病的发生有关。
