Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA 17033, USA.
J Sleep Res. 2010 Jun;19(2):358-65. doi: 10.1111/j.1365-2869.2009.00807.x. Epub 2010 Mar 8.
We examined the effects of sleep stages and sleep-disordered breathing (SDB) on autonomic modulation in 700 children. Apnea hypopnea index (AHI) during one 9 h night-time polysomnography was used to define SDB. Sleep stage-specific autonomic modulation was measured by heart rate variability (HRV) analysis of the first available 5 min RR intervals from each sleep stage. The mean [standard deviation (SD)] age was 112 (21) months (49% male and 25% non-Caucasian). The average AHI was 0.79 (SD = 1.03) h(-1), while 73.0%, 25.8% and 1.2% of children had AHI <1 (no SDB), 1-5 (mild SDB) and >or=5 (moderate SDB), respectively. In the no SDB group, the high frequency (HF) and root mean square SD (RMSSD) increased significantly from wake to Stage 2 and slow wave sleep (SWS), and then decreased dramatically when shifting into rapid eye movement (REM) sleep. In the moderate SDB group, the pattern of HRV shift was similar to that of no SDB. However, the decreases in HF and RMSSD from SWS to REM were more pronounced in moderate SDB children [between-group differences in HF (-24% in moderate SDB versus -10% in no SDB) and RMSSD (-27% versus -12%) were significant (P < 0.05)]. The REM stage HF is significantly lower in the moderate SDB group compared to the no SDB group [mean (standard error): 4.49 (0.43) versus 5.80 (0.05) ms(2), respectively, P < 0.05]. Conclusions are that autonomic modulation shifts significantly towards higher parasympathetic modulation from wake to non-rapid eye movement sleep, and reverses to a less parasympathetic modulation during REM sleep. However, the autonomic modulation is impaired among children with moderate SDB in the directions of more reduction in parasympathetic modulation from SWS to REM sleep and significantly weaker parasympathetic modulation in REM sleep, which may lead to higher arrhythmia vulnerability, especially during REM sleep.
我们在 700 名儿童中检查了睡眠阶段和睡眠呼吸障碍（SDB）对自主调节的影响。使用一夜 9 小时多导睡眠图期间的呼吸暂停低通气指数（AHI）来定义 SDB。通过从每个睡眠阶段的前 5 分钟 RR 间隔中获得的心率变异性（HRV）分析来测量睡眠阶段特异性自主调节。[标准差（SD）]的平均年龄为 112（21）个月（49%为男性，25%为非白种人）。平均 AHI 为 0.79（SD = 1.03）h（-1），而 73.0%、25.8%和 1.2%的儿童 AHI<1（无 SDB）、1-5（轻度 SDB）和≥5（中度 SDB）。在无 SDB 组中，高频（HF）和均方根标准差（RMSSD）从清醒状态到 2 期和慢波睡眠（SWS）显着增加，然后在快速眼动（REM）睡眠时急剧下降。在中度 SDB 组中，HRV 变化模式与无 SDB 组相似。然而，从中 SWS 到 REM 的 HF 和 RMSSD 的减少在中度 SDB 儿童中更为明显[组间 HF 差异（中度 SDB 中为-24%，无 SDB 中为-10%）和 RMSSD 差异（-27%对-12%）显着（P<0.05）]。与无 SDB 组相比，中度 SDB 组的 REM 阶段 HF 显着降低[平均值（标准误差）：分别为 4.49（0.43）与 5.80（0.05）ms（2），P<0.05]。结论是，自主调节从清醒状态到非快速眼动睡眠显着向更高的副交感神经调节转变，而在 REM 睡眠期间则恢复为较弱的副交感神经调节。然而，中度 SDB 儿童的自主调节在从 SWS 到 REM 睡眠的副交感神经调节减少的方向上受到损害，并且 REM 睡眠中的副交感神经调节明显减弱，这可能导致更高的心律失常易感性，尤其是在 REM 睡眠期间。
