儿童睡眠呼吸紊乱与心脏自主神经调节。
Sleep-disordered breathing and cardiac autonomic modulation in children.
机构信息
Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA 17033, USA.
出版信息
Sleep Med. 2010 May;11(5):484-8. doi: 10.1016/j.sleep.2009.11.012. Epub 2010 Apr 1.
OBJECTIVES
To investigate the adverse cardiac autonomic effects of sleep-disordered breathing (SDB) in a large population-based sample and a clinical sample of children.
METHODS
Subjects included a population-based sample of 700 and a clinically diagnosed sample of 43 SDB children. SDB was defined based on an apnea hypopnea index (AHI) 1 during one night of polysomnography. Cardiac autonomic modulation was measured by heart rate variability (HRV) analysis of the beat-to-beat RR interval data collected during polysomnography.
RESULTS
The mean (SD) age was 112 (21) months, with 49% male and 25% non-white. About 73.0% had AHI<1 (no SDB), 25.8% had 1-5 AHI (mild SDB), and 1.2% had 5 AHI (moderate SDB). Among individuals with moderate SDB in the population-based sample and the clinically diagnosed SDB patients, the mean (SE) of HRV-high frequency power (HF) was significantly lower compared to children without SDB [6.00 (0.32) and 6.24 (0.14), respectively, vs. 6.68 (0.04) ms(2), p<0.05 and p<0.01, respectively], whereas the low frequency power to high frequency power ratio (LF/HF) was significantly higher [1.62 (0.20) and 1.74 (0.09), respectively, vs. 0.99 (0.02), both p<0.01)].
CONCLUSIONS
SDB in healthy young children and in clinical patients is significantly associated with impaired cardiac autonomic modulation, i.e., sympathetic overflow and weaker parasympathetic modulation, which may contribute to increased risk of acute cardiac events in persons with SDB, even before reaching the "high risk age."
目的
在一个大型基于人群的样本和一个临床确诊的儿童睡眠呼吸紊乱（SDB）样本中，研究 SDB 对心脏自主神经的不良影响。
方法
研究对象包括一个基于人群的 700 名儿童样本和一个临床诊断的 43 名 SDB 儿童样本。SDB 根据一晚上多导睡眠图的呼吸暂停低通气指数（AHI）1 来定义。通过对多导睡眠图期间收集的逐拍 RR 间期数据进行心率变异性（HRV）分析来测量心脏自主神经调节。
结果
平均（标准差）年龄为 112（21）个月，其中 49%为男性，25%为非白种人。约 73.0%的人 AHI<1（无 SDB），25.8%的人 AHI 为 1-5（轻度 SDB），1.2%的人 AHI 为 5（中度 SDB）。在基于人群的样本中存在中度 SDB 的个体和临床诊断的 SDB 患者中，HRV-高频功率（HF）的平均值（SE）明显低于无 SDB 的儿童[分别为 6.00（0.32）和 6.24（0.14），而 6.68（0.04）ms(2)，p<0.05 和 p<0.01，分别]，而低频功率与高频功率之比（LF/HF）明显更高[分别为 1.62（0.20）和 1.74（0.09），而 0.99（0.02），均 p<0.01]）。
结论
健康的年轻儿童和临床患者中的 SDB 与心脏自主神经调节受损显著相关，即交感神经亢进和副交感神经调节减弱，这可能导致 SDB 患者发生急性心脏事件的风险增加，甚至在达到“高危年龄”之前。
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