Division of Neuromuscular Disorders, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
Clin Auton Res. 2012 Feb;22(1):1-8. doi: 10.1007/s10286-011-0131-9. Epub 2011 Jul 28.
Obstructive sleep apnea (OSA) has been hypothesized to cause a hypersympathetic state, which may be the mechanism for the increased incidence of cardiovascular disease in OSA. However, there is a high prevalence of hyperglycemia in OSA patients, which may also contribute to autonomic dysfunction.
Thirty-five patients with OSA and 11 controls with average body mass index (BMI) of 32.0 ± 4.6 underwent polysomnography, glucose tolerance testing, autonomic function tests, lying and standing catecholamines, overnight urine collection, and baseline ECG and continuous blood pressure measurements for spectral analysis. A linear regression model adjusting for age and BMI was used to analyze spectral data, other outcome measures were analyzed with Kruskal-Wallis test.
Twenty-three OSA patients and two control patients had hyperglycemia (based on 2001 American Diabetes Association criteria). Apnea-hypopnea index (AHI) correlated with total power and low frequency (LF) power (r = 0.138, 0.177, p = 0.031; and r = 0.013) but not with the LF/high frequency (HF) ratio (p = 0.589). Glucose negatively correlated with LF systolic power (r = -0.171, p = 0.038) but not AHI (p = 0.586) and was marginally associated with pnn50, total power, LF, and HF power (p ranged from 0.07 to 0.08).
These data suggest that patients with OSA and mild hyperglycemia have a trend towards lower heart rate variability and sympathetic tone. Hyperglycemia is an important confounder and should be evaluated in studies of OSA and autonomic function.
阻塞性睡眠呼吸暂停（OSA）被认为会导致交感神经过度兴奋，这可能是 OSA 患者心血管疾病发病率增加的机制。然而，OSA 患者中存在高血糖的高发率，这也可能导致自主神经功能障碍。
35 名 OSA 患者和 11 名平均 BMI 为 32.0±4.6 的对照组患者接受了多导睡眠图、葡萄糖耐量测试、自主神经功能测试、卧位和立位儿茶酚胺、夜间尿液收集以及基线心电图和连续血压测量进行频谱分析。使用调整年龄和 BMI 的线性回归模型分析频谱数据，使用 Kruskal-Wallis 检验分析其他结果指标。
23 名 OSA 患者和 2 名对照患者存在高血糖（根据 2001 年美国糖尿病协会标准）。呼吸暂停-低通气指数（AHI）与总功率和低频（LF）功率相关（r=0.138，0.177，p=0.031；和 r=0.013），但与 LF/高频（HF）比值无关（p=0.589）。血糖与 LF 收缩压呈负相关（r=-0.171，p=0.038），但与 AHI 无关（p=0.586），并与 pnn50、总功率、LF 和 HF 功率呈边缘相关（p 范围从 0.07 到 0.08）。
这些数据表明，患有 OSA 和轻度高血糖的患者心率变异性和交感神经张力呈下降趋势。高血糖是一个重要的混杂因素，在 OSA 和自主神经功能研究中应进行评估。
