Noda A, Suzuki R, Yokota M, Takeuchi J, Okada T, Ohta T, Yasuma F, Hayashi H
Department of Clinical Laboratory, Nagoya University Hospital.
Kokyu To Junkan. 1990 Nov;38(11):1097-105.
Sleep apnea syndrome (SAS) is often associated with arrhythmias. The study was performed to clarify the characteristics and mechanisms of the heart rate (HR) changes during and after sleep induced apneas. Thirty-one patients with SAS without definitive heart disease, aged 17-78 years (mean 54.2 years), were examined by electroencephalograms, electrocardiograms, electrooculograms, nasal and oral breathing, thoracic and abdominal respiratory movements and arterial oxygen saturation (SaO2). [Results and Discussion] At the onset of sleep apnea, some showed progressive reductions in HR, followed by abrupt tachycardia on the resumption of breathing. Thirty-one patients with SAS were classified into three Groups (A, B, C). Group A demonstrated that HR changes occurred associated with apnea both in stage REM and in stage non-REM. Group B demonstrated that HR changes occurred associated with apnea only in stage REM. Group C demonstrated that HR changes did not occur associated with apnea. In Group A, apnea frequency and apnea index were higher than those of Group C. In Group A, the lowest SaO2 was lower than that of Group C, total time under 90% of arterial oxygen saturation (SaO2) was longer than that of Group C. There was a good negative correlation between oxygen saturation and HR changes. Further, HR changes were augmented by arousal response. This might be related to the arousal response as well as to the cardiostimulatory effects of hypoxia associated with increased ventilation. The arousability in response to apneas might be important in HR changes. In SAS, the degree of HR changes was related to apnea frequency, apnea index, apnea length and sleep stage.(ABSTRACT TRUNCATED AT 250 WORDS)
睡眠呼吸暂停综合征(SAS)常与心律失常相关。本研究旨在阐明睡眠诱发呼吸暂停期间及之后心率(HR)变化的特征及机制。对31例无明确心脏病的SAS患者进行了检查,年龄在17 - 78岁(平均54.2岁),检查项目包括脑电图、心电图、眼电图、鼻和口腔呼吸、胸腹部呼吸运动以及动脉血氧饱和度(SaO2)。[结果与讨论]在睡眠呼吸暂停开始时,一些患者心率逐渐降低,随后在恢复呼吸时突然心动过速。31例SAS患者被分为三组(A、B、C)。A组显示在快速眼动(REM)期和非快速眼动期,心率变化均与呼吸暂停相关。B组显示心率变化仅在REM期与呼吸暂停相关。C组显示心率变化与呼吸暂停无关。A组的呼吸暂停频率和呼吸暂停指数高于C组。A组的最低SaO2低于C组,动脉血氧饱和度(SaO2)低于90%的总时间长于C组。血氧饱和度与心率变化之间存在良好的负相关。此外,唤醒反应会增强心率变化。这可能与唤醒反应以及与通气增加相关的缺氧对心脏的刺激作用有关。对呼吸暂停的唤醒能力在心率变化中可能很重要。在SAS中,心率变化的程度与呼吸暂停频率、呼吸暂停指数、呼吸暂停时长及睡眠阶段有关。(摘要截选至250字)