Véber Orsolya, Lendvai Zsofia, Ronai Katalin Zsuzsanna, Dunai Andrea, Zoller Rezso, Lindner Anett Virag, Turányi Csilla Zita, Szocs Julia Luca, Keresztes Katalin, Tabák Adam Gyula, Novak Marta, Molnar Miklos Z, Mucsi Istvan
1 Institute of Behavioural Sciences, Sleep Medicine Team, Semmelweis University Faculty of Medicine , Budapest, Hungary .
Metab Syndr Relat Disord. 2014 Mar;12(2):117-24. doi: 10.1089/met.2013.0111. Epub 2013 Dec 14.
Obstructive sleep apnea (OSA) is often accompanied by the metabolic syndrome. Because both conditions are associated with depressed heart rate variability (HRV) separately, our aim was to study whether co-morbid OSA is associated with more reduced HRV in male patients with the metabolic syndrome.
In this cross-sectional study, 35 men (age, 57±11 years) with the metabolic syndrome (according to International Diabetes Federation criteria) were included. OSA severity was defined by the apnea-hypopnea index (AHI). HRV was assessed by 24-hr ambulatory electrocardiographic monitoring. Standard deviation of all normal-to-normal RR intervals (SDNN), the high frequency power (HFP), and the ratio of low- to high-frequency power (LF/HF) were measured.
There were 14, 6, and 8 cases of severe (AHI ≥30/hr), moderate (15/hr≤AHI <30/hr), and mild (5/hr ≤AHI <15/hr) OSA, respectively. Seven patients had no OSA. Patients with mild-moderate or severe OSA had reduced SDNN and HFP values compared to those without OSA. Increasing OSA severity was associated significantly with lower daytime LF/HF ratio [standardized β regression coefficient (β)=-0.362, P=0.043] and higher night/day LF/HF ratio (β=0.377, P=0.023) after controlling for age, duration of diabetes, and severity of metabolic syndrome.
Co-morbid OSA is associated with decreased overall HRV, parasympathetic loss, and impaired diurnal pattern of sympathovagal balance that may further increase the cardiovascular vulnerability of male patients with the metabolic syndrome. The role of the HRV analysis in the risk assessment of these patients warrants further studies.
阻塞性睡眠呼吸暂停（OSA）常伴有代谢综合征。由于这两种情况分别与心率变异性（HRV）降低有关，我们的目的是研究合并OSA是否与代谢综合征男性患者HRV降低更多相关。
在这项横断面研究中，纳入了35名患有代谢综合征（根据国际糖尿病联盟标准）的男性（年龄57±11岁）。OSA严重程度由呼吸暂停低通气指数（AHI）定义。通过24小时动态心电图监测评估HRV。测量所有正常RR间期的标准差（SDNN）、高频功率（HFP）以及低频与高频功率之比（LF/HF）。
分别有14例、6例和8例严重（AHI≥30次/小时）、中度（15次/小时≤AHI＜30次/小时）和轻度（5次/小时≤AHI＜15次/小时）OSA患者。7名患者无OSA。与无OSA的患者相比，轻度 - 中度或重度OSA患者的SDNN和HFP值降低。在控制年龄、糖尿病病程和代谢综合征严重程度后，OSA严重程度增加与较低的日间LF/HF比值[标准化β回归系数（β）=-0.362，P = 0.043]和较高的夜间/日间LF/HF比值（β = 0.377，P = 0.023）显著相关。
合并OSA与总体HRV降低、副交感神经功能丧失以及交感迷走神经平衡的昼夜模式受损有关，这可能会进一步增加代谢综合征男性患者的心血管易损性。HRV分析在这些患者风险评估中的作用值得进一步研究。
