合并或未合并心力衰竭的阻塞性睡眠呼吸暂停患者心率变异性与嗜睡的关系。
Relationship of heart rate variability to sleepiness in patients with obstructive sleep apnea with and without heart failure.
作者信息
Taranto Montemurro Luigi, Floras John S, Picton Peter, Kasai Takatoshi, Alshaer Hisham, Gabriel Joseph M, Bradley T Douglas
机构信息
Sleep Research Laboratory of the Toronto Rehabilitation Institute ; Centre for Sleep Medicine and Circadian Biology of the University of Toronto.
the Departments of Medicine of the University Health Network Toronto General Hospital ; Mount Sinai Hospital, Toronto, Ontario, Canada.
出版信息
J Clin Sleep Med. 2014 Mar 15;10(3):271-6. doi: 10.5664/jcsm.3526.
BACKGROUND
Many patients with severe obstructive sleep apnea (OSA) do not complain of excessive daytime sleepiness (EDS), possibly due to increased sympathetic nervous activity (SNA) and accompanying heightened alertness. We hypothesized that in patients with OSA, those without subjective EDS (Epworth Sleepiness Scale, ESS score < 11) would have higher very low frequency (VLF) heart rate variability (HRV) during sleep, reflecting greater sympathetic heart rate modulation than patients with an ESS score ≥ 11.
METHODS
Patients with severe OSA (AHI ≥ 30: 26 with and 65 without heart failure) were divided into those with and without EDS. Heart rate (HR) signals were acquired in stage 2 sleep during periods of recurrent apneas and hypopneas and submitted to coarse graining spectral analysis, which extracts harmonic, neurally mediated contributions to HRV from total spectral power. Because the apnea-hyperpnea cycle entrains muscle SNA at VLF (0 to 0.04 Hz), VLF power was our principal between-group comparison.
RESULTS
Subjects without EDS had higher harmonic VLF power (944 ± 839 vs 447 ± 461 msec(2), p = 0.003) than those with EDS, irrespective of the presence or absence of heart failure (1218 ± 944 vs 426 ± 299 msec(2), p = 0.043, and 1029 ± 873 vs 503 ± 533 msec(2), p = 0.003, respectively). ESS scores correlated inversely with VLF power in all (r = -0.294, p = 0.005) and in heart failure subjects (r = -0.468, p = 0.016).
CONCLUSIONS
Patients with severe OSA but without EDS have higher VLF-HRV than those with EDS. This finding suggests that patients with severe OSA but without EDS have greater sympathetic modulation of HRV than those with EDS that may reflect elevated adrenergically mediated alertness.
CITATION
Taranto Montemurro L; Floras JS; Picton P; Kasai T; Alshaer H; Gabriel JM; Bradley TD. Relationship of heart rate variability to sleepiness in patients with obstructive sleep apnea with and without heart failure.
背景
许多重度阻塞性睡眠呼吸暂停（OSA）患者并未主诉日间过度嗜睡（EDS），这可能是由于交感神经活动（SNA）增加及随之而来的警觉性提高所致。我们推测，在OSA患者中，那些无主观EDS（爱泼华嗜睡量表，ESS评分<11）的患者在睡眠期间会有更高的极低频（VLF）心率变异性（HRV），这反映出其交感神经对心率的调节作用强于ESS评分≥11的患者。
方法
重度OSA患者（呼吸暂停低通气指数≥30：26例合并心力衰竭，65例未合并心力衰竭）被分为有EDS组和无EDS组。在反复出现呼吸暂停和低通气期间的2期睡眠中采集心率（HR）信号，并进行粗粒化频谱分析，该分析从总频谱功率中提取对HRV的谐波、神经介导的贡献。由于呼吸暂停-高通气周期在VLF（0至0.04Hz）时夹带肌肉SNA，VLF功率是我们主要的组间比较指标。
结果
无论有无心力衰竭，无EDS的受试者比有EDS的受试者具有更高的谐波VLF功率（944±839 vs 447±461msec²，p = 0.003）（合并心力衰竭组：1218±944 vs 426±299msec²，p = 0.043；未合并心力衰竭组：1029±873 vs 503±533msec²，p = 0.003）。在所有受试者（r = -0.294，p = 0.005）以及心力衰竭受试者（r = -0.468，p = 0.016）中，ESS评分与VLF功率呈负相关。
结论
重度OSA但无EDS的患者比有EDS的患者具有更高的VLF-HRV。这一发现表明，重度OSA但无EDS的患者对HRV的交感神经调节作用强于有EDS的患者，这可能反映了肾上腺素能介导的警觉性升高。
引用文献
Taranto Montemurro L; Floras JS; Picton P; Kasai T; Alshaer H; Gabriel JM; Bradley TD. 阻塞性睡眠呼吸暂停合并或不合并心力衰竭患者心率变异性与嗜睡的关系
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