Yoshihisa Akiomi, Suzuki Satoshi, Takiguchi Mai, Shimizu Takeshi, Abe Satoshi, Sato Takamasa, Yamaki Takayoshi, Sugimoto Koichi, Kunii Hiroyuki, Nakazato Kazuhiko, Suzuki Hitoshi, Saitoh Shu-ichi, Takeishi Yasuchika
Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan; Department of Advanced Cardiac Therapeutics, Fukushima Medical University, Fukushima, Japan.
Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan.
PLoS One. 2014 Jun 26;9(6):e101307. doi: 10.1371/journal.pone.0101307. eCollection 2014.
Sleep-disordered breathing (SDB) is associated with adverse outcomes in patients with chronic heart failure (CHF). Additionally, heart rate turbulence (HRT) reflects changes in the sinus cycle length of baroreceptor in response to hemodynamic fluctuations after ventricular premature beat. Recent studies have suggested that HRT as a marker of vagal activity has a predictive value of poor prognosis in CHF patients. However, little is known about the relationship between SDB and HRT in CHF patients.
In this study, 75 patients with CHF were enrolled. We simultaneously performed Holter ECG during a 24-hr period and portable sleep monitoring at nighttime, and determined the respiratory disturbance index (RDI), HRT (turbulence onset (TO) and turbulence slope (TS)) during that 24-hr period. These patients were divided into two groups based on the presence of severe SDB: Group A (RDI≥30, n = 17) and Group B (RDI<30, n = 58). TS was significantly lower in Group A than in Group B across the 24-hr period (nighttime: 3.6±1.1 vs. 6.9±1.3; daytime: 3.7±0.8 vs. 7.0±1.1; all-day: 3.5±0.7 vs. 6.7±0.9% ms/RR, P<0.05, respectively). TO did not differ between the two groups. Furthermore, there was a significant negative correlation between all-day TS and RDI (R = -0.257, P = 0.027). Moreover, in the multiple regression analysis, RDI was an independent factor to determine all-day TS.
In patients with severe SDB, blunted TS was observed across 24 hours. These results suggest that SDB induce impairment of vagal activity across a 24-hour period and may be associated with poor prognosis in CHF patients.
睡眠呼吸紊乱（SDB）与慢性心力衰竭（CHF）患者的不良预后相关。此外，心率震荡（HRT）反映了室性早搏后压力感受器的窦性周期长度随血流动力学波动的变化。最近的研究表明，HRT作为迷走神经活动的标志物，对CHF患者的不良预后具有预测价值。然而，关于CHF患者中SDB与HRT之间的关系知之甚少。
本研究纳入了75例CHF患者。我们在24小时内同步进行动态心电图监测，并在夜间进行便携式睡眠监测，测定该24小时内的呼吸紊乱指数（RDI）、HRT（震荡起始（TO）和震荡斜率（TS））。根据是否存在严重SDB将这些患者分为两组：A组（RDI≥30，n = 17）和B组（RDI<30，n = 58）。在整个24小时期间，A组的TS显著低于B组（夜间：3.6±1.1对6.9±1.3；白天：3.7±0.8对7.0±1.1；全天：3.5±0.7对6.7±0.9%ms/RR，P均<0.05）。两组之间的TO无差异。此外，全天TS与RDI之间存在显著负相关（R = -0.257，P = 0.027）。而且，在多元回归分析中，RDI是决定全天TS的独立因素。
在严重SDB患者中，24小时内均观察到TS减弱。这些结果表明，SDB在24小时内导致迷走神经活动受损，可能与CHF患者的不良预后相关。
