Guaita Marc, Melia Umberto, Vallverdú Montserrat, Caminal Pere, Vilaseca Isabel, Montserrat Josep M, Gaig Carles, Salamero Manel, Santamaria Joan
Multidisciplinary Unit of Sleep Disorders, Hospital Clinic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Dept. ESAII, Centre for Biomedical Engineering Research, BarcelonaTech, CIBER of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain.
PLoS One. 2015 Apr 10;10(4):e0122645. doi: 10.1371/journal.pone.0122645. eCollection 2015.
The present study aimed to analyse the autonomic nervous system activity using heart rate variability (HRV) to detect sleep disordered breathing (SDB) patients with and without excessive daytime sleepiness (EDS) before sleep onset.
Two groups of 20 patients with different levels of daytime sleepiness -sleepy group, SG; alert group, AG- were selected consecutively from a Maintenance of Wakefulness Test (MWT) and Multiple Sleep Latency Test (MSLT) research protocol. The first waking 3-min window of RR signal at the beginning of each nap test was considered for the analysis. HRV was measured with traditional linear measures and with time-frequency representations. Non-linear measures -correntropy, CORR; auto-mutual-information function, AMIF- were used to describe the regularity of the RR rhythm. Statistical analysis was performed with non-parametric tests.
Non-linear dynamic of the RR rhythm was more regular in the SG than in the AG during the first wakefulness period of MSLT, but not during MWT. AMIF (in high-frequency and in Total band) and CORR (in Total band) yielded sensitivity > 70%, specificity >75% and an area under ROC curve > 0.80 in classifying SG and AG patients.
The regularity of the RR rhythm measured at the beginning of the MSLT could be used to detect SDB patients with and without EDS before the appearance of sleep onset.
本研究旨在利用心率变异性（HRV）分析自主神经系统活动，以检测入睡前期有无日间过度嗜睡（EDS）的睡眠呼吸障碍（SDB）患者。
从清醒维持试验（MWT）和多次睡眠潜伏期试验（MSLT）研究方案中连续选取两组各20名具有不同程度日间嗜睡的患者——嗜睡组（SG）；清醒组（AG）。每次午睡试验开始时最初清醒的3分钟RR信号窗口用于分析。HRV采用传统线性测量方法和时频表示法进行测量。采用非线性测量方法——相关熵（CORR）、自互信息函数（AMIF）来描述RR节律的规律性。采用非参数检验进行统计分析。
在MSLT的首个清醒期，SG组RR节律的非线性动态比AG组更规律，但在MWT期间并非如此。在对SG组和AG组患者进行分类时，AMIF（高频和全频段）和CORR（全频段）的敏感性>70%，特异性>75%，ROC曲线下面积>0.80。
MSLT开始时测量的RR节律规律性可用于在入睡前期出现之前检测有无EDS的SDB患者。
