长期持续气道正压通气治疗可改善阻塞性睡眠呼吸暂停患者睡眠时的心脏自主神经功能。
Long-term continuous positive airway pressure therapy improves cardiac autonomic tone during sleep in patients with obstructive sleep apnea.
机构信息
Sleep Unit, Clinical Neurophysiology Section, University Clinic of Navarra, Pío XII s/n 31008, Pamplona, Spain.
Department of Neurology, Dysautonomia Center, New York University School of Medicine, 530 First Avenue, Suite 9Q, New York, NY, 10016, USA.
出版信息
Clin Auton Res. 2015 Aug;25(4):225-32. doi: 10.1007/s10286-015-0297-7. Epub 2015 May 23.
BACKGROUND
Cardiac autonomic tone after long-term continuous positive airway pressure therapy in patients with obstructive sleep apnea remains unexplored.
METHODS
Thirty patients with obstructive sleep apnea (14 with moderate and 16 with severe obstructive sleep apnea) were studied during a baseline polysomnographic study, after a full night of acute continuous positive airway pressure treatment, and after long-term (~2 years) chronic continuous positive airway pressure therapy. Twenty age- and gender-matched controls with baseline sleep study were selected for comparison purposes. Cross-spectral analysis and the low-frequency (LF) and high-frequency (HF) components of the heart rate variability were computed separately over 10-min ECG epochs during rapid eye movement sleep, non-rapid eye movement sleep, and wakefulness.
RESULTS
During the baseline study, obstructive sleep apnea patients exhibited increased LF, decreased HF, and increased LF/HF ratio during sleep when compared to controls. In a multiple regression model, the mean oxygen saturation explained the increased LF during rapid and non-rapid eye movement sleep in obstructive sleep apnea patients. Acute continuous positive airway pressure therapy decreased the LF modulations and the LF/HF ratio and increased the HF modulations during sleep in patients with severe obstructive sleep apnea. Long-term continuous positive airway pressure therapy decreased LF modulations and LF/HF ratio with increased HF modulations during sleep in patients with moderate and severe obstructive sleep apnea.
CONCLUSIONS
Long-term continuous positive airway pressure reduces the sympathovagal imbalance in patients with moderate and severe obstructive sleep apnea, both during rapid and non-rapid eye movement sleep. Continuous positive airway pressure seems to exert its changes in cardiac autonomic modulation by decreasing the burden of nocturnal hypoxia.
背景
阻塞性睡眠呼吸暂停患者经长期持续气道正压通气治疗后的心脏自主神经张力仍未得到探索。
方法
研究了 30 例阻塞性睡眠呼吸暂停患者（14 例中度和 16 例重度阻塞性睡眠呼吸暂停），在基线多导睡眠图研究期间、急性持续气道正压通气治疗后的一整夜以及长期（~2 年）慢性持续气道正压通气治疗后进行了研究。选择 20 名具有基线睡眠研究的年龄和性别匹配的对照者用于比较目的。在快速眼动睡眠、非快速眼动睡眠和清醒期间，分别在 10 分钟 ECG 段上计算心率变异性的交叉谱分析和低频（LF）和高频（HF）分量。
结果
在基线研究中，与对照组相比，阻塞性睡眠呼吸暂停患者在睡眠期间表现出 LF 增加、HF 降低和 LF/HF 比值增加。在多元回归模型中，平均氧饱和度解释了阻塞性睡眠呼吸暂停患者快速和非快速眼动睡眠期间 LF 的增加。急性持续气道正压通气治疗降低了严重阻塞性睡眠呼吸暂停患者睡眠期间的 LF 调制和 LF/HF 比值，并增加了 HF 调制。长期持续气道正压通气治疗降低了中度和重度阻塞性睡眠呼吸暂停患者睡眠期间的 LF 调制和 LF/HF 比值，并增加了 HF 调制。
结论
长期持续气道正压通气降低了中重度阻塞性睡眠呼吸暂停患者的交感神经-副交感神经失衡，无论是在快速眼动睡眠还是非快速眼动睡眠期间。持续气道正压似乎通过降低夜间低氧血症的负担来发挥其对心脏自主神经调节的改变。
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