Sleep Disorders Center, Neurologic Institute, Cleveland Clinic, Cleveland, OH, USA.
Department of Electrical Engineering and Computer Science, Case Western Reserve University, Cleveland, OH, USA.
JACC Clin Electrophysiol. 2017 May;3(5):451-460. doi: 10.1016/j.jacep.2016.09.001.
Autonomic dysfunction contributes to atrial fibrillation (AF).
We hypothesized that polysomnogram (PSG)-based heart rate variability (HRV) autonomic function biomarkers are associated with incident AF and these associations are modified by measures of sleep disordered breathing (SDB).
2350 participants of a multi-center prospective study (Outcomes of Sleep Disorders in Older Men Study) without baseline AF underwent sleep studies with incident adjudicated AF follow up (8.0 ± 2.6 years). Cox proportional hazard models were used to analyze sleep study-ECG spectral HRV indices [low and high frequency power (LF, HF), LF/HF] and time domain indices [mean of normal to normal beats (MNN), short and long term variability (STV, LTV) and STV/LTV] and premature atrial contractions (PACs) and incident AF (HR and 95% CI). Statistical interactions between HRV and SDB were examined. Models were adjusted for age, race, body mass index, waist circumference, cardiac medications, co-morbid diseases, alcohol use and study site.
Lower LF/HF and lower LF were associated with higher AF incidence (LF/HF Q1 vs. Q4: 1.46, 1.02-2.08, LF Q1 vs. Q4: 1.46, 1.02-2.10). Higher STV/LTV was associated with an increased risk of AF (p-trend= 0.028). The highest PAC quartile had a 3-fold increased AF risk (2.99, 1.94-4.62) compared to the lowest quartile. A significant interaction of obstructive apnea was observed in the LF-AF relationship (0.045).
Sleep-related reduced sympathovagal balance (LF/HF) and increased atrial ectopy are independently associated with future AF; a relationship modified by obstructive apnea.
自主神经功能障碍可导致心房颤动（AF）。
我们假设多导睡眠图（PSG）为基础的心率变异性（HRV）自主功能生物标志物与 AF 的发生有关，这些关联可以通过睡眠障碍呼吸（SDB）的指标来改变。
一项多中心前瞻性研究（老年男性睡眠障碍研究）的 2350 名参与者没有基线 AF，进行了睡眠研究，随后进行了 AF 事件的后续随访（8.0±2.6 年）。采用 Cox 比例风险模型分析睡眠研究-心电图频谱 HRV 指数[低频和高频功率（LF、HF）、LF/HF]和时域指数[正常到正常心跳的平均值（MNN）、短程和长程变异性（STV、LTV）和 STV/LTV]以及房性早搏（PAC）和 AF （HR 和 95%CI）的发生。检查了 HRV 和 SDB 之间的统计学相互作用。模型调整了年龄、种族、体重指数、腰围、心脏药物、合并症、饮酒和研究地点。
较低的 LF/HF 和 LF 与较高的 AF 发生率相关（LF/HF Q1 与 Q4：1.46，1.02-2.08，LF Q1 与 Q4：1.46，1.02-2.10）。较高的 STV/LTV 与 AF 风险增加相关（p 趋势=0.028）。与最低四分位数相比，PAC 最高四分位数的 AF 风险增加了 3 倍（2.99，1.94-4.62）。在 LF-AF 关系中观察到阻塞性呼吸暂停的显著交互作用（0.045）。
与睡眠相关的交感神经-迷走神经平衡降低（LF/HF）和心房异位增加与未来的 AF 独立相关；阻塞性呼吸暂停改变了这种关系。
