Sima C A, Inskip J A, Sheel A W, van Eeden S F, Reid W D, Camp P G
Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada.
Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, Canada.
Rev Port Pneumol (2006). 2017 Nov-Dec;23(6):338-342. doi: 10.1016/j.rppnen.2017.06.001. Epub 2017 Jul 8.
Reduced heart rate variability (HRV), a marker of autonomic system dysfunction, has been reported in patients with chronic obstructive pulmonary disease (COPD). Yet, limited data exists on the reliability of HRV measurement in this population. Here we investigated the reliability of short-term HRV measurement performed during spontaneous breathing in patients with COPD.
Thirteen individuals (8 males) with moderate-to-severe COPD (FEV 46±16% predicted; FEV/FVC 49±13) underwent standard time and frequency domain HRV measurements derived from 5-minute electrocardiograms collected on two separate days using a SphygmoCor device. Absolute and relative reliability was assessed by a number of coefficients including within-subject random variation, systematic change in the mean, and retest correlations.
Within-subject coefficients of variation (CV) ranged from 4.3% to 193.4%. The intraclass correlation coefficients (ICCs) ranged from 0.72 to 0.93 for parameters related to overall HRV, and from 0.57 to 0.59 for those related to parasympathetic tone in both time and frequency domains. Mean heart rate was the only parameter that showed excellent absolute and relative reliability (CV=4.3%, ICC=0.93).
The HRV measurements showed overall moderate-to-substantial reliability during spontaneous breathing in COPD population. Our findings support the use of HRV parameters for diagnosis and cardiac risk assessment, but only mean heart rate can be used reliably for monitoring changes in autonomic status following rehabilitation intervention in this population.
心率变异性（HRV）降低是自主神经系统功能障碍的一个指标，慢性阻塞性肺疾病（COPD）患者中已有相关报道。然而，关于该人群HRV测量可靠性的数据有限。在此，我们研究了COPD患者在自主呼吸期间进行的短期HRV测量的可靠性。
13名中重度COPD患者（8名男性）（预测FEV为46±16%；FEV/FVC为49±13）使用SphygmoCor设备在两天内分别采集5分钟心电图，进行标准时域和频域HRV测量。通过包括受试者内随机变异、均值的系统变化和重测相关性在内的多个系数评估绝对和相对可靠性。
受试者内变异系数（CV）范围为4.3%至193.4%。与整体HRV相关参数的组内相关系数（ICC）范围为0.72至0.93，与副交感神经张力相关参数在时域和频域的ICC范围为0.57至0.59。平均心率是唯一显示出优异绝对和相对可靠性的参数（CV = 4.3%，ICC = 0.93）。
在COPD人群自主呼吸期间，HRV测量总体显示出中度至高度可靠性。我们的研究结果支持使用HRV参数进行诊断和心脏风险评估，但在该人群中，只有平均心率可可靠地用于监测康复干预后自主神经状态的变化。
