外周动脉疾病患者的心率变异性改变与术后主要不良心血管和脑血管事件的相关性有限，需要进行手术血运重建。
Alterations in heart rate variability in patients with peripheral arterial disease requiring surgical revascularization have limited association with postoperative major adverse cardiovascular and cerebrovascular events.
机构信息
Division of Medicine, Turku University Hospital, Turku, Finland.
Sleep Research Centre, University of Turku, Turku, Finland.
出版信息
PLoS One. 2018 Sep 13;13(9):e0203519. doi: 10.1371/journal.pone.0203519. eCollection 2018.
OBJECTIVE
Obstructive sleep apnea (OSA) is common in peripheral arterial disease (PAD) and associates with high mortality after surgery. Since abnormal heart rate variability (HRV) is predictive of postoperative complications, we investigated the relations of HRV with PAD, OSA and major adverse cardiovascular and cerebrovascular events (MACCE).
MATERIALS AND METHODS
Seventy-five patients (67±9 years) scheduled for sub-inguinal revascularization and 15 controls (63±6 years) underwent polysomnography and HRV analyses. OSA with an apnea-hypopnea index (AHI) ≥20/hour was considered significant. HRV was measured during wakefulness, S2, S3-4 and rapid eye movement (REM) sleep with time and frequency domain methods including beat-to-beat variability, low frequency (LF) and high frequency (HF) power, and detrended fluctuation analysis (DFA). MACCE was defined as cardiac death, myocardial infarction, coronary revascularization, hospitalized angina pectoris and stroke.
RESULTS
Thirty-six patients (48%) had AHI≥20/hour. During follow-up (median 52 months), 22 patients (29%) suffered a MACCE. Compared to controls, fractal correlation of HRV (scaling exponent alpha 1 measured with DFA) was weaker during S2 and evening wakefulness in all subgroups (+/-AHI≥20/hour, +/-MACCE) but only in patients with AHI≥20/hour during morning wakefulness. The LF/HF ratio was lower in all subgroups during S2 but only in patients with AHI ≥20/hour during evening or morning wake. In the covariance analysis adjusted for age, body mass index, coronary artery disease and PAD duration, the alpha 1 during morning wakefulness remained significantly lower in patients with AHI≥20/hour than in those without (1.12 vs. 1.45; p = 0.03). Decreased HF during REM (p = 0.04) and S3-4 sleep (p = 0.03) were predictive of MACCE. In analyses with all sleep stages combined, mean heart rate as well as very low frequency, LF, HF and total power were associated with OSA of mild-to-moderate severity (AHI 10-20/hour).
CONCLUSIONS
HRV is altered in patients with PAD. These alterations have a limited association with OSA and MACCE.
目的
阻塞性睡眠呼吸暂停（OSA）在周围动脉疾病（PAD）中很常见，并且与手术后的高死亡率相关。由于异常的心率变异性（HRV）可预测术后并发症，因此我们研究了 HRV 与 PAD、OSA 和主要不良心血管和脑血管事件（MACCE）的关系。
材料和方法
75 名患者（67±9 岁）计划进行下肢动脉再血管化，15 名对照者（63±6 岁）接受了多导睡眠图和 HRV 分析。睡眠呼吸暂停低通气指数（AHI）≥20/h 的患者被认为存在显著的 OSA。通过时间和频率域方法（包括逐搏变异性、低频（LF）和高频（HF）功率以及去趋势波动分析（DFA））测量清醒、S2、S3-4 和快速眼动（REM）睡眠期间的 HRV。MACCE 定义为心脏死亡、心肌梗死、冠状动脉血运重建、住院心绞痛和中风。
结果
36 名患者（48%）的 AHI≥20/h。在随访（中位数 52 个月）期间，22 名患者（29%）发生了 MACCE。与对照组相比，所有亚组（+/-AHI≥20/h、+/-MACCE）的 S2 和傍晚清醒期间的 HRV 分形相关性（用 DFA 测量的标度指数 alpha 1）均较弱，但仅在 AHI≥20/h 的患者中在早晨清醒时较弱。所有亚组在 S2 期间的 LF/HF 比值均较低，但仅在 AHI≥20/h 的患者在傍晚或早晨清醒时较低。在调整年龄、体重指数、冠状动脉疾病和 PAD 持续时间后进行协方差分析，AHI≥20/h 的患者的清晨清醒时 alpha 1 明显低于无 OSA 的患者（1.12 比 1.45；p=0.03）。REM 睡眠期间（p=0.04）和 S3-4 睡眠期间（p=0.03）的 HF 降低与 MACCE 相关。在所有睡眠阶段结合的分析中，平均心率以及极低频、LF、HF 和总功率与轻度至中度 OSA（AHI 10-20/h）相关。
结论
PAD 患者的 HRV 发生改变。这些改变与 OSA 和 MACCE 的相关性有限。
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