Aslan Sabina, Erbil Nurhan, Tezer F Irsel
Departments of Neurology and.
Biophysics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
J Clin Neurophysiol. 2019 Mar;36(2):104-111. doi: 10.1097/WNP.0000000000000544.
Heart rate variability is a noninvasive measure of autonomic function. The aim of this study was to determine the risk of cardiovascular autonomic dysfunction during sleep in patients with narcolepsy. The effect of daytime napping was also examined in patients with narcolepsy type 1 and type 2.
Polysomnography recordings and multiple sleep latency tests from 11 patients with narcolepsy type 1 (N1) and 20 patients with narcolepsy type 2 (N2) were included and compared with 12 healthy controls. Heart rate variability values (measured by time- and frequency-domain parameters) were calculated using electrocardiography data from the polysomnography-multiple sleep latency test recordings.
As an indicator of increasing sympathovagal imbalance, the low-frequency/high-frequency ratio was higher in all patients than in controls during non-rapid eye movement (NREM)-2 stage sleep (P ≤ 0.01). The root mean square of successive RR interval differences was lower (indicating parasympathetic tone) in N1 patients compared with N2 patients during REM sleep (P ≤ 0.04). In addition, decreased heart rate variability values were observed during sleep-onset REM-negative multiple sleep latency test periods compared with sleep-onset REM-positive periods.
Heart rate variability abnormalities during sleep and the role of these changes on the development of cardiovascular diseases must be investigated in prospective follow-up studies of patients with narcolepsy. Heart rate variability changes during night sleep, daytime napping, and presence of sleep-onset REM periods may affect the life-threatening events.
心率变异性是自主神经功能的一种非侵入性测量方法。本研究的目的是确定发作性睡病患者睡眠期间心血管自主神经功能障碍的风险。还对1型和2型发作性睡病患者白天小睡的影响进行了研究。
纳入11例1型发作性睡病（N1）患者和20例2型发作性睡病（N2）患者的多导睡眠图记录和多次睡眠潜伏期测试，并与12名健康对照者进行比较。使用多导睡眠图-多次睡眠潜伏期测试记录中的心电图数据计算心率变异性值（通过时域和频域参数测量）。
作为交感迷走神经失衡加剧的指标，在非快速眼动（NREM）-2期睡眠期间，所有患者的低频/高频比值均高于对照组（P≤0.01）。在快速眼动（REM）睡眠期间，N1患者的连续RR间期差值的均方根较低（表明副交感神经张力），与N2患者相比（P≤0.04）。此外，与睡眠起始REM阳性期相比，在睡眠起始REM阴性的多次睡眠潜伏期测试期间观察到心率变异性值降低。
在发作性睡病患者的前瞻性随访研究中，必须研究睡眠期间的心率变异性异常以及这些变化对心血管疾病发展的作用。夜间睡眠、白天小睡期间的心率变异性变化以及睡眠起始REM期的存在可能会影响危及生命的事件。
