Bradicich Matteo, Sievi Noriane A, Grewe Fabian A, Gasperetti Alessio, Kohler Malcolm, Schwarz Esther I
Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland.
University Heart Center, University Hospital Zurich, Zurich, Switzerland.
J Thorac Dis. 2020 Oct;12(Suppl 2):S129-S138. doi: 10.21037/jtd-cus-2020-005.
Obstructive sleep apnoea (OSA) results in sympathetic overdrive. Increased nocturnal heart rate variability (HRV) is a surrogate marker of autonomic disturbance. The aim was to study the association of the apnoea-hypopnea index (AHI), nocturnal hypoxaemia, and sleep fragmentation with nocturnal HRV to address the pathophysiological mechanisms underlying autonomic disturbance in OSA.
Participants of the Sleep Hearth Health Study with available data on nocturnal HRV and an AHI ≥10/h have been included in this cross-sectional analysis. The main outcome of interest was the association of sleep fragmentation, nocturnal hypoxaemia, and the AHI with nocturnal HRV. Multivariate regression modelling with the mean of the standard deviations of normal-sinus-to-normal-sinus-interbeat intervals in all 5-minute segments (SDNNIDX) and with low to high frequency power-ratio (LF/HF) as dependent variables controlling for prespecified confounders (age, sex, cups of coffee, beta blocker, nocturnal heart rate) was used to assess the contribution of the arousal index, total sleep time with an oxygen saturation <90% (TST90) and the AHI not due to arousals to HRV. The significance level was set at P<0.01.
In 258 patients with OSA (mean ± SD age 62±10 years, BMI 29±4 kg/m, median (IQR) AHI 18.6/h (14.0-25.6), the arousal index (coef =0.42, P=0.002) was independently positively associated with SDNNIDX also after having controlled for potential confounders, whereas the AHI (coef =0.22, P=0.030) and TST90 (coef =0.36, P=0.054) were not. The arousal index-but not TST and AHI-was also independently associated with LF/HF.
In OSA, pronounced sleep fragmentation is associated with higher nocturnal HRV and a sympatho-vagal imbalance with sympathetic dominance. OSA severity and nocturnal hypoxaemia did not independently predict nocturnal HRV.
阻塞性睡眠呼吸暂停（OSA）会导致交感神经亢进。夜间心率变异性（HRV）增加是自主神经功能紊乱的一个替代指标。本研究旨在探讨呼吸暂停低通气指数（AHI）、夜间低氧血症和睡眠片段化与夜间HRV之间的关联，以阐明OSA自主神经功能紊乱的病理生理机制。
纳入睡眠心脏健康研究中具有夜间HRV数据且AHI≥10次/小时的参与者进行横断面分析。主要研究指标是睡眠片段化、夜间低氧血症和AHI与夜间HRV之间的关联。采用多变量回归模型，以所有5分钟时间段正常窦性心律至正常窦性心律心跳间期标准差的平均值（SDNNIDX）以及低频与高频功率比（LF/HF）作为因变量，控制预先设定的混杂因素（年龄、性别、咖啡杯数、β受体阻滞剂、夜间心率），以评估觉醒指数、氧饱和度<90%的总睡眠时间（TST90）以及非觉醒引起的AHI对HRV的影响。显著性水平设定为P<0.01。
在258例OSA患者中（平均±标准差年龄62±10岁，体重指数29±4kg/m²，中位数（四分位间距）AHI为18.6次/小时（14.0 - 25.6）），在控制潜在混杂因素后，觉醒指数（系数 =0.42，P =0.002）与SDNNIDX独立正相关，而AHI（系数 =0.22，P =0.030）和TST90（系数 =0.36，P =0.054）则不然。觉醒指数而非TST和AHI也与LF/HF独立相关。
在OSA中，明显的睡眠片段化与较高的夜间HRV以及以交感神经占优势的交感 - 迷走神经失衡有关。OSA严重程度和夜间低氧血症并不能独立预测夜间HRV。
