Blanchard Margaux, Gervès-Pinquié Chloé, Feuilloy Mathieu, Le Vaillant Marc, Trzepizur Wojciech, Meslier Nicole, Paris Audrey, Pigeanne Thierry, Racineux Jean-Louis, Balusson Frédéric, Oger Emmanuel, Girault Jean-Marc, Gagnadoux Frédéric
Ecole Supérieure d'Electronique de l'Ouest, Angers, France.
Laboratoire d'Acoustique de l'Université du Mans, Unité Mixte de Recherche Centre National de Recherche Scientifique 6613, Le Mans, France.
Ann Am Thorac Soc. 2021 Jun;18(6):1043-1051. doi: 10.1513/AnnalsATS.202009-1202OC.
Nocturnal hypoxemia and sympathetic/parasympathetic imbalance might contribute to the occurrence or atrial fibrillation (AF) in patients with obstructive sleep apnea (OSA). During sleep recordings, pulse rate variability (PRV) derived from oximetry might provide an accurate estimation of heart rate variability, which reflects the autonomic cardiovascular control. We aimed to evaluate whether indices of oxygen desaturation and PRV derived from nocturnal oximetry were associated with AF incidence in patients investigated for OSA. Data from a large multicenter cohort of AF-free patients investigated for OSA between May 15, 2007, and December 31, 2017, were linked to health administrative data to identify hospitalized and nonhospitalized patients with new-onset AF. Cox proportional hazards models were used to evaluate the association between AF incidence and oximetry-derived indices automatically generated from sleep recordings. After a median (interquartile range) follow-up of 5.34 (3.3-8.0) years, 181 of 7,205 patients developed AF (130 were hospitalized for AF). After adjusting for confounders, including anthropomorphic data, alcohol intake, cardiac, metabolic and respiratory diseases, β blocker/calcium channel blocker medications, type of sleep study, study site, and positive airway pressure adherence, AF risk was associated with increasing nocturnal hypoxemia ( trend = 0.004 for quartiles of percentage of recording time with oxygen saturation <90%) and PRV ( trend < 0.0001 for quartiles of root mean square of the successive normal-normal beat interval differences), and decreasing sympathetic/parasympathetic tone ( trend = 0.0006 for quartiles of low-frequency power/high-frequency power ratio). The highest risk of AF was observed in patients with the highest quartiles of both the percentage of recording time with oxygen saturation <90% and the root mean square of the successive normal-normal beat interval differences compared with those with neither of these conditions (adjusted hazard ratio, 3.61; 95% confidence interval, 2.10-6.22). Similar associations were observed when the analyses were restricted to hospitalized AF. In patients investigated for OSA, nocturnal hypoxemia and PRV indices derived from single-channel pulse oximetry were independent predictors of AF incidence. Patients with both marked nocturnal hypoxemia and high PRV were at higher risk of AF. Oximetry may be used to identify patients with OSA at greatest risk of developing AF.
夜间低氧血症以及交感神经/副交感神经失衡可能促使阻塞性睡眠呼吸暂停（OSA）患者发生心房颤动（AF）。在睡眠记录期间，通过血氧饱和度测定得出的脉搏率变异性（PRV）可能为心率变异性提供准确估计，而心率变异性反映自主心血管控制情况。我们旨在评估夜间血氧饱和度测定得出的氧饱和度降低指标和PRV是否与因OSA接受检查的患者的AF发病率相关。2007年5月15日至2017年12月31日期间，对一大群因OSA接受检查的无AF患者的数据与卫生行政数据相关联，以识别新发AF的住院和非住院患者。采用Cox比例风险模型评估AF发病率与从睡眠记录自动生成的血氧饱和度测定指标之间的关联。在中位（四分位间距）随访5.34（3.3 - 8.0）年后，7205例患者中有181例发生AF（130例因AF住院）。在对包括人体测量数据、酒精摄入量、心脏、代谢和呼吸系统疾病、β受体阻滞剂/钙通道阻滞剂用药、睡眠研究类型、研究地点以及气道正压依从性等混杂因素进行调整后，AF风险与夜间低氧血症增加（血氧饱和度<90%的记录时间百分比四分位数的趋势=0.004）和PRV相关（连续正常 - 正常搏动间期差值的均方根四分位数的趋势<0.0001），以及交感神经/副交感神经张力降低相关（低频功率/高频功率比值四分位数的趋势=0.0006）。与两种情况均无的患者相比，血氧饱和度<90%的记录时间百分比和连续正常 - 正常搏动间期差值的均方根均处于最高四分位数的患者中观察到AF风险最高（调整后风险比，3.61；95%置信区间，2.10 - 6.22）。当分析仅限于住院AF患者时，观察到类似的关联。在因OSA接受检查的患者中，夜间低氧血症和单通道脉搏血氧饱和度测定得出的PRV指标是AF发病率的独立预测因素。夜间低氧血症明显且PRV高的患者发生AF的风险更高。血氧饱和度测定可用于识别发生AF风险最高的OSA患者。
