[阻塞性睡眠呼吸暂停患者客观日间嗜睡对心率变异性的影响]

[Effect of Objective Daytime Sleepiness on Heart Rate Variability in Patients With Obstructive Sleep Apnea].

作者信息

Zhang Meng-Qi, Ren Rong, Zhang Ye, Shi Yuan, Zhu Jie, Tan Lu, Li Tao-Mei, Tang Xiang-Dong

机构信息

Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China.

出版信息

Sichuan Da Xue Xue Bao Yi Xue Ban. 2023 Mar;54(2):298-303. doi: 10.12182/20230360202.

DOI:10.12182/20230360202

PMID:36949689

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10409155/

Abstract

OBJECTIVE

Excessive daytime sleepiness (EDS) is associated with cardiovascular events in patients with obstructive sleep apnea (OSA). Our study explored the correlation between objective daytime sleepiness assessed with daytime multiple sleep latency tests (MSLT) and heart rate variability (HRV) in OSA patients. The results may provide insight into possible mechanisms underlying increased risk of cardiovascular events in patients with OSA.

METHODS

A retrospective analysis was conducted with the data of 139 patients with OSA and 35 patients with primary snoring. All subjects underwent polysomnography (PSG) and MSLT at West China Hospital between January 2019 and May 2022. We used mean sleep latency (MSL) to measure the severity of EDS and to categorize OSA patients into three groups, severe EDS, light EDS, and non-EDS, with MSL of less than 5 minutes, 5 to 10 minutes, and greater than 10 minutes as the respective defining criteria for classification. A comparison of sleep structure, clinical characteristics, and HRV parameters was performed in order to evaluate the difference between OSA subgroups with varying levels of objective EDS and the primary snoring group. In addition, we also analyzed the correlation between MSL and HRV parameters.

RESULTS

Severe EDS patients had higher values of standard deviation of all N-N intervals (SDNN), total spectral power (TOT), and low-frequency power (LF) as compared to non-EDS patients, which was indicative of sympathetic stimulation ( <0.05). Additionally, high-frequency power (HF) was also higher in severe EDS patients, which indicated decreased parasympathetic drive. A significantly positive correlation was found between MSL and the values of SDNN, TOT, LF, and HF in OSA patients.

CONCLUSION

OSA patients with objective EDS have elevated sympathetic drive and decreased parasympathetic drive. A positive correlation was found between this change in neural activity and the shortening of MSL.

摘要

目的

阻塞性睡眠呼吸暂停（OSA）患者的日间过度嗜睡（EDS）与心血管事件相关。我们的研究探讨了通过日间多次睡眠潜伏期测试（MSLT）评估的客观日间嗜睡与OSA患者心率变异性（HRV）之间的相关性。研究结果可能有助于深入了解OSA患者心血管事件风险增加的潜在机制。

方法

对139例OSA患者和35例原发性打鼾患者的数据进行回顾性分析。2019年1月至2022年5月期间，所有受试者均在华西医院接受了多导睡眠图（PSG）和MSLT检查。我们使用平均睡眠潜伏期（MSL）来衡量EDS的严重程度，并将OSA患者分为三组，即严重EDS组、轻度EDS组和无EDS组，分别以MSL小于5分钟、5至10分钟和大于10分钟作为分类的定义标准。为了评估不同客观EDS水平的OSA亚组与原发性打鼾组之间的差异，我们对睡眠结构、临床特征和HRV参数进行了比较。此外，我们还分析了MSL与HRV参数之间的相关性。

结果

与无EDS患者相比，严重EDS患者的所有N-N间期标准差（SDNN）、总谱功率（TOT）和低频功率（LF）值更高，这表明交感神经受到刺激（P<0.05）。此外，严重EDS患者的高频功率（HF）也更高，这表明副交感神经驱动力下降。在OSA患者中，发现MSL与SDNN、TOT、LF和HF值之间存在显著正相关。