Chiang Jui-Kun, Lin Yen-Chang, Kao Yee-Hsin
Department of Family Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Road, Dalin, Chiayi 622, Taiwan.
Nature Dental Clinic, Puli Township, Nantou 404, Taiwan.
Healthcare (Basel). 2023 Oct 9;11(19):2701. doi: 10.3390/healthcare11192701.
(1) Background: Snoring is a cardinal symptom of obstructive sleep apnea (OSA) and has been suggested to potentially increase sympathetic activity. On the other hand, sleep itself usually leads to a decrease in sympathetic activity. Heart rate variability (HRV) analysis is a non-invasive technique used to assess autonomic nervous system function. However, there is limited research on the combined impact of sleep and snoring on sympathetic activity in individuals with OSA, particularly during the first hour of sleep (non-rapid eye movement sleep). The current study aims to investigate the net effect of sleep and snoring on sympathetic activity and explore factors that might contribute to increased sympathetic activity in individuals with OSA during the first hour of sleep. (2) Methods: The participants were referred from the outpatient department for OSA diagnosis and underwent whole-night polysomnography (PSG). Electrocardiogram (EKG) data from the PSG were downloaded for HRV analysis. HRV measurements were conducted in both the time and frequency domain, including the root mean square of successive differences between normal heartbeats (RMSSD) and the ratio of the absolute power of the low-frequency (LF) band (0.04-0.15 Hz) to the absolute power of the high-frequency (HF) band (0.15-0.4 Hz) (LF/HF ratio), respectively. (3) Results: A total of 45 participants (38 men and 7 women) were included in the analysis. The RMSSD gradually increased from 0-5 min to 50-60 min ( = 0.024), while the LF/HF ratio decreased ( < 0.001) during the first hour of sleep (non-rapid eye movement sleep). The LF/HF ratios of the "S" (snoring) episodes were compared with those of the pre-S episodes. An elevated LF/HF ratio during the S episode was associated with the first snoring episode occurring more than 20 min after lying down to sleep (Odds ratio, OR = 10.9, = 0.004) and with patients diagnosed with severe OSA (OR = 5.01, = 0.045), as determined by logistic regression. (4) Conclusions: The study observed an increase in the value of RMSSD and a decrease in the value of the LF/HF ratio during the first hour of sleep for patients with OSA. Higher LF/HF ratios were associated with the first occurrence of snoring while lying down for more than 20 min and with patients with severe OSA.
（1）背景：打鼾是阻塞性睡眠呼吸暂停（OSA）的主要症状，且有研究表明其可能会增加交感神经活动。另一方面，睡眠本身通常会导致交感神经活动减少。心率变异性（HRV）分析是一种用于评估自主神经系统功能的非侵入性技术。然而，关于睡眠和打鼾对OSA患者交感神经活动的综合影响的研究有限，尤其是在睡眠的第一个小时（非快速眼动睡眠期）。本研究旨在调查睡眠和打鼾对交感神经活动的净效应，并探索可能导致OSA患者在睡眠第一个小时交感神经活动增加的因素。（2）方法：参与者来自门诊进行OSA诊断，并接受了整夜多导睡眠图（PSG）检查。从PSG中下载心电图（EKG）数据用于HRV分析。HRV测量在时域和频域进行，分别包括正常心跳之间连续差值的均方根（RMSSD）以及低频（LF）频段（0.04 - 0.15 Hz）的绝对功率与高频（HF）频段（0.15 - 0.4 Hz）的绝对功率之比（LF/HF比值）。（3）结果：共有45名参与者（38名男性和7名女性）纳入分析。在睡眠的第一个小时（非快速眼动睡眠期），RMSSD从0 - 5分钟逐渐增加到50 - 60分钟（P = 0.024），而LF/HF比值下降（P < 0.001）。将“打鼾（S）”发作期间的LF/HF比值与发作前的比值进行比较。S发作期间升高的LF/HF比值与入睡后20分钟以上首次出现打鼾发作相关（优势比，OR = 10.9，P = 0.004），并且与诊断为重度OSA的患者相关（OR = 5.01，P = 0.045），这是通过逻辑回归确定的。（4）结论：该研究观察到OSA患者在睡眠的第一个小时内RMSSD值增加，LF/HF比值降低。较高的LF/HF比值与入睡后20分钟以上首次出现打鼾以及重度OSA患者相关。
