Shin Ji Hye, Song Min Ji, Kim Ji Hyun
Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Republic of Korea.
J Clin Med. 2023 Dec 10;12(24):7606. doi: 10.3390/jcm12247606.
Autonomic dysregulation is associated with cardiovascular consequences in obstructive sleep apnea (OSA). This study aimed to investigate the effect of acute continuous positive airway pressure (CPAP) treatment on autonomic activity and to identify factors contributing to heart rate variability (HRV) changes in OSA. Frequency domain HRV parameters were calculated and compared between the baseline polysomnography and during the CPAP titration in 402 patients with moderate to severe OSA. There were significant reductions in total power, very low-frequency band power, low-frequency band power, and high-frequency band power during the CPAP titration as compared to the baseline polysomnography. This tendency was pronounced in male patients with severe OSA. Multivariate analysis found that changes in the apnea-hypopnea index and oxygen saturation were significantly associated with changes in sympathetic and parasympathetic activity, respectively. This study demonstrated that HRV parameters significantly changed during the CPAP titration, indicating a beneficial effect of CPAP in the restoration of sympathetic and parasympathetic hyperactivity in OSA. Prospective longitudinal studies should determine whether long-term CPAP treatment aids in maintaining the long-lasting improvement of the autonomic functions, thereby contributing to the prevention of cardiovascular and cerebrovascular diseases in patients with OSA.
自主神经调节异常与阻塞性睡眠呼吸暂停（OSA）的心血管后果相关。本研究旨在探讨急性持续气道正压通气（CPAP）治疗对自主神经活动的影响，并确定导致OSA患者心率变异性（HRV）变化的因素。计算了402例中重度OSA患者在基线多导睡眠图检查时和CPAP滴定期间的频域HRV参数并进行比较。与基线多导睡眠图检查相比，CPAP滴定期间总功率、极低频带功率、低频带功率和高频带功率均显著降低。这种趋势在重度OSA男性患者中更为明显。多变量分析发现，呼吸暂停低通气指数和血氧饱和度的变化分别与交感神经和副交感神经活动的变化显著相关。本研究表明，CPAP滴定期间HRV参数显著变化，表明CPAP对恢复OSA患者交感神经和副交感神经功能亢进具有有益作用。前瞻性纵向研究应确定长期CPAP治疗是否有助于维持自主神经功能的持久改善，从而有助于预防OSA患者的心血管和脑血管疾病。
