Department of Neurology, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, NO. 16766, Jingshi Road, Jinan, Shandong, 250014, People's Republic of China.
Stem Cell Clinical Research Center, National Joint Engineering Laboratory, Regenerative Medicine Center, The First Affiliated Hospital of Dalian Medical University, Dalian Innovation Institute of Stem Cell and Precision Medicine, Dalian, Liaoning Province, China.
Sleep Breath. 2024 Jun;28(3):1105-1118. doi: 10.1007/s11325-023-02983-1. Epub 2024 Jan 3.
Heart rate variability (HRV) is becoming more prevalent as a measurable parameter in wearable sleep-monitoring devices, which are simple and effective instruments for illness evaluation. Currently, most studies on investigating OSA severity and HRV have measured heart rates during wakefulness or sleep. Therefore, the objective of this study was to investigate the circadian rhythm of HRV in male patients with OSA and its value for the estimation of OSA severity using group-based trajectory modeling.
Patients with complaints of snoring were enrolled from the Sleep Center of Shandong Qianfoshan Hospital. Patients were divided into 3 groups according to apnea hypopnea index (AHI in events/h), as follows: (<15, 15≤AHI<30, and ≥30). HRV parameters were calculated using 24 h Holter monitoring, which included time-domain and frequency-domain indices. Circadian differences in the standard deviation of normal to normal (SDNN) were evaluated for OSA severity using analysis of variance, trajectory analysis, and multinomial logistic regression.
A total of 228 patients were enrolled, 47 with mild OSA, 48 moderate, and 133 severe. Patients with severe OSA exhibited reduced triangular index and higher very low frequency than those in the other groups. Circadian HRV showed that nocturnal SDNN was considerably higher than daytime SDNN in patients with severe OSA. The difference among the OSA groups was significant at 23, 24, 2, and 3 o'clock sharp between the severe and moderate OSA groups (all P<0.05). The heterogeneity of circadian HRV trajectories in OSA was strongly associated with OSA severity, including sleep structure and hypoxia-related parameters. Among the low-to-low, low-to-high, high-to-low, and high-to-high groups, OSA severity in the low-to-high group was the most severe, especially compared with the low-to-low and high-to-low SDNN groups, respectively.
Circadian HRV in patients with OSA emerged as low daytime and high nocturnal in SDNN, particularly in men with severe OSA. The heterogeneity of circadian HRV revealed that trajectories with low daytime and significantly high nighttime were more strongly associated with severe OSA. Thus, circadian HRV trajectories may be useful to identify the severity of OSA.
心率变异性（HRV）作为可衡量的参数，在可穿戴睡眠监测设备中越来越普遍，这些设备是评估疾病的简单有效的工具。目前，大多数研究都是通过检测觉醒或睡眠时的心率来评估阻塞性睡眠呼吸暂停（OSA）严重程度和 HRV。因此，本研究的目的是通过基于群组的轨迹建模来研究男性 OSA 患者的 HRV 昼夜节律及其对 OSA 严重程度评估的价值。
从山东千佛山医院睡眠中心招募有打鼾症状的患者。根据呼吸暂停低通气指数（AHI，事件/小时）将患者分为 3 组，如下：（<15、15≤AHI<30 和≥30）。使用 24 小时动态心电图监测计算 HRV 参数，包括时域和频域指标。使用方差分析、轨迹分析和多项逻辑回归分析评估 OSA 严重程度的正常到正常标准差（SDNN）的昼夜差异。
共纳入 228 例患者，轻度 OSA47 例，中度 48 例，重度 133 例。重度 OSA 患者的三角指数降低，极低频升高。夜间 SDNN 明显高于日间 SDNN。重度 OSA 组与中重度 OSA 组在 23、24、2 和 3 点之间的 SDNN 差异有统计学意义（均 P<0.05）。OSA 严重程度与昼夜 HRV 轨迹的异质性密切相关，包括睡眠结构和缺氧相关参数。在低-低、低-高、高-低和高-高组中，低-高组的 OSA 严重程度最严重，尤其是与低-低和高-低 SDNN 组相比。
OSA 患者的昼夜 HRV 表现为 SDNN 的日间降低和夜间升高，尤其是男性重度 OSA 患者。昼夜 HRV 的异质性表明，日间低、夜间显著升高的轨迹与重度 OSA 相关性更强。因此，昼夜 HRV 轨迹可能有助于识别 OSA 的严重程度。
