Grzęda-Hałon Magda, Poręba Małgorzata, Gut Gabriela, Czerwińska Karolina, Gać Paweł, Martynowicz Helena, Mazur Grzegorz, Poręba Rafał
Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, PL Poland.
Department of Paralympic Sports, Wroclaw University of Health and Sport Sciences, Witelona 25a, 51-617 Wroclaw, PL Poland.
Sleep Biol Rhythms. 2022 Sep 14;21(2):143-154. doi: 10.1007/s41105-022-00424-2. eCollection 2023 Apr.
The aim of this study was to analyze the relationship between the initiation of CPAP therapy and HRV in patients with OSA. The study group consisted of 37 patients, aged 34-79 (mean 54.95 years) with OSA treated with CPAP. Two subgroups of patients were distinguished: less than severe (AHI < 30, = 16) and severe OSA (AHI ≥ 30, = 21). The second study was carried out around a month after the initiation of therapy. CPAP therapy caused the improvement in polysomnographic parameters, however, in most parameters in time and frequency analysis, there were no significant positive changes in parasympathetic tone. Moreover, in HRV time analysis, the reduced rMSSD and pNN50 parameters in the hours of night rest and rMSSD and SDSD during the 15-min N3 sleep period were noted. Especially, in the group with AHI ≥ 30, we observed significant decreases in rMSSD and pNN50 for the entire time. The changes were mainly for the night periods including the N3 sleep period, which is especially connected with sleep apnea (parameters: rMSSD, SDSD, and pNN50). In spectral analysis, the decrease in HF from the 15-min daily activity period and the N3 sleep period was observed. Inverse correlations were seen between the maximum, median, and mean positive airway pressure (PAP) and the change in rMSSD, SDNN, and SDSD, mainly during night hours and the N3 sleep period. Only in patients with AHI < 30 the increase in SDNN was observed in 15-min N3 sleep period. The beneficial increase in SDNN parameter from time analysis was observed only in one sleep period in less ill patients with OSA. The lack of significant changes was observed in the majority of the parameters of heart rate variability after initiation of CPAP therapy in a short observational time; however, the shift towards reduced HRV was observed in patients with AHI > 30, so the response to CPAP therapy may depends on the severity of the apnea. The results may suggest that a longer observational period is needed in such studies, and the problem is still not fully elucidated.
本研究的目的是分析阻塞性睡眠呼吸暂停（OSA）患者持续气道正压通气（CPAP）治疗起始与心率变异性（HRV）之间的关系。研究组由37例接受CPAP治疗的OSA患者组成，年龄在34 - 79岁之间（平均54.95岁）。区分出两个患者亚组：轻度（呼吸暂停低通气指数[AHI]<30，n = 16）和重度OSA（AHI≥30，n = 21）。第二次研究在治疗开始约一个月后进行。CPAP治疗使多导睡眠图参数得到改善，然而，在时间和频率分析的大多数参数中，副交感神经张力没有显著的正向变化。此外，在HRV时间分析中，注意到夜间休息时段的rMSSD和pNN50参数以及15分钟N3睡眠期的rMSSD和SDSD降低。特别是，在AHI≥30的组中，我们观察到整个时间段rMSSD和pNN50显著降低。这些变化主要发生在包括N3睡眠期在内的夜间时段，这尤其与睡眠呼吸暂停相关（参数：rMSSD、SDSD和pNN50）。在频谱分析中，观察到每日15分钟活动期和N3睡眠期高频功率（HF）降低。在夜间时段和N3睡眠期，最大、中位数和平均气道正压（PAP）与rMSSD、标准差（SDNN）和SDSD的变化之间呈负相关。仅在AHI<30的患者中，观察到15分钟N3睡眠期SDNN增加。在病情较轻的OSA患者中，仅在一个睡眠时段观察到时间分析中SDNN参数的有益增加。在短观察期内启动CPAP治疗后，大多数心率变异性参数没有显著变化；然而，在AHI>30的患者中观察到HRV降低的趋势，因此对CPAP治疗的反应可能取决于呼吸暂停的严重程度。结果可能表明，此类研究需要更长的观察期，且该问题仍未完全阐明。
