Covain Sandro, Baillieul Sébastien, Doutreleau Stéphane, Guinot Michel, Pépin Jean-Louis, Tamisier Renaud, Bricout Véronique-Aurélie
Inserm U1300, CHU Grenoble Alpes, HP2, Université Grenoble Alpes, Grenoble, 38000, France.
INSERM U1300, Sports et pathologies, CHU Sud, avenue de Kimberley, Echirolles, F-38130, France.
Sci Rep. 2025 Apr 3;15(1):11484. doi: 10.1038/s41598-025-90455-9.
Sleep apnea (SA) is common in Down syndrome (DS), but its impact on daytime autonomic control is poorly described. The aim of this study was to assess the impact of SA on autonomic control of heart rate (HR) and blood pressure (BP) during a Head-Up Tilt test (HUTT) in adults with DS. Ancillary cross-sectional analysis of an observational study conducted on 28 adults with DS (31.7 ± 7.4 years; 32% female) free from congenital cardiopathy, thyroid disorders, or medication that impact autonomic control were included. Full-night polysomnography and HUTT were performed. Temporal and spectral analyses were performed on the signals of RR intervals, systolic and diastolic blood pressures (SBP and DBP). SBP and DBP min-max variations were specifically analyzed during the initial 3 min post-tilting (3minUp). 21 (75%) subjects presented moderate-severe SA (Apnea-Hypopnea Index ≥ 15/h). During the 3minUp, moderate-severe SA group showed reduced min-max variations in systolic and diastolic blood pressures (40.0 ± 10.2 vs. 51.7 ± 18.7 mmHg and 27.0 ± 7.2 vs. 39.9 ± 17.4 mmHg, all p < 0.05) with blunted vascular sympathetic activity during the entire orthostatic phase (LF; 24.3 ± 11.7 vs. 28.6 ± 9.8 nu; p < 0.05). SA-related intermittent hypoxia, rather than sleep fragmentation was associated with changes in SBP during the 3minUp. The baroreflex sensitivity and heart rate variability parameters were similar in both groups. SA was associated with a blunted autonomic control of BP during HUTT, without changes in HR variability parameters. SA-related intermittent hypoxia, rather than sleep fragmentation seems to play a key role in these alterations.
睡眠呼吸暂停（SA）在唐氏综合征（DS）中很常见，但其对白天自主神经控制的影响鲜有描述。本研究的目的是评估SA对DS成年患者在头高位倾斜试验（HUTT）期间心率（HR）和血压（BP）自主控制的影响。纳入了一项对28名无先天性心脏病、甲状腺疾病或影响自主神经控制药物的DS成年患者（31.7±7.4岁；32%为女性）进行的观察性研究的辅助横断面分析。进行了全夜多导睡眠图和HUTT检查。对RR间期、收缩压和舒张压（SBP和DBP）信号进行了时域和频谱分析。特别分析了倾斜后最初3分钟（3minUp）期间SBP和DBP的最小-最大变化。21名（75%）受试者存在中度至重度SA（呼吸暂停-低通气指数≥15次/小时）。在3minUp期间，中度至重度SA组的收缩压和舒张压最小-最大变化减小（40.0±10.2 vs. 51.7±18.7 mmHg和27.0±7.2 vs. 39.9±17.4 mmHg，均p<0.05），在整个直立期血管交感神经活动减弱（低频；24.3±11.7 vs. 28.6±9.8 nu；p<0.05）。SA相关的间歇性缺氧而非睡眠片段化与3minUp期间SBP的变化有关。两组的压力反射敏感性和心率变异性参数相似。SA与HUTT期间BP的自主神经控制减弱有关，心率变异性参数无变化。SA相关的间歇性缺氧而非睡眠片段化似乎在这些改变中起关键作用。
