Bauer T, Ewig S, Schäfer H, Jelen E, Omran H, Lüderitz B
Department of Internal Medicine, University of Bonn, Germany.
Cardiology. 1996 Nov-Dec;87(6):492-6. doi: 10.1159/000177144.
The increased mortality among patients with obstructive sleep apnea syndrome has been explained in part by the increased incidence of arterial and pulmonary hypertension. A decreased heart rate variability (HRV) has been shown to be associated with an increased mortality as well. We investigated 53 patients, admitted to the hospital for chest pain for sleep-related breathing disorders (SRBD) with an ambulatory screening device (MESAM-IV). HRV was recorded simultaneously. All patients received coronary artery catheterization and 36 had significant coronary artery disease (CAD; 67.9%). Standard time domain parameters were compared by a 4-way Anova for patients with an oxygen desaturation index of more and less than 5/hour and the factors CAD, diabetes and beta-blocker use. The percentage of differences between RR intervals that differ more than 50 ms (pNN > 50: 9.0 +/- 11.1 vs. 19.2 +/- 22.2%: p < 0.05) as well as the root mean square of these differences (38.0 +/- 29.0 vs. 59.2 +/- 51.5 ms; p < 0.05) were significantly decreased in patients with SRBD. In an hourly breakdown the number of desaturations was not correlated with a change in HRV. Mean oxygen saturation was significantly decreased in patients with SRBD (95.2 +/- 1.8 vs. 96.2 +/- 1.42%, p < 0.05), and positively correlated with the pNN > 50 (r = 0.34, p < 0.01). This correlation might suggest a more profound pathophysiological interaction between HRV and SRBD than short-term vagal activation alone. The results favor HRV for inclusion in future risk stratification models in patients with sleep apnea syndrome.
阻塞性睡眠呼吸暂停综合征患者死亡率增加，部分原因是动脉高血压和肺动脉高压发病率上升。心率变异性（HRV）降低也与死亡率增加有关。我们使用动态筛查设备（MESAM-IV）对53例因胸痛入院且患有睡眠相关呼吸障碍（SRBD）的患者进行了调查。同时记录HRV。所有患者均接受冠状动脉导管插入术，36例患有严重冠状动脉疾病（CAD；67.9%）。对于氧饱和度下降指数大于和小于5次/小时的患者，以及CAD、糖尿病和使用β受体阻滞剂这些因素，通过四因素方差分析比较标准时域参数。RR间期差异超过50毫秒的百分比（pNN>50：9.0±11.1对19.2±22.2%：p<0.05）以及这些差异的均方根（38.0±29.0对59.2±51.5毫秒；p<0.05）在SRBD患者中显著降低。按小时细分，饱和度下降次数与HRV变化无关。SRBD患者的平均氧饱和度显著降低（95.2±1.8对96.2±1.42%，p<0.05），且与pNN>50呈正相关（r=0.34，p<0.01）。这种相关性可能表明HRV与SRBD之间存在比单纯短期迷走神经激活更深刻的病理生理相互作用。结果支持将HRV纳入未来睡眠呼吸暂停综合征患者的风险分层模型。
