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目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者微觉醒与夜间心率变异(HRV)的关系。方法本研究对象为27例经整夜多导睡眠图(PSG)诊断为中重度 OSAHS 的患者。所有患者每人选择1h 连续非快速动眼睡眠(NREM)的 PSG 记录,将1h 内每个呼吸紊乱相关微觉醒开始前10s 的平均心率(HR)和微觉醒开始后10s 的最高 HR 进行比较,同时计算1h 内呼吸紊乱相关微觉醒指数(B-ArI)和脉率升高指数(PRRI)并作相关分析。此外对18例中重度 OSAHS 患者选择NREM 睡眠时10个不伴微觉醒的事件和10个伴有微觉醒的事件[按最低动脉血氧饱和度(minSaO_2)进行匹配],比较两组事件终止前后心率变化(ΔHR)。结果微觉醒开始后10s 的最高 HR[(81.6±9.4)次/min]显著高于微觉醒开始前10s 的平均 HR[(69.6±7.3)次/min,t=-14.87、P<0.01],且 B-ArI 与 PRRI 呈显著正相关(r=0.97,P<0.01),伴有微觉醒的呼吸事件终止前后ΔHR[(11.1±2.8)次/min]显著高于不伴微觉醒的呼吸事件[(7.0±2.4)次/min,t=4.702、P<0.01]。结论 B-ArI 与夜间 HRV 相关,提示微觉醒可影响心血管调节功能,频繁的微觉醒是导致 OSAHS 患者心血管后果的重要原因之一。
Objective To investigate the relationship between arousal and nighttime heart rate variability (HRV) in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods The subjects were 27 patients diagnosed as moderate-to-severe OSAHS with overnight polysomnography (PSG). All patients were enrolled in PSG recordings of 1h continuous non-fast eye movement sleep (NREM), and the mean HR (HR) at 10 seconds before onset of arousal related to each respiratory disorder within 1 hour was compared with the highest HR at 10 seconds after the onset of arousal. At the same time, the B-ArI and PRRI of 1h respiratory distress were calculated and correlated. In addition, in 18 patients with moderate-to-severe OSAHS, 10 patients with no arousal and 10 patients with arousal [matched by minSaO_2] during NREM sleep were selected and compared before and after termination of both groups Heart rate change (ΔHR). Results The highest HR at 10 seconds ([81.6 ± 9.4] min / min] after arousal onset was significantly higher than the mean HR at 10 seconds before arousal onset (69.6 ± 7.3 times / min, t = 14.87, P <0.01) There was a significant positive correlation between B-ArI and PRRI (r = 0.97, P <0.01). The ΔHR [(11.1 ± 2.8) beats / min before and after the arousal respiratory event was significantly higher than that of the non-arousal respiratory event [(7.0 ± 2.4) times / min, t = 4.702, P <0.01]. Conclusions B-ArI is associated with HRV at night, suggesting that arousals may affect cardiovascular regulation. Frequent arousal is one of the major causes of cardiovascular outcomes in patients with OSAHS.