应用心率变异性初筛睡眠呼吸暂停低通气综合征  

Screening of sleep apnea-hypopnea syndrome by heart rate variability

作　　者：佟光明[1] 郭继鸿[1] 张兆国[1] 韩芳[2] 李静[2] 韩旭[2] 张海澄[1] 

机构地区：[1]北京大学人民医院心内科,北京100044 [2]北京大学人民医院睡眠中心,北京100044

出　　处：《中国心脏起搏与心电生理杂志》2007年第1期44-46,共3页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的以多导睡眠仪(PSG)作对照,探讨应用动态心电图(AECG)的心率变异性(HRV)初筛诊断睡眠呼吸暂停低通气综合征(SAHS)的可行性。方法对120例患者进行整夜(>7h)PSG监测,同时同步进行动态心电图检查。根据PSG结果分别作出有无SAHS的诊断,通过比较SAHS与非SAHS患者HRV的夜昼差异,用受试者工作特性曲线(ROC)法得出敏感指标及临界值,作为初筛标准。评价应用HRV初筛SAHS的可行性。结果SAHS患者与非SAHS患者比较,SDNNi、LF、LF/HF的夜/昼差值有差异,用ROC法,得到ROC曲线下面积分别为0.731,0.759,0.661,与Az=0.5比较,差异有统计学意义。取SDNNi夜/昼差值≥6.92为阈值,诊断的灵敏度73.9%、特异度59.4%;取LF夜/昼差值≥37.55为阈值,诊断的灵敏度78.4%、特异度68.7%;取LF/HF夜/昼差值≥-0.77为阈值,诊断的灵敏度56.8%、特异度81.2%。联合使用三项指标进行初筛,ROC曲线下面积为0.765。结论应用HRV可作为初筛SAHS的工具。Objective To evaluate the feasibility of screening sleep apnea- hypopnea syndrome （SAHS） by heart rate variability. Methods The overnight sleep investigation was administered to 120 subjects by polysomnogram （PSG） and 24 hours ambulatory electrocardiogram（AECG） monitoring simultaneously. The diagnosis of SAHS was given according to the result of PSG. Through analyzing the difference between nighttime and daytime of heart rate variability （ HRV ） of SAHS and non-SAHS cases, We derived sensitive index and critical value by receiver operating characteristic（ROC） curves in order to evaluate the feasibility of screening SAHS by HRV of AECG. Results Mean of the standard deviations of all NN intervals for all consecutive 5-minute segments of the recording （SDNNindex）, low-frequency power（LF） and the low-frequency power/high-frequency ratio （LF/HF） between nighttime and daytime values were significantly associated with SAHS. By using the ROC curves, the area under the curve were 0.731, 0.759, 0.661 respectively. Compared with Az = 0. 5 ,it showed statistical significance. The threshold value of 6.92 for △ [ nighttime/daytime] SDNNindex determined a sensitivity of 73.9%, and a specificity of 53.4%, the threshold value of 37.55 for △[ nighttime/daytime] LF determined a sensitivity of 75.9% , and a specificity of 68.7% , the threshold value of -0.77 for △[ nighttime/daytime] LF/HF determined a sensitivity of 56.8% , and a specificity of 81.2%. When analysis combined with the three items, the area under the curve was 0.765. Conclusions Analysis of HRV may represent a screening tool in suspected SAHS patients.

关 键 词：心血管病学 睡眠呼吸暂停 动态心电图 多导睡眠分析仪 心率变异性 

分 类 号：R540.41[医药卫生—心血管疾病]