重度阻塞性睡眠呼吸暂停综合征与窦房结功能障碍相关性的研究  

Association between severe obstructive sleep apnea syndrome and sinus dysfunction

作　　者：王昊[1] 张希龙[1] 蔡毓英[1] 胡玲[1] 李翀[1] 

机构地区：[1]南京医科大学第一附属医院呼吸科,210029

出　　处：《中华医学杂志》2007年第31期2185-2188,共4页National Medical Journal of China

摘　　要：目的初步探讨重度阻塞性睡眠呼吸暂停综合征(OSAS)与窦房结功能障碍(SD)间的关系。方法分析2005年3月至2006年6月我院睡眠实验室确诊的所有重度 OSAS 患者70例及单纯鼾症患者36例的多导睡眠监测中的心电图变化。对最低心率<40次/min 或最高窦性心率<90次/min 或最长 R-R 间期>2.0 s 者在超微心电图(UMECG)监测下行阿托品试验,以观察和比较他们的窦房结功能,并分析 SD 的危险因素。以 SPSS13.0软件包处理数据。结果 SD 在重度 OSAS 患者中占22.9%;在单纯鼾症者中占5.6%,差异有统计学意义(P=0.025)。经 Logistic 回归法分析提示睡眠期最低脉氧饱和度的降低是发生 SD 的一个主要危险因素(P=0.003,OR<0.001,95%CI0.000～0.016)。结论重度 OSAS 患者 SD 的发生率高于鼾症者。睡眠期最低脉氧饱和度降低为重度 OSAS 患者发生 SD 的一个主要危险因素。Objective To priliminarily investigate the association between severe obstructive sleep apnea syndrome （OSAS） and sinus dysfunction （SD）. Methods From March of 2005 to June of 2006, 70 patients with severe OSAS and 36 simple snorers underwent electrocardiography by polysomnograph. In order to compare their sinus function and analyse the risk factors of SD, atropine test with simultaneous monitoring of ultramieroelectrocardigram （UMECG） was performed in those with the lowerest heart rate 〈 40 pbm, the highest sinus heart rate 〈90 bpm, or the longest R-R interval 〉 2.0 seconds. All data were statistically analyzed with SPSS 13.0 software. Results Sixteen of the 70 severe OSAS patients were diagnosed as with SD with an incidence of 22.9%, significantly higher than that in the patients with simple snorer （ 2/36, 5.6% , P = 0. 025 ）. In 70 patients with severe OSAS （16 patients with SD ）, single factor analysis indicated that there was a significant difference between those with SD and those without SD in Nadir pulse oxygen saturation , longest apnea duration and incidence of coronary artery disease （ T test,P = 0. 002 ; T test, P = 0. 029 ; Fisher＇s Exact test, P = 0. 043 ）, and Logistic regressive analysis showed that the risk factors of SD were the decrease of Nadir pulse oxygen saturation（P =0. 003, OR 〈0. 001,95% CI 0.000-0. 016） and age（P=0.055,OR = 1.053,95%CI 1.007-1. 125）. Conclusions The incidence of SD in patients with severe OSAS is higher than that in simple snorer. Lower Nadir pulse oxygen saturation during sleep was the major risk factor for occurrence of SD in patients with severe OSAS.

关 键 词：睡眠呼吸暂停 阻塞性 窦房结 超微心电图 阿托品试验 

分 类 号：R766[医药卫生—耳鼻咽喉科]