阻塞性睡眠呼吸暂停低通气综合征对患者心肌缺血负荷的影响  

Myocardial ischemia burden in patients with obstructive sleep apnea hypopnea syndrome

作　　者：朱云云[1] 潘伟民[1] 傅卜年[2] 黄依琴[2] 郭勇娟[3] 李冬波[3] 

机构地区：[1]宁波市第一医院心内科,315010 [2]宁波市第一医院睡眠监测室,315010 [3]宁波市第一医院心电科,315010

出　　处：《中国心血管杂志》2011年第5期352-355,共4页Chinese Journal of Cardiovascular Medicine

摘　　要：目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对患者心肌缺血的影响及可能机制。方法纳入52例OSAHS患者和21名健康体检者,应用多导睡眠监测系统(PSG)行至少7 h睡眠呼吸监测,长程动态心电图(Holter)同步记录心电动态变化,分析心肌缺血与呼吸紊乱指数(AHI)的关系。结果轻中度OSAHS组(5次/h≤AHI<30次/h)与重度OSAHS组(AHI≥30次/h)均表现为睡眠时心肌缺血负荷显著大于觉醒时,且OSAHS患者AHI与睡眠时心肌缺血负荷相关(r=0.667,P<0.01)。轻中度OSAHS组与重度OSAHS组分别根据有无心肌缺血情况,分为心肌缺血组和无心肌缺血组。轻中度组亚组分析显示,与无心肌缺血组相比,心肌缺血组清醒时与睡眠时的平均心率均显著增快[(83.33±6.86)次/min比(76.30±8.52)次/min;(64.71±6.94)次/min比(59.18±2.94)次/min,均为P<0.05]。重度组亚组分析显示,与无心肌缺血组相比,心肌缺血组睡眠效率(74.71%±8.32%比86.36%±6.33%,P<0.01)、最低血氧饱和度(52.36%±17.32%比64.80%±14.86%,P<0.05)、平均血氧饱和度(87.93%±4.80%比92.00%±1.73%,P<0.01)及总非快速动眼期时间/总睡眠时间(68.67%±4.19%比76.87%±7.16%,P<0.05)均显著降低,SaO_2<90%的时间及最长呼吸暂停时间[(236.65±132.72)min比(124.10±82.99)min;(71.63±15.94)s比(55.28±22.05)s,均为P<0.05]均显著延长。结论 OSAHS患者睡眠时的心肌缺血与阻塞性睡眠呼吸暂停相关。轻中度OSAHS患者睡眠时心肌缺血可能由反复交感神经系统激活相关的改变所致,重度OSAHS患者的心肌缺血可能与低氧血症及睡眠结构紊乱相关。Objective To investigate the influence of obstructive sleep apnea hypopnea syndrome （OSAHS） on myocardial ischemia. Methods Fifty-two patients with OSAHS and 21 normal controls were monitored by polysomnography for at least 7 hours and apnea hypopnea index （ AHI ） were calculated. Dynamic ECG （Holter） was recorded for all subjects at the same time. Myocardial ischemia was defined as ECG ST depression equal to or more than 1 mm lasting at least 1 minute. Patients with OSAHS were divided into mild to moderate group and severe group according to AHI. Results Myocardial ischemia during sleep in both mild to moderate group （5 times/h ≤ AHI 〈 30 times/h） and severe group （AHI ≥30 times/h） occurred more frequently than in control group. Myocardial ischemia was positively related with AHI in patients with OSAHS （r = 0. 667, P 〈 0. 01 ）. In mild to moderate group, patients with myocardial ischemia had significantly faster heart rate during both awareness and sleep than those without [ （ 83.33 ± 6. 86 ） bpm vs. （ 76. 30 ± 8.52） bpm and （64.71±6.94） bpm vs. （59.18±2.94） bpm, both P 〈0.05]. In severe group, patients with myocardial ischemia had significantly lower sleep efficiency （74. 71% ± 8.32% vs. 86. 36% ±6. 33% , P 〈 0. 01 ）, lowest SaO2（52.36% ±17.32% vs. 64.80% ±14.86%, P〈0.05）, mean SaO2 87.93% ±4.80% vs. 92.00% ±1.73%, P 〈0. 01 ） and total NREM% SPT （68.67% ±4. 19% vs. 76. 87%±7. 16%, P 〈0. 05） than those without. Conclusions Myocardial ischemia during sleep is related to recurrent obstructive sleep apnea in patients with OSAHS. In mild to moderate OSAHS patients, myocardial isehemia may be caused by sleep-related, repeated sympathetic nervous system activation. In severe patients, myocardial ischemia may be mainly related to hypoxemia and sleep disorders.

关 键 词：睡眠呼吸暂停 阻塞性 心电描记术 便携式 心肌缺血 

分 类 号：R766[医药卫生—耳鼻咽喉科]