心率变异性指标对阻塞性睡眠呼吸暂停综合征患者的辅助诊断价值  

Auxiliary diagnostic value of heart rate variability index in patients with obstructive sleep apnea syndrome

作　　者：陈辉[1] 张冬花[2] 刘虹宏 康立惠[2] 陶娟[2] 孙俊平[2] 林运[2] Chen Hui;Zhang Donghua;Liu Honghong;Kang Lihui;Tao Juan;Sun Junping;Lin Yun(Department of Electrocardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心电生理科,北京100029 [2]首都医科大学附属北京安贞医院心内五科,北京100029

出　　处：《中国循证心血管医学杂志》2021年第5期623-625,629,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨心率变异性(HRV)的指标作为阻塞型睡眠呼吸暂停综合征(OSAS)患者的辅助诊断的可行性。方法回顾性分析北京安贞医院心内科门诊于2017年1月至2018年12月诊断阻塞型睡眠呼吸暂停综合征并同时监测动态心电图(Holter ECG)与多导呼吸睡眠监测(PSG)的患者268例,依据PSG监测出的睡眠呼吸暂停低通气指数(AHI)按病情程度分为四组:正常(A组)56例(AHI<5次/h);轻度(B组)64例(AHI 5~15次/h);中度(C组)60例(AHI>15~30次/h);重度(D组)88例(AHI>30次/h)。比较四组患者Holter ECG中的HRV数据和心律失常数据(至少包含7 h睡眠时的数据)。结果A组患者中的正常R-R间期标准差(SDNN)、每5 min正常R-R间期平均值标准差(SDANN)、相邻正常R-R间期差的均方根(Rmssd)、一定时间内相邻两个正常心动周期差值>50 ms的心搏数占全程心搏数的百分比(PNN50)、高频谱功率(HF)明显高于其余三组;B组患者中的PNN50、HF指标均显著高于C、D两组;C、D两组中的低频谱功率(LF)显著高于A、B组,其差异有统计学意义(P<0.05);A组患者中心律失常发生率明显低于另外三组,差异有统计学意义(P<0.05)。结论心率变异性的指标对于阻塞性睡眠呼吸暂停综合征患者的初步诊断具有一定辅助价值。Objective To investigate the feasibility of heart rate variability(HRV)as an adjunct diagnostic tool in patients with obstructive sleep apnea syndrome(OSAS).Methods The diagnosis of obstructive sleep apnea syndrome was retrospectively analyzed in the cardiology outpatient department of Anzhen Hospital from January 2017 to December 2018.Holter was also monitored.268 patients with ECG and polysomnography(PSG)were divided into four groups according to the degree of disease according to the sleep apnea-hypopnea index(AHI)monitored by PSG,56 patients in normal group A(AHI<5 times/h),64 patients in mild group B(AHI 5-15 times/h),60 patients in moderate group C(AHI>15~30 times/h),and 88 patients in severe group D(AHI>30 times/h).HRV data in Holter ECG and arrhythmia data(including at least 7 hours of sleep)were compared among the four groups.Results Standard deviation of normal R-R interval(SND),mean standard deviation of normal R-R interval every 5 minutes(SDANN),root mean square(Rmssd)of adjacent normal R-R interval difference,percentage of hearts with difference of>50 ms between two adjacent normal cardiac cycles in a certain period of time(PNN50)and high frequency spectral power(HF)were significantly higher in group A than in the other three groups.The indexes of PNN50 and HF in group B were significantly higher than those in group C and D,and the low frequency power(LF)in group C and D was significantly higher than that in group A and B,the difference was statistically significant(P<0.05).The incidence of arrhythmia in group A was significantly lower than that in the other three groups,the difference was statistically significant(P<0.05).Conclusion Indicators of heart rate variability can be helpful in the initial diagnosis of patients with obstructive sleep apnea syndrome.

关 键 词：心率变异性 低通气指数 阻塞型睡眠呼吸暂停综合征 

分 类 号：R563.8[医药卫生—呼吸系统]