微觉醒对老年中重度阻塞性睡眠呼吸暂停低通气综合征患者心率变异的影响  

Effect of Micro-arousal on Heart Rate Variation in Elderly Patients with Moderate-severe Obstructive Sleep Apnea Hypopnea Syndrome

作　　者：王冉 许辉杰[1] 彭好[1] Wang Ran;Xu Huijie;Peng Hao(Department of Otolaryngology,Beijing Hospital,National Center of Gerontology,Beijing,100730,China;Peking University Fifth School of Clinical Medicine,Beijing,100730,China)

机构地区：[1]北京医院耳鼻咽喉科国家老年医学中心中国医学科学院老年医学研究院,北京100730 [2]北京大学第五临床医学院

出　　处：《听力学及言语疾病杂志》2021年第5期535-539,共5页Journal of Audiology and Speech Pathology

基　　金：国家自然科学基金资助项目(61271410)。

摘　　要：目的探讨微觉醒对老年中重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者心血管系统的影响。方法研究对象为34对根据呼吸暂停指数(AHI)和体质量指数(BMI)1∶1匹配的、经多导睡眠监测(PSG)诊断为中重度OSAHS的老年(老年组)与中青年(中青年组)患者,每人选择连续1小时非快速动眼(NREM)期,记录每个阻塞性呼吸事件造成的最低血氧饱和度(lSaO2)、事件开始前10秒的平均心率(mHR)、最低心率(lHR)和事件后10秒内最高心率(hHR),计算微觉醒前后心率变异△HR1(△HR1=hHR-mHR,无微觉醒为△HR1’)和△HR2(△HR2=hHR-lHR,无微觉醒为△HR2’),配对出lSaO2完全一致的伴与不伴微觉醒的呼吸事件,并计算C1(△HR1-△HR1’)、C2(△HR2-△HR2’),比较微觉醒对两组患者心率变异影响的差异。结果①两组患者微觉醒发生后心率均较前明显升高(P<0.001);②老年组△HR1(8.0±5.4次/分)及△HR2(12.2±8.2次/分)显著低于中青年组△HR1(11.0±6.5次/分)、△HR2(18.1±10.8次/分)(Z=6.634,P<0.001,Z=7.949,P<0.001);③伴微觉醒的阻塞性呼吸暂停事件前后心率差△HR1(8.9±6.0次/分)、△HR2(14.1±10.2次/分)明显高于lSaO2一致的不伴微觉醒的呼吸事件△HR1’(5.1±4.0次/分)、△HR2’(9.3±7.1次/分)(Z=8.069,P<0.001,Z=7.399,P<0.001);④老年组C1(2.1±1.9次/分)、C2(2.5±2.4次/分)均明显低于中青年组C15.4±4.1次/分、C27.0±7.0次/分(t=-5.125,P<0.001,t=-4.313,P<0.001)。结论微觉醒可刺激OSAHS患者心血管自主神经系统兴奋,从而引起患者心率增快,与中青年患者相比,微觉醒对老年中重度OSAHS患者心血管自主神经系统的刺激性相对较轻。Objective To study the effect of arousal on the cardiovascular system in elderly patients with moderate to severe obstructive sleep apnea-hypopnea syndrome(OSAHS).Methods The subjects of the study were 34 pairs of elderly and middle-aged and young patients who were diagnosed as moderate to severe OSAHS by polysomnography(PSG)according to 1∶1 matching of AHI and BMI.The consecutive 1 hour non-rapid eye movement period(NREM period)was choosed in each person,to record the lowest blood oxygen saturation(lSaO2)caused by each obstructive respiratory event,the average heart rate(mHR)and the lowest heart rate(lHR)10 seconds before the event and the maximum heart rate(hHR)within 10 seconds after the event,to calculate the heart rate variation△HR1(△HR1=hHR-mHR,without arousal as△HR1')and△HR2(△HR2=hHR-lHR,without arousal as△HR2').The respiratory events with and without arousal were matched according lSaO2,and C1(△HR1-△HR1')and C2(△HR2-△HR2')were calculated to compare the difference in the effect of arouosals on heart rate variation between the two groups.Results①The heart rate of two groups after micro-arousals were significantly higher than before(P<0.001);②The heart rate variation△HR1(8.0±5.4 vs 11.0±6.5),△HR2(12.2±8.2 vs 18.1±10.8)in elderly group was significantly lower than that in the young-middle-aged group(Z=6.634,P<0.001,Z=7.949,P<0.001);③The heart rate variation△HR1(8.9±6.0 vs 5.1±4.0),△HR2(14.1±10.2 vs 9.3±7.1)of micro-arousal events were significantly higher than that of respiratory events without micro-arousal with the same minimum oxygen saturation(Z=8.069,P<0.001,Z=7.399,P<0.001);④The differences C1(2.1±1.9 vs 5.4±4.1),C2(2.5±2.4 vs 7.0±7.0)of the heart rate variation between events with and without micro-arousal in elderly group was significantly lower than that of the young-middle-aged group(t=-5.125,P<0.001,t=-4.313,P<0.001).Conclusion Micro-arousal can stimulate the cardiovascular autonomic nervous system in OSAHS patients and cause damage to the cardiovas

关 键 词：阻塞性睡眠呼吸暂停低通气综合征 微觉醒 心率变异 老年 

分 类 号：R764.43[医药卫生—耳鼻咽喉科]