阻塞性睡眠呼吸暂停对心脏自主神经稳态的影响  

Effect of obstructive sleep apnea on cardiac autonomic nerve homeostasis.

作　　者：穆热提·阿卜迪肖库尔 冯艳[1] Mureti·Abudixiaokuer;FENG Yan(Department of Electrocardiogram,the Peopled Hospital of Xinjiang,Urumqi 830001,Xinjiang,China)

机构地区：[1]新疆维吾尔自治区人民医院心电学科,新疆乌鲁木齐830001

出　　处：《中国心脏起搏与心电生理杂志》2021年第6期548-552,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)对患者心脏自主神经稳态的影响。方法于本院诊断OSAHS患者为观察组,同期非OSAHS患者为对照组。分析两组患者在基线资料、睡眠监测、心率变异性时域分析指标、外周血甲氧基肾上腺素(MN)、甲氧基去甲肾上腺素(NMN)等方面的差异。根据呼吸暂停指数(AHI)将观察组分为轻、中、重三组后予以比较,并进行年龄、AHI、夜间最低氧饱和度(LSaO_(2))与时域指标、血儿茶酚胺代谢产物之间的相关性分析。结果观察组正常连续窦性RR间期差值均方根(rMSSD)、相邻RR间期差值>50 ms占间期总数的百分化(PNN50%)均明显小于对照组(P<0.05),而AHI、MN、NMN均明显大于对照组(P<0.05);重、中度组PNN50%明显小于轻度组(P<0.05);重、中度组患者MN水平明显高于轻度组(P<0.05);重度组NMN水平明显高于轻、中度组(P<0.05);OSAHS患者的年龄与SDNN、rMSSD、pNN50%呈负相关(P均<0.05),与NMN正相关(P<0.05);AHI与SDNN、pNN50%呈负相关(P均<0.01),与NMN呈正相关(P<0.05);LSaO_(2)与SDNN、pNN50%呈正相关(P均<0.05),与香草扁桃酸2呈负相关(P<0.05)。结论OSAHS患者夜间存在明显的心脏交感神经和迷走神经平衡紊乱现象。Objective To investigate the effect of obstructive sleep apnea hypopnea syndrome(OSAHS)on cardiac autonomic nerve homeostasis.Methods OSAHS patients diagnosed in our hospital were used as the observation group and non OSAHS patients in the same period were used as the control group.The differences of baseline data,sleep monitoring,time-domain analysis indexes of heart rate variability,peripheral blood methoxyepinephrine(MN)and methoxynorepinephrine(NMN)between the two groups were analyzed.The observation groups were divided into light,medium and severe groups according to apnea hypopnea index(AHI),and the correlation between age,AHI,nocturnal hypoxic saturation(LSaO_(2))and time domain indexes and blood catecholamine metabolites was analyzed.Results In the observation group,the root mean square of normal continuous sinus RR interval difference(RMSD)and the percentage of adjacent RR interval difference>50 ms in the total number of intervals(pNN50%)were significantly lower than those in the control group(P<0.05),while AHI,MN and NMN were significantly higher than those in the control group(P<0.05);PNN50%in severe and medium group was significantly lower than that in mild group(P<0.05);The level of MN in severe and medium group was significantly higher than that in mild group(P<0.05);The level of NMN in severe group was significantly higher than that in mild and medium group(P<0.05);The age of OSAHS patients was negatively correlated with SDNN,RMSD and pNN50%(P<0.05),and positively correlated with NMN(P<0.05);AHI was negatively correlated with SDNN and pNN50%(P<0.01),and positively correlated with NM(P<0.05);LSaO_(2) was positively correlated with SDNN and pNN50%(P<0.05),and negatively correlated with vanilla mandelic acid 2(P<0.05).Conclusion Patients with OSAHS have obvious cardiac sympathetic and vagus nerve balance disorder at night.

关 键 词：心血管病学 阻塞性睡眠呼吸暂停综合征 心率变异性 血儿茶酚胺 相关性 

分 类 号：R56[医药卫生—呼吸系统] R540.41[医药卫生—内科学]