阻塞性睡眠呼吸暂停综合征患者的心率变异性和心室重构分析  

Analysis of heart rate variability and ventricular remodeling in patients with obstructive sleep apnea syndrome

作　　者：贾燕 彭永平 JIA Yan;PENG Yongping(Department of Cardiology,Nanjing Jinling Hospital,Affiliated Hospital of Medical School,Nanjing University/General Hosptial of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China)

机构地区：[1]南京大学医学院附属金陵医院(东部战区总医院)心血管内科,南京210002

出　　处：《医学研究与战创伤救治》2024年第2期172-176,共5页Journal of Medical Research & Combat Trauma Care

摘　　要：目的研究阻塞性睡眠呼吸暂停综合征(OSAS)对心率变异性和心室重构的影响。方法回顾性分析2020年1月至2022年12月就诊于东部战区总医院心血管内科睡眠打鼾的400例住院患者。根据睡眠呼吸暂停低通气指数(AHI)分为对照(n=115例)、轻度(n=105例)和中重度(n=180例),分析所有患者动态心电图心率变异性(HRV)时域/频域性指标和M型超声心动图,并进行HRV与心室重构的相关性分析。结果中重度OSAS患者RR间期的平均值标准差(SDANN)较对照组明显降低(P<0.05),低频功率(LF)值明显增加(P<0.05),左心室后壁厚度(LVPW)明显增厚,左心室心肌质量(LVM)和左心室心肌质量指数(LVMI)明显增加(P<0.05)。多重线性回归方程,结果显示AHI对SDANN(P=0.003)和LF(P=0.001)的影响有统计学差异。中重度OSAS患者为向心性肥厚(LVMI和RWT均超过正常)。构建多重线性回归方程后,结果显示AHI对LVMI有影响(P=0.001)。中重度OSAS患者LF与LVPW和LVMI呈正相关(r=0.23、0.26,P<0.05)。结论中重度OSAS患者存在心率变异性降低和心室重构,而心率变异性降低可能会加剧心室重构。Objective To investigate the effects of obstructive sleep apnea syndrome(OSAS)on heart rate variability and ventricular remodeling.Methods From January 2020 to December 2022,400 patients with sleep snoring in the cardiovascular department of Eastern Theater General Hospital were retrospectively analyzed.Sleep apnea hypopnea index(AHI)was divided into control group(n=115 cases),mild group(n=105 cases)and moderate and severe group(n=180 cases).Time/frequency domain index of holter ECG heart rate variability(HRV)and M-mode echocardiography were analyzed in all patients,and the correlation between HRV and ventricular remodeling was analyzed.Results The mean standard deviation of RR interval in moderate to severe OSAS patients was significantly lower than that in control group(P<0.05),the low frequency power(LF)value was significantly increased(P<0.05),and the left ventricular posterior wall thickness(LVPW)was significantly thickened.Left ventricular myocardial mass(LVM)and left ventricular myocardial mass index(LVMI)were significantly increased(P<0.05).The results of multiple linear regression equation showed that AHI had a statistically significant effect on SDANN(P=0.003)and LF(P=0.001).Patients with moderate to severe OS AS have centripetal hypertrophy(both LVMI and RWT exceed normal).After constructing multiple linear regression equations,the results showed that AHI had an effect on LVMI(P=0.001).LVPW and LVMI were positively correlated with LF in moderate and severe OSAS patients(r=0.23,0.26,P<0.05).Conclusion Patients with moderate and severe OS AS have decreased heart rate variability and ventricular remodeling,and decreased heart rate variability may aggravate ventricular remodeling.

关 键 词：阻塞性睡眠呼吸暂停综合征 心率变异性 心室重构 向心性肥厚 

分 类 号：R540.4[医药卫生—心血管疾病]