Relationship among the severity of sleep apnea syndrome, cardiac arrhythmias, and autonomic imbalance
Relationship among the severity of sleep apnea syndrome, cardiac arrhythmias, and autonomic imbalance
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DOI：
10.1046/j.1460-9592.2003.00116.x
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发表时间：
2003-03-01
影响因子：
1.8
通讯作者：
Barthélémy, JC
中科院分区：
文献类型：
--
作者：
Roche, F;Xuong, ANT;Barthélémy, JC
ROCHE，E，等人：睡眠呼吸暂停综合征严重程度与心律失常和自主神经失衡的关系成人阻塞性睡眠呼吸暂停综合征（OSAS）、心律失常和传导障碍之间的关系仍存在争议。早期的研究表明，流行率高于最近的流行病学研究和设计。为了阐明转诊接受OSAS评估的患者中心律失常和传导障碍的实际患病率，进行了一项前瞻性队列研究：147名连续患者（103名男性;平均年龄54.5 ± 10.7岁）接受了时间同步多导睡眠图和ECG霍尔特监测。根据呼吸暂停低通气指数（AHI）≥ 10，66例（44.9%）被诊断为OSAS。心力衰竭、既往心肌梗死、高血压和室性心律失常的患病率在有或无OSAS的患者中相似。OSAS患者夜间阵发性心搏停止的发生率明显高于对照组（10.6%比1.2%; P < 0.02），且心动过缓和停搏的发生次数随综合征的严重程度而增加。几乎所有心动过缓事件都发生在重度OSAS（AHI > 30）、动脉血氧饱和度下降时间延长和昼夜清醒PaO 2较低的患者中。此外，使用心率变异性分析，夜间鼻窦功能障碍对比迟钝的昼夜副交感神经调制的窦房结。频繁的夜间非持续性室上性心动过速主要见于严重睡眠相关呼吸障碍的患者;然而，室性心律失常的风险增加并没有发现。在持续气道正压通气治疗下，对OSAS患者夜间暂停的1年随访没有发现任何值得进行特定干预的药物事件。
ROCHE, E, ET AL.: Relationship Among the Severity of Sleep Apnea Syndrome, Cardiac Arrhythmias, and Autonomic Imbalance. The relationship between obstructive sleep apnea syndrome (OSAS), cardiac arrhythmias, and conduction disturbances in adults remains controversial. Early studies showed a higher prevalence than more recent and designed epidemiological studies. To clarify the actual prevalence of cardiac arrhythmias and conduction disturbances in patients referred for assessment of OSAS, a prospective cohort study was conducted: 147 consecutive patients (103 men; mean age of 54.5 +/- 10.7 years) underwent time-synchronized polysomnography and ECG Holter monitoring. OSAS was diagnosed in 66 (44.9%) of them based on an apnea hypopnea index (AHI) greater than or equal to10. Prevalence of heart failure, of prior myocardial infarction, of hypertension, and of ventricular arrhythmias were similar in patients with or without OSAS. Nocturnal paroxysmal asystole was significantly more prevalent in OSAS patients (10.6 vs 1.2%; P < 0.02) and the number of episodes of bradycardia and pauses increased with the severity of the syndrome. Almost all bradycardic events occurred in patients with severe OSAS (AHI > 30), prolonged periods of arterial oxyhemoglobin desaturation, and low diurnal awake PaO2. Moreover, using heart rate variability analysis, nocturnal sinusal dysfunction contrasted with a blunted diurnal parasympathetic modulation of the sinus node. Frequent nocturnal nonsustained supraventricular tachycardias were predominantly found in patients with severe sleep related breathing disorders; however, an increased risk of ventricular arrhythmias was not found. Under continuous positive airway pressure treatment, the 1-year follow-up of OSAS patients with nocturnal pauses did not reveal any arrhythmic event justifying a specific intervention.