Changes in Heart Rate Variability After Adenotonsillectomy in Children With Obstructive Sleep Apnea-猫眼课题宝

DOI：

10.1378/chest.10-1555

发表时间：

2011-05-01

期刊：

CHEST

影响因子：

9.6

通讯作者：

中科院分区：

医学1区

文献类型：

作者：

Muzumdar, Hiren V.;Sin, Sanghun;Arens, Raanan

背景资料：阻塞性睡眠呼吸暂停综合征（OSAS）与心血管疾病的发病率和死亡率有关，交感神经活动增加被认为是这种联系的一个致病环节。据报道，患有OSAS的儿童交感神经活动水平较高。交感神经优势在心率变异性（HRV）分析中通过心率（HR）增加和低频与高频带功率（LF/HF）的较高比率来指示。因此，OSAS患儿行腺样体扁桃体切除术（AT）后OSAS的改善可能与HR降低和LF/HF降低有关。方法：回顾性分析了OSAS患儿AT前后进行多导睡眠图检查的轻、深、快动眼（REM）睡眠期间无呼吸事件的2分钟内HR和HRV的时间和频率成分的变化。研究了18名OSAS儿童，年龄为4.9 ± 2.4岁（平均值± SD）。AT后，呼吸暂停低通气指数从31.9 +/- 24.8次事件/h降至4.1 +/- 3.7次事件/h。AT后各睡眠阶段HR均降低（99.8 +/- 16.9次/分至80.7 +/- 12.9次/分[浅睡眠]; 100.2 +/- 15.4次/分至80.5 +/- 12.4次/分[深睡眠]）;和106.9 +/- 16.4次/分至87.0 +/- 12.1次/分[REM睡眠]），LF/HF也是如此。（1.6 +/- 2.7至0.6 +/- 0.5 [浅睡眠]; 1.2 +/- 1.6至0.5 +/- 0.6 [深睡眠]; 3.0 +/- 5.4至1.4 +/- 1.7 [快速眼动睡眠]）。AT后OSAS儿童自主神经系统交感神经活性的比例下降，与睡眠呼吸障碍的改善有关。胸部2011; 139（5）：1050-1059

Background: Obstructive sleep apnea syndrome (OSAS) is associated with cardiovascular morbidity and mortality, and increased sympathetic activity is considered to be a causative link in this association. Higher levels of sympathetic activity have been reported in children with OSAS. Sympathetic predominance is indicated on heart rate variability (HRV) analysis by increased heart rate (HR) and a higher ratio of low-frequency to high-frequency band power (LF/HF). Improvement in OSAS after adenotonsillectomy (AT) in children with OSAS could, therefore, be associated with reduced HR and reduced LF/HF.Methods: Changes in HR and time and frequency components of HRV were retrospectively analyzed in 2-min epochs free of respiratory events during light, deep, and rapid-eye-movement (REM) sleep in children with OSAS who underwent polysomnography before and after AT.Results: Eighteen children with OSAS, aged 4.9 +/- 2.4 years (mean +/- SD) were studied. After AT, the apnea-hypopnea index decreased from 31.9 +/- 24.8 events/h to 4.1 +/- 3.7 events/h. The HR decreased after AT in all stages of sleep (99.8 +/- 16.9 beats/min to 80.7 +/- 12.9 beats/min [light sleep]; 100.2 +/- 15.4 beats/min to 80.5 +/- 12.4 beats/min [deep sleep]); and 106.9 +/- 16.4 beats/min to 87.0 +/- 12.1 beats/min [REM sleep]), as did the LF/HF (1.6 +/- 2.7 to 0.6 +/- 0.5 [light sleep]; 1.2 +/- 1.6 to 0.5 +/- 0.6 [deep sleep]; and 3.0 +/- 5.4 to 1.4 +/- 1.7 [REM sleep]).Conclusions: The proportion of sympathetic activity of the autonomic nervous system declines in children with OSAS after AT in association with improvement in sleep-disordered breathing. CHEST 2011; 139(5):1050-1059

Changes in Heart Rate Variability After Adenotonsillectomy in Children With Obstructive Sleep Apnea

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