REM sleep-related brady-arrhythmia syndrome
REM sleep-related brady-arrhythmia syndrome
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DOI：
10.1007/s11325-007-0105-2
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发表时间：
2007-09-01
影响因子：
2.5
通讯作者：
Buyse, Bertien
中科院分区：
文献类型：
--
作者：
Janssens, Wim;Willems, Rik;Buyse, Bertien
快速眼动（REM）睡眠相关性心律失常综合征是一种心脏节律紊乱，其特征是在其他健康个体的REM睡眠期间持续数秒的心搏停止。与阻塞性睡眠呼吸暂停相关的心律失常相反，REM睡眠相关的窦性停搏和房室（AV）阻滞与呼吸暂停或呼吸不足发作无关。在文献中，只有少数病例被发表，这表明这种夜间节律紊乱的患病率非常罕见。在本文中，我们报告两个新的病例快速眼动睡眠相关的窦性停搏和一个快速眼动睡眠相关的总房室传导阻滞。为了探索潜在的机制，进行了心率变异性分析。在匹配的对照人群中，我们观察到慢波睡眠中的低频/高频（LF/HF）比显著低于REM睡眠（分别为2.04 +/- 1.2 vs 4.55 +/- 1.82 [ Mann-Whitney U检验p < 0.01]），表明REM期间交感神经活动全面增加。当在三名REM相关心律失常患者中的两名中使用相同的技术时，从慢波睡眠到REM睡眠的LF/HF比率增加的变化往往较低。这可能反映了这些受试者在REM睡眠期间迷走神经活动（HF成分）增加。因此，我们假设，在我们的REM睡眠相关心律失常患者中，REM期间交感神经活动的总体优势是存在的，但程度较低，并且当REM爆发时暂时切换为迷走神经优势。由于目前尚不清楚这些REM睡眠相关的心搏停止是否需要起搏，我们将我们的治疗和先前报道的病例与当前美国心脏病学会/美国心脏协会心脏起搏器植入指南进行了比较。
Rapid eye movement ( REM) sleep-related bradyarrhytmia syndrome is a cardiac rhythm disorder characterised by asystoles lasting several seconds during REM sleep in otherwise healthy individuals. In contrast to arrhythmias associated with obstructive sleep apnea, REM sleep-related sinus arrests and atrioventricular ( AV) blocks are not associated with episodes of apnea or hypopnea. In literature, only few cases have been published, suggesting that the prevalence of this nighttime rhythm disorder is very rare. In this paper, we report two new cases of REM sleep-related sinus arrests and one case of REM sleep- related total AV block. To explore the underlying mechanism, an analysis of heart rate variability was performed. In a matched control population, we observed a significant lower low-to-high frequency ( LF/HF) ratio in slow wave sleep as compared to REM sleep ( 2.04 +/- 1.2 vs 4.55 +/- 1.82, respectively [ Mann-Whitney U test p < 0.01]), demonstrating a global increase in sympathetic activity during REM. When using the same technique in two of three patients with REM-related arrhythmias, the shift to an increased LF/HF ratio from slow wave sleep to REM sleep tended to be lower. This may reflect an increased vagal activity ( HF component) during REM sleep in these subjects. We, therefore, hypothesise that, in our patients with REM sleep-related arrhythmias, the overall dominance of sympathetic activity during REM is present but to a lesser extent and temporarily switches into vagal dominance when the bursts of REMs occur. As it was still unclear whether these REM sleep-related asystoles needed to be paced, we compared our treatment and these of previously reported cases with the current American College of Cardiology/American Heart Association guidelines for implantation of cardiac pacemakers.