Hypoglossal Nerve Stimulation and Heart Rate Variability: Analysis of STAR Trial Responders
Hypoglossal Nerve Stimulation and Heart Rate Variability: Analysis of STAR Trial Responders
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DOI：
10.1177/0194599818800284
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发表时间：
2019-01-01
影响因子：
3.4
通讯作者：
Clifford, Gari D.
中科院分区：
文献类型：
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作者：
Dedhia, Raj C.;Shah, Amit J.;Clifford, Gari D.
目的舌下神经刺激是治疗中重度阻塞性睡眠呼吸暂停的一种新方法；然而，它对心血管的影响尚不清楚。我们检查舌下神经刺激对心率变异性的影响，心率变异性是自主神经功能的一种测量。研究设计STAR试验（刺激治疗呼吸暂停减少）的子研究：多中心前瞻性单组队列。在美国和欧洲设立学术和私人执业中心。研究对象和方法STAR试验中有反应的参与者（n = 46）在手术后12个月随机分为停药组或维持治疗组。心率变异性分析包括R-R间隔的标准差（SDNN）、R-R间隔的低频功率和R-R间隔的高频功率。在基线期、12个月期和维持/停药期，通过5分钟滑动窗口睡眠进行分析。结果从基线到12个月，在所有睡眠阶段，SDNN和低频心率变异性都有显著改善。SDNN分析显示尾迹期无变化（平均+/- SD: 0.042 +/- 0.01 vs 0.077 +/- 0.07, P = 0.19）。SDNN的降低与呼吸暂停-低通气指数的改善相关（r = 0.39, P = 0.03）。在治疗停药组中，N1/N2、N3或快速眼动睡眠的SDNN未见显著变化。结论舌下神经刺激疗法可降低睡眠时心率变异性。这种减少不受1周停药期的影响。为了更好地了解舌下神经刺激对阻塞性睡眠呼吸暂停患者自主神经功能障碍的影响，需要更大规模的前瞻性研究。
Objective Hypoglossal nerve stimulation represents a novel therapy for the treatment of moderate-severe obstructive sleep apnea; nonetheless, its cardiovascular effects are not known. We examine the effects of hypoglossal nerve stimulation on heart rate variability, a measure of autonomic function. Study Design Substudy of the STAR trial (Stimulation Therapy for Apnea Reduction): a multicenter prospective single-group cohort. Setting Academic and private practice centers in the United States and Europe. Subjects and Methods A subset of responder participants (n = 46) from the STAR trial was randomized to therapy withdrawal or therapy maintenance 12 months after surgery. Heart rate variability analysis included standard deviation of the R-R interval (SDNN), low-frequency power of the R-R interval, and high-frequency power of the R-R interval. Analysis was performed by sleep with 5-minute sliding window epochs during baseline, 12 months, and the maintenance/withdrawal period. Results A significant improvement from baseline to 12 months in heart rate variability was seen for SDNN and low frequency across all sleep stages. SDNN analysis demonstrated no change in the wake period (mean +/- SD: 0.042 +/- 0.01 vs 0.077 +/- 0.07, P = .19). Reduction in SDNN was correlated to improvement in apnea-hypopnea index (r = 0.39, P = .03). In the therapy withdrawal group, no significant changes in SDNN were seen for N1/N2, N3, or rapid eye movement sleep. Conclusion Hypoglossal nerve stimulation therapy appears to reduce heart rate variability during sleep. This reduction was not affected by a 1-week withdrawal period. Larger prospective studies are required to better understand the effect of hypoglossal nerve stimulation on autonomic dysfunction in obstructive sleep apnea.