Nocturnal cardiac arrhythmia in patients with obstructive sleep apnea
Nocturnal cardiac arrhythmia in patients with obstructive sleep apnea
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DOI：
10.1016/j.sleep.2007.08.015
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发表时间：
2008-07-01
期刊：
影响因子：
4.8
通讯作者：
Fanfulla, Francesco
中科院分区：
文献类型：
--
作者：
Olmetti, Francesca;La Rovere, Maria Teresa;Fanfulla, Francesco
背景和目的：阻塞性睡眠呼吸暂停(OSA)患者发生夜间心律失常，据报道是由于反复发生的呼吸暂停和随后的氧减饱和的自主神经效应的结果。方法：对257例OSA患者进行多导睡眠图(PSG)监测，分析其心率紊乱的发生率，并分析其与呼吸模式(正常、呼吸暂停/低呼吸、恢复呼吸、鼾声)和血氧饱和度的关系。结果：18.5%的患者出现心律失常。与无心律失常组比较，有夜间缓慢性心律失常患者的呼吸紊乱程度(呼吸暂停低通气指数58.8±/-36.8vs37.2+/-30.3，p=0.02)，平均减饱和幅度(8.9±/-4vs5.9+/-3.4%，p=0.03)，SaO2最低值(69%vs77%，p=0.003)。AHI&Gt；=30/h组BA患病率显著高于AHI+lt；30/h组(7.8%vs1.5%，x(2)=5.61，P=0.01)。而快速性心律失常(TA)患者的AHI、平均减饱和幅度和SaO(2)最低值与无心律失常患者相比差异无统计学意义。除了快速性心律失常与慢性阻塞性肺疾病(COPD)的相关性(优势比2.53；95%可信区间1.1-5.8，p=0.03)外，未发现心律失常与合并疾病或合并药物治疗之间的相关性。结论：虽然睡眠中的BA与OSA的严重程度有关，但合并COPD或β(2)治疗可能在睡眠中TA的发生中起作用。(C)2007 Elsevier B.V.保留所有权利。
Background and purpose: Nocturnal cardiac arrhythmias occur in patients with obstructive sleep apnea (OSA), reportedly as a consequence of the autonomic effects of recurrent apnea with subsequent oxygen desaturation. We have investigated whether different patterns of OSA are associated with specific arrhythmia during sleep.Patients and methods: Electrocardiographic (ECG) data recorded during polysomnography (PSG) were analysed in 257 consecutive OSA patients to determine the prevalence of cardiac rhythm disturbances, and to relate these to breathing pattern (normal, apnea/hypopnea, recovering ventilation, snoring) and oxygen saturation.Results: Arrhythmias were found in 18.5%, of patients. Patients with nocturnal bradyarrhythmia (BA) had higher values of ventilatory disturbance (apnea-hypopnea index [AHI] 58.8 +/- 36.8 vs 37.2 +/- 30.3, p = 0.02), mean desaturation amplitude (8.9 +/- 4 vs 5.9 +/- 3.4%, p = 0.03), and a lower SaO(2) nadir (69% vs 77%, p = 0.003) than those without arrhythmia. The prevalence of BA in patients with AHI >= 30/h was significantly higher than that observed in those with AHI < 30/h (7.8% vs 1.5%, respectively;, chi(2) = 5.61, p = 0.01). In contrast, patients with tachyarrhythmia (TA) had no significant differences in AHI, mean desaturation amplitude or SaO(2) nadir than those without arrhythmia. No associations were found between arrhythmia and the presence of comorbidity or concomitant medical therapy, except for an association between tachyarrhythmia and chronic obstructive pulmonary disease (COPD) (odds ratio 2.53; 95% confidence intervals 1.1-5.8, p = 0.03).Conclusions: We conclude that while BA during sleep is associated with OSA severity, concomitant COPD or beta(2)-treatment may play a role ill the development of TA during sleep. (C) 2007 Elsevier B.V. All rights reserved.