【摘要】 目的研究阻塞性睡眠呼吸暂停综合征(OSAS)患者心率变异性(HRV)昼夜变化,探讨利用HRV指标筛选OSAS的效果。方法对80例研究对象测量体重、身高、血压、计算体重指数(BMI)、询问有无糖尿病史、心肌梗死病史。对可疑OSAS者用多导睡眠图(PSG)行整夜(至少7h)睡眠检测,同步记录脑电图、眼电图、下颌肌电图、口鼻气流、胸腹呼吸、鼾声、血氧饱和度(SaO2)、血压及脉搏情况。所有研究对象同步进行动态心电图及24h HRV检查。以研究OSAS患者HRV昼夜变化。行PSG检测的50例患者,通过PSG、HRV分析各自的诊断标准在互相不沟通的情况下做出OSAS阳性、阴性诊断。以PSG检测为标准,评介HRV分析筛选OSAS的效果。结果△[昼/夜]OSAS阳性组与OSAS阴性组HRV时域指标的平均夜间SDNN、△[昼/夜]SDNN、夜间RMSSD、△[昼/夜]RMSSD、夜间PNN50、△[昼/夜]PNN50有显著性差异;频域指标的平均夜间ULF、夜间VLF、△[昼/夜]VLF、夜间LF、△[昼/夜]LF、夜间HF、△[昼/夜]HF有显著性差异。平均心率变异四项指标评分,≥1分敏感性为75%,特异性为70%,符合率为74%;≥2分敏感性为70%,特异性为80%,符合率为72%;≥3分敏感性为37.5%,特异性为90%,符合率为48%。结论OSAS患者夜间HRV增强;应HRV分析筛选OSAS有其临床实用价值。更多还原

【Abstract】 Objective To investigate daytime and nighttime variation of heart rate variability(HRV)in patients with obstructive sleep apnea syndrome(OSAS),and to evaluate the screening capacity of HRV.Methods 80 subjects were selectedm,their parameters as BMI and blood pressure were measured and their histories of diabetes and hypertension were investigated.The patients for suspected sleep apnea underwent 7 hour mocturnal polysomnography(PSG)recording wirh standard methods in sleep lab.The presence and stages of sleep were monitored by use of 2 pairs of EEO leads,2pairs of electro-oculographic leads,and chin electromyographic leads.Air flow was measured by anoronasal ther-mocoupler.Respiratory efforts were monitoed by use of respiratory plethysmography with transducers placed around the chest and abdomen.Arterial oxygen saturation wsa continuously recorded by pulse oximetry during the entire night.All subjects undrtwent ambulatory electrocardiography(Holter)monitoring.According to the gold standard of PSG,the screening capacity of HRV was evaluated.Results The time-domain analysis parameters,mean nighe SDNN,△SDNN,mean nighe PMSSD,△PMSSD,mean night PNN(50),△PNN(50) and the frequency-analysis parameters mean night ULF,mean night VLF,△VLF,mean night LF,△LF,mean night HF,△HF were significantly higher in OSAS patients,the threshold value of-11 for △SDNN deteemined a sensitivity of 70% and a speciticity of 50%,and the theshold valus of-13 for△RMSSD determined a Sensitivity of 70% and a Specificity of 60%.The totd evdoation of △SDNN,△RMSSD,△PNN(50)and mean heart≥1determined a sensitivity of 75%and a speci-ficity of 70%,≥2 determined a sensityvity of 70% and a specificity of 80%,≥3 determined a sensitivity of 37.5% and a specificity of 90%.Conclusion The patients with OSAShave enhanced noctutnal heart rate variability.There are prac-tical value to screen obstructive sleep apnea syndrome by heart rate variability analysis.更多还原