连续气道正压通气对男性阻塞性睡眠呼吸暂停患者自主神经调制的影响

摘要

Objective To analyze the effect of continuous positive airway pressure( CPAP) for autonomic modulation function with obstructive sleep apnea hypopnea syndrome( OSAHS). Methods The 60 OSAHS palients( OSAHS group) and 25 healthy voluntrers ( control group) were recruited in the study. The states of autonomic modulation function were evaluated by dynamic cardiography and received polysomnography. Autonomic modulation function were reassessed in OSAHS patients after 3 months of CPAP treatment. Results Compared to the control group, SDNN . rMSSD, SDANN and HF were significantly decreased in patients with OSAHS(P <0. 01) ;LF and LF/HF ratio were significantly higher in patients with OSAHS (P <0. 01 ). SDNN, rMSSD, SDANN and HF were negatively correlated to the Apnea hyponea index (AHI)(r = -0.531, -0.421, -0.311 and -0. 386,all P <0. 01 ). The LF and LF/HF ratio were positively related to the AH] (r = 0. 684,0. 673 ,all P <0. 01) . The LF/HF ratio was affected by AM and the lowest SaO_2 in the order named in the regression analysis. Conclusion The autonomic modulation function are existed in OSAHS patients,and they are correlated to AHI and hypoxia during sleep. CPAP treatment can improve autonomic modulation function.%目的 探讨连续气道正压通气(CPAP)对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者自主神经调制的影响.方法 选择OSAHS患者60例和对照组25例,对所有受试者进行多导睡眠图及动态心电图监测,采用时域分析法分析患者心率变异性以评价自主神经调制功能.对OSAHS患者使用CPAP治疗3个月后再次评估自主神经调制功能.结果 与对照组相比,OSAHS组自主神经调制功能指标正常RR间期标准差(SDNN)、RR间期差值均方根(rMSSD)、每5分钟节段平均正常RR间期标准差(SDANN)和高频功率(HF)均低于对照组,且与呼吸紊乱指数呈负相关；低频功率(LF)和低频与高频之比(LF/HF)高于对照组,与呼吸紊乱指数呈正相关.LF/HF值与呼吸紊乱指数和最低血氧饱和度呈线性回归关系.结论 OSAHS患者存在自主神经调制功能损害,与呼吸紊乱指数和低氧有关；经CPAP治疗后,OSAHS患者自主神经调制功能损害明显改善,且对CPAP耐受良好.