睡眠阶段对阻塞性睡眠呼吸暂停期间RR间期的影响
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江苏高校优势学科建设工程;南京医科大学第一附属医院创新团队工程(IRT-016);江苏省卫生厅“科教兴卫工程”医学重点学科基金(XK200719)开放课题(XK19200901);教育部留学回国人员科研启动基金(20101174)


The influence of sleep stage to RR intervals of patients with obstructive sleep apnea syndrome
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    摘要:

    目的:探讨不同睡眠阶段下阻塞性睡眠呼吸暂停(OA)进程中自主神经功能活动的特点。方法:选择30例经标准多导睡眠图(PSG)监测诊断为阻塞性睡眠呼吸暂停综合征(OSAS)的男性患者。在PSG上选取OA发生期间(Event)及其前后各15 s(Pre-,Post-)的3个连续区间,提取各区间相应的RR间期变化的时间序列资料及相关睡眠背景等资料。计算并整理出浅睡眠期(S1~2)及快动眼期(REM)OA进程中3个连续区间的心率变异性(HRV)分析指标,分析不同睡眠阶段下RR间隔变动趋势,探讨睡眠阶段对OSAS患者自主神经功能活性的影响。结果:随着OA的发生,RR-平均值-标准差随着呼吸暂停逐步降低,相邻RR则逐步增大,而这一变化随着呼吸暂停的结束而回复。无论在S1~2期还是REM期该趋势相同。但在不同睡眠阶段下,REM睡眠阶段RR-平均值始终较小,但OA结束后差异消失。结论:OSAS患者夜间自主神经功能因睡眠阶段和OA的影响发生反复的波动,在REM期和呼吸暂停期间交感活性占主导地位。这可能与其伴发心血管疾病的病理机制有关。

    Abstract:

    Objective:To investigate the changes of the autonomic nervous system (ANS) activity induced by obstructive sleep apnea (OA) during different sleep stages. Methods:Thirty male patients who were diagnosed with obstructive sleep apnea syndrome (OSAS) by polysomnography(PSG) were enrolled in the study. The RR intervals,sleep stages and relative data were extracted during the OA (Event),as well as a 15-second period before and after the OA(Pre-,Post-). Heart rate variability (HRV) parameters were calculated and classified in light sleep stage (S1~2) and REM. Then the influence of sleep stages on HRV was analyzed and compared. Results:RR-Mean and RR-SD shifted to the lowest and ΔRR-Mean turned to the highest with in both stage 1~2 and REM with OA,while the trends shifted back again after OA. However,RR-Mean in REM was lower than that in S1~2 during the whole process. Conclusion:Sleep stages and respiratory events lead to repeated changes of autonomic nervous system activity in patients with OSAS during sleep. The sympathetic activity dominates during REM and OA. These might be associated with the development of cardiovascular diseases in patients with OSAS.

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魏先梅,张娜娜,殷 敏,程 雷,Miyazaki S.睡眠阶段对阻塞性睡眠呼吸暂停期间RR间期的影响[J].南京医科大学学报(自然科学版),2013,(6):812-815

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  • 收稿日期:2013-04-23
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  • 在线发布日期: 2013-06-25
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