阻塞性睡眠呼吸暂停综合征患者窦房结功能障碍检出率的初步研究

目的 观察阻塞性睡眠呼吸暂停综合征(OSAHS)患者中窦房结功能障碍(SD)的表现,探讨初步提高SD检出率的方法.方法 选择2007年1月至2008年6月因打鼾在南京医科大学第一附属医院睡眠实验室行多导睡眠监测(PSG)且在超微心电图(UMECG)观察下行阿托品试验的患者119例,其中阿托品试验阳性确诊窦房结功能障碍者78例(SD_(UMECG)组),阿托品试验结果阴性41例(非SD_(UMECG)组).比较组间OSAHS的患病率、SD_(UMECG)组中PSG心电图监测诊断窦房结功能障碍与UMECG诊断的敏感度,并观察OSAHS患者PSG参数的特点及其与PSG心电图表现的关系.结果 非SD_(UMECG)组中OSAHS检出率14/41,低于SDUMECG组(43/78,P<0.05).非SD_(UMECG)组中未发现PSG结果符合SD者(SD_(PSG));而SD_(UMECG)组中SD_(PSG)/UMECG在OSAHS患者中为26/43(60%),在非OSAHS者中为29/35(83%,P<0.05).对SDUMECG组中合并OSAHS者的观察显示:(1)SD_(PSC)在轻、中度OSAHS及重度OSAHS者中分别占50%(10/20)和70%(16/23);(2)与非SD_(PSG)相比,SD_(PSG)者的平均呼吸暂停持续时间和最长呼吸暂停持续时间延长(均P<0.05),且最低SaO_2较低(P>0.05);(3)非SD_(PSG)的OSAHS者中13例(13/17)尽管存在睡眠期缺氧,但最高窦性心率仍低于90次/min.结论 SD可能与OSAHS有关,以PSG心电图监测结果判定患者是否存在SD可能低估了OSAHS患者,特别是轻、中度患者中SD的发生率.对睡眠期缺氧但最高窦性心率仍低于90次/min的OSAHS患者应考虑是否存在SD,在UMECG观察下行阿托品试验可明显提高SD的检出率.

A preliminary study on the early diagnosis of sinus dysfunction in patients with obstructive sleep apnea syndrome

Objectives To observe the characteristics of sinus dysfunction (SD) in patients with obstructive sleep apnea syndrome (OSAHS) and to explore the method for early detection of SD in these patients. Methods From January 2007 to June 2008, 119 snorers were recruited. All of them underwent polysomnograph (PSG) examination and received atropine test under ultramicroelectrocardiogram (UMECG). Based on the results of atropine test, they were divided into 2 groups: the UMECG group (n =78) including subjects diagnosed as having SD by a positive result of atrpine test with UMECG, and the non-UMECG group (n =41) including subjects with a negative result of atropine test. Comparison was made for the incidence of OSAHS between the 2 groups and the diagnostic sensitivities for SD between UMECG and PSG electrocardiogram (SD_(PSG)). The association was also observed between PSG parameters and SD_(PSG). Results The incidence of OSAHS in the non-UMECG group was significantly higher than that in the UMECG group (31% vs 55%, P <0.05). SD_(PSG), was not detected in the non-UMECG group. In the UMECG group, SD_(PSG)/UMECG was 26/43 (60%) in the OSAHS subjects and 29/35 (83%) in the non-OSAHS subjects(P < 0.05). Of the OSAHS subjects in the UMECG group, SD_(PSG)/UMECG was 10/20(50%) in the mild to moderate OSAHS subjects and 16/23 (70%)in the severe OSAHS subjects (P < 0.05). Compared with the OSAHS subjects with UMECG but without SD_(PSG), the average duration of apnea events as well as the longest apnea event were prolonged while the minimal SaO_2 was lower in those OSAHS patients with SD_(PSG). Among all of the 17 OSAHS subjects with SD_(UMECG) but with out SDPSG, there were 13 subjects (76%) with a fastest sinus heart rate slower than 90 beats/min even though they also had hypoxemia during sleep. Conclusions SD was associated with OSAHS. The actual incidence of SD may be underestimated by PSG only, especially in those with mild to moderate OSAHS. SD should be suspected in OSAHS patients whose fastest sinus rate is lower than 90 beats/min in spite of hypoxemia. UMECG was more sensitive for early detection of SD.