중증 및 중등도 폐쇄성 수면무호흡증 환자에서 양압기 압력측정 직후 심박수와 심박변이도 분석
Analysis of Heart Rate and Heart Rate Variability Immediately After Continuous Positive Airway Pressure Titration in Patients With Moderate to Severe Obstructive Sleep Apnea
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Background and Objectives Recurrent hypoxia, hypercapnia, and arousal during sleepcan induce hyperactivity of the sympathetic nervous system (SNS) in patients with obstructivesleep apnea (OSA), which contributes to the development of hypertension and cardiovasculardisease. This study was designed to compare changes in heart rate (HR) and heart rate variability(HRV), both of which reflect the activity of the autonomic nervous system (ANS) in OSApatients before and immediately after continuous positive airway pressure (CPAP) titration. Subjects and Method Thirty-five OSA patients (47.8±12.3 years) and 16 healthy subjects(43.2±12.5 years) were enrolled in this study. A night CPAP titration was performed on theOSA patients, and HRV was calculated by RR intervals from the electrocardiogram signalsduring the total sleep time. Results The mean age of OSA patients was 47.8 years (M:F=34:1), and the control groupwas 43.3 years (M:F=14:2). The mean AHI of OSA patients was 53.4±31.9, and decreased17.3±19.4 after CPAP titration, and 4.3±1.6 in the normal controls. During CPAP titration,the mean HR of OSA patients was 68.0±8.9, which was significantly higher than that of thenormal controls, 59.5±9.0 (p=0.003). For HRV, standard deviation of all NN intervals (p=0.001), root mean square of the successive NN intervals (p<0.001), and low frequency (LF)(p=0.006) values were significantly decreased after CPAP titration compared to the baseline. After CPAP titration, LF (p=0.017) and LF/HF (p=0.003) values were still significantly higherthan those of the normal controls. Conclusion HRV analysis revealed that CPAP titration for one day caused decreased SNSactivity but did not induce a balance in ANS when compared to the normal controls.
Abstract
Background and Objectives Recurrent hypoxia, hypercapnia, and arousal during sleepcan induce hyperactivity of the sympathetic nervous system (SNS) in patients with obstructivesleep apnea (OSA), which contributes to the development of hypertension and cardiovasculardisease. This study was designed to compare changes in heart rate (HR) and heart rate variability(HRV), both of which reflect the activity of the autonomic nervous system (ANS) in OSApatients before and immediately after continuous positive airway pressure (CPAP) titration. Subjects and Method Thirty-five OSA patients (47.8±12.3 years) and 16 healthy subjects(43.2±12.5 years) were enrolled in this study. A night CPAP titration was performed on theOSA patients, and HRV was calculated by RR intervals from the electrocardiogram signalsduring the total sleep time. Results The mean age of OSA patients was 47.8 years (M:F=34:1), and the control groupwas 43.3 years (M:F=14:2). The mean AHI of OSA patients was 53.4±31.9, and decreased17.3±19.4 after CPAP titration, and 4.3±1.6 in the normal controls. During CPAP titration,the mean HR of OSA patients was 68.0±8.9, which was significantly higher than that of thenormal controls, 59.5±9.0 (p=0.003). For HRV, standard deviation of all NN intervals (p=0.001), root mean square of the successive NN intervals (p<0.001), and low frequency (LF)(p=0.006) values were significantly decreased after CPAP titration compared to the baseline. After CPAP titration, LF (p=0.017) and LF/HF (p=0.003) values were still significantly higherthan those of the normal controls. Conclusion HRV analysis revealed that CPAP titration for one day caused decreased SNSactivity but did not induce a balance in ANS when compared to the normal controls.
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