摘要
目的确定睡眠呼吸暂停是否可导致由心电图ST段下降所反映的夜间心肌缺血,以及这种心肌缺血的严重程度是否可通过持续气道内正压通气(CPAP)治疗所减轻。方法对32名无冠心病病史的中重度睡眠呼吸暂停综合征患者行整夜的多导睡眠图研究,同时行三导联的动态心电图(Holter)监测,全部病例接受一夜的CPAP治疗。ST段下降定义为相对于基线下降至少1mm并持续至少1min。计算ST段下降指数(minh),即将ST段下降的时间与整个睡眠时间相比较。结果11例(34%)的患者睡眠中出现ST段下降。当患者没有接受CPAP治疗时,ST段下降时的呼吸暂停指数和觉醒指数明显高于ST段处于等电位状态时,而血氧饱和度无明显差异。全部ST段下降者经CPAP治疗后,其ST段下降的时间明显减少〔(33.4±19.7)minhvs(10.2±12.9)minh,P<0.05〕,与之相关联的呼吸暂停低通气指数、觉醒指数及血氧饱和度<90%的时间占睡眠时间的百分比均明显下降,其值分别为(61.8±23.4)hvs(8.1±6.6)h,(50.2±18.3)hvs(7.6±5.3)h和(52.6±21.7)%vs(12.9±14.7)%(P<0.05)。结论中重度睡眠呼吸暂停综合征患者睡眠中的ST段下降相对常见,CPAP治疗可以明显地减少ST段下降的时间。此类患者的ST段下降可能反映了真实存在的心肌缺血。
Objective To investigate whether patients with sleep apnea develop myocardial ischemia reflected by ST-segment depression during sleep and whether nasal continuous positive airway pressure (CPAP) treatment could reverse the ST depression. Methods Overnight sleep studies and simultaneous 3-channel Holter monitoring were performed in 32 patients with moderate to severe sleep apnea hypopnea syndrome (SAHS) without history of coronary artery disease. Each patient received CPAP for one night after sleep testing. An episode of significant ST depression was defined as ST segment decreased by over 1mm from baseline for at least one minute. Results Eleven patients(34%) had ST depression during sleep. Although oxygen saturation was at the same level, the apnea hypopnea index (AHI) and arousal index were higher during ST depression than that during ST segments in isoelectric state. In all 11 patients, the duration of ST depression decreased significantly after CPAP treatment 〔(33.4±19.7)min/h vs (10.2±12.9)min/h, P <0.05〕 and this change was associated with reduction in the AHI 〔(61.8±23.4)/h vs ( 8.1± 6.6)/h, P <0.05〕, arousal index〔(50.2±18.3)/h vs (7.6±5.3)/h, P <0.05〕 and the time when oxygen saturation was below 90% as percentage of total sleep time 〔(52.6±21.7)% vs (12.9±14.7)%, P <0.05〕. Conclusions ST depression is common in patients with moderate to severe SAHS during sleep and CPAP treatment can improve ST depression significantly. ST depression in these patients may reflect true myocardial ischemia or non-ischemic changes associated with sleep apneas.
出处
《中华老年多器官疾病杂志》
2005年第1期34-37,共4页
Chinese Journal of Multiple Organ Diseases in the Elderly
基金
军队"十五"重点课题 (0 2Z0 0 9)
