| Objective:We did the research to investigate the relationship between myocardial ischemia and recurrence obstructive sleep apnea of OSAHS patients during sleep, and possible mechanisms of cardiac electrophysiological changes and conditions of autonomic nervous system.Methods: 73 subjects given DCG and PSG on the same day, were divided into control group (AHI <5)(n=21), mild-moderate group (5≤AHI <30)(n=23) and severe group (AHI≥30)(n=29).We calculated myocardial ischemic burden of subjects during awake and asleep time. We did sub-group analysis of mild-moderate group and severe group, and respectively, compared myocardial ischemia group(ST segment depression) with non-myocardial ischemia group(without ST segment depression) about the sleep- and respiratory- parameters. We compared mild-moderate group, severe group with the control group on sleep-, respiration- parameter and blood oxygen saturation, and analyzed HRT and arrhythmia of normal adult and OSAHS patients.Results: Ischemic burden during sleep of both mild-moderate group and severe group were significantly greater than control group. There was relation between AHI and myocardial ischemia in OSAHS patients(r=0.667,p<0.01) .In mild-moderate group, sub-group analysis showed that compared with non-myocardial ischemia group, heart rate of myocardial ischemia group was significantly fast(p <0.05). In severe group, sub-group analysis showed that compared with non-myocardial ischemia group, sleep efficiency and the lowest SaO2, mean SaO2 and total NREM% SPT of myocardial ischemia group were significantly lower (p <0.05), SaO2 <90% of the time and the longest apnea time were significantly longer (p <0.05). Compared with the control group, frequency domain indexes (LF, HF and TP) of mild-moderate sleep group were significantly higher (p <0.05), while time domain indexes (SDNN, SDNN Index, CV and sleep with the awakening MeanRR SD) were no significant difference between the two groups (p> 0.05); both time and frequency domain indexes of severe group during sleep were significantly higher than the normal control group (p <0.05),while time domain indexes were lower during awake time(p <0.05). Between mild-moderate group and the control group, lowest SaO2, SaO2 lower, SaO2 <90% of the time, Stage2% SPT, and total NREM% SPT were significantly different (p <0.05). Compared with the control group, SaO2 lower, SaO2 <90% of the time, sleep efficiency, arousal index, Stage2% SPT, and total NREM% SPT of severe group were significantly higher (p <0.05), and lowest SaO2, the average SaO2, sleep latency, WASO% SPT, and Delta% SPT were significantly lower (p <0.05). Compared with normal adults, TO of OSAHS patients increased (p <0.001), and TS decreased (p <0.001); OSAHS patients have more arrhythmia (p <0.01).Conclusion: Myocardial ischemia of OSAHS patients during sleep is relationship with recurrent obstructive sleep apnea. Myocardial ischemia of mild-moderate OSAHS patients may be caused by sleep-related, repeated sympathetic nervous system activation. In severe patients, myocardial ischemia may be mainly related to hypoxemia and sleep architecture disorders. Severe group has higher HRV during sleep and lower HRV during awake than control group. Whether mild, moderate and severe OSAHS patients during sleep have significantly autonomic nervous tension increased. It was probably mainly caused by recurrent apnea, hypoxemia, and sleep architecture disturbances. According with abnormal HRT, it's further confirmed that OSAHS... |
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