The Effect Of Obstructive Sleep Apnea-Hypopnea Syndrome On Cardiac Arrhythmias In Patients With Hypertension And Its Mechanisms

Objective Obstructive Sleep Apnea-hypopnea Syndrome (OSAHS) is correlated to hypertension. The aim of our study is to observe the effect OSAHS on cardiac arrhythmias in patients with hypertension , also to observe silent myocardial ischemia (SMI), HRV and determine urinary CA concentration .To approach its mechanisms in order to provide evidence to prevent and cure cardiac arrhythmia in hypertension patients with OSAHS.Methods 67 patients with hypertension and OSAHS (Group HT+OSAHS), 52 patients with OSAHS without hypertension (Group OSAHS), 42 patients with hypertension without OSAHS (Group HT) and 41 healthy people (Group N) were enrolled. 24-h Holter ECG were performed on all subjects, Polysomnograpyh were performed on subjects of Group HT+OSAHS and Group OSAHS. Analyses of the incidence of cardiac arrhythmia, silent myocardial ischemic(SMI) and heart rate variability (HRV) were executed to evaluate the activity of autonomic nerve system (ANS), noctonal and diunal Epinephrine (E), Norepinephrine (NE), Dopamine(DA) in urine of all subjects was determined by High performance liquid chromatogram—fluorescence (HPLC—F).Results⑴The incidence of cardiac arrhythmia in hypertension patients with OSAHS was significantly higher than in hypertension patients without OSAHS(37.3% vs 16.7%, p <0.05), which had no significant differences comparing to OSAHS patients(p >0.05); the incidence of cardiac arrhythmia in OSAHS patients was 32.6%, significantly higher than health controls 4.8% (p <0.05).⑵The incidence of SMI in hypertension patients with OSAHS was significantly higher than in hypertension patients without OSAHS, (35.8% vs 19.0%, P<0.05), which had no significant differences comparing to OSAHS patients (P>0.05); the incidence of SMI in patients with OSAHS was significantly higher than health person (26.9% vs 9.8%, P<0.05).⑶SDNN night,SDANN day,SDANN night,LF day,LF night,L/H night were significantly higher in hypertension patients with OSAHS than those in hypertension patients without OSAHS(P<0.05), while rMSSD night,HF night were significantly lower(P<0.05), SDNN night,rMSSD day,HF day,L/H day had no significant differences(P>0.05); comparing to health controls, SDNN day,SDNN night,SDANN day,SDANN night,LF day,LF night,L/H day,L/H night were significantly higher in OSAHS patients (P<0.05), while rMSSD night and HF night were significantly lower(P<0.05), HF day had no significant differences(P>0.05).⑷Comparing to hypertension patients without OSAHS, E day,E night, NE day,NE night,DA night were significantly higher in hypertension patients with OSAHS(p<0.05), while DA day had no significant differences(P>0.05); Comparing to health controls, E day,E night,NE night,DA night were significantly higher in OSAHS patients(p<0.05), while NE day,DA day had no significant differences(P>0.05).⑸LSaO2 was correlated to PSVB and VE, (r=-0.534, p=0.016) and (r=-0.408, p=0.033); MeanSaO2 was corrlated to SA(r=-0.384, p=0.046); NEnight was correlated to PSVB and VE(r=0.55, p=0.0001)and (r=0.63, p=0.0001).Conclusions OSAHS showed deleterious effects on cardiac arrhythmia and SIM in patients with hypertension; OSAHS aggravated the imbalance between sympathetic and parasympathetic nerve system and ANS function of hypertension patients. SMI,ANS impairment and hypoxemia possibly are the mchanisms to cardiac arrhythmia in patients with hypertension with OSAHS.