反復(fù)覺醒對心血管系統(tǒng)的影響：探究OSAHS患者心血管并發(fā)癥的發(fā)生機制
發(fā)布時間：2018-07-15 08:10
【摘要】：目標(biāo)：本研究旨在探究反復(fù)覺醒對健康受試者心血管系統(tǒng)的影響,從而明確這一病理生理過程在阻塞性睡眠呼吸暫停綜合征患者心血管并發(fā)癥發(fā)生過程中的地位。 方法：20名青年男性健康受試者(年齡25.0±2.1歲,BMI22.9±1.9kg·m2),在睡眠實驗室接受連續(xù)兩夜多導(dǎo)睡眠圖監(jiān)測。第一夜為基礎(chǔ)對照夜,不對受試者進行任何干預(yù)；第二夜為刺激實驗夜,應(yīng)用音頻信號對受試者進行反復(fù)刺激以誘發(fā)覺醒,此種音頻信號刺激持續(xù)整個睡眠過程,期望達到的覺醒指數(shù)(arousal index, ArI)為60次/小時。比較兩夜的睡眠結(jié)構(gòu)、主觀睡眠質(zhì)量、血壓、心率變異率、動脈硬度指數(shù)以及特定血清學(xué)指標(biāo)。睡眠結(jié)構(gòu)指標(biāo)包括總睡眠時間,N1、N2、N3、REM各期睡眠時間及比例以及Arl。St Mary's醫(yī)院睡眠問卷用于對睡眠質(zhì)量及連續(xù)性進行主觀評價。分別在對照夜睡前(C1)、醒后(C2),實驗夜睡前(T1)、醒后(T2)測量血壓,并記錄清醒平靜仰臥狀態(tài)下的心電圖及指端血流量脈搏(digital volume pulse, DVP)。用快速傅立葉變換進行心率變異率分析,得到上述四個時間點的標(biāo)準(zhǔn)化低頻功率(low frequency power in normalized unit, LF),標(biāo)準(zhǔn)化高頻功率(high frequency power in normalized unit, HF)以及低頻-高頻功率之比(LF/HF ratio, LHR),并以此來評價自主神經(jīng)系統(tǒng)狀態(tài)；對指端血流量脈搏波形進行分析,得到上述四個時間點的動脈硬度指數(shù)(stiffness index, SI)。比較上述血壓、心率變異率指標(biāo)以及硬度指數(shù)在對照夜和實驗夜的改變量有無顯著性差異(即T2-T1與C2-C1是否有差別),若有則進一步分析這些指標(biāo)各自在對照夜前后及實驗夜前后發(fā)生了何種變化。測定血清中CRP、IL-6, TNF-α、VEGF、NO、ET-1的濃度,比較兩日之間有無顯著性差異。Spearman相關(guān)分析用于分析上述指標(biāo)間的相關(guān)性。 結(jié)果：實驗夜實際達到的覺醒指數(shù)為44±9(27-55.2)次/小時。在各項睡眠結(jié)構(gòu)指標(biāo)中,兩夜相比其差異具有統(tǒng)計學(xué)意義的為實驗夜N3期睡眠時間顯著短于對照夜(P=0.039)；實驗夜ArI顯著高于對照夜(P0.001)。就“醒后頭腦清醒程度”而言,受試者認為實驗夜不如對照夜(P=0.019),實驗夜受試者能意識到的覺醒次數(shù)顯著多于對照夜(P0.001)。實驗夜醒后舒張壓顯著高于睡前(P=0.003),且升高的程度與對照夜相比具有統(tǒng)計學(xué)意義(P=0.026)；兩夜舒張壓改變量的差值與兩夜N2睡眠比例的差值具有線性相關(guān)關(guān)系(P=0.011)。實驗夜醒后LF和LHR顯著高于睡前(P0.001),HF顯著低于睡前(P0.001),這些變化的程度與對照夜相比具有統(tǒng)計學(xué)意義(均有P0.001)；實驗夜HF的改變與REM睡眠時間及比例具有線性相關(guān)關(guān)系(P=0.003,P=0.006)；實驗夜LHR的改變同樣與REM睡眠時間及比例具有線性相關(guān)關(guān)系(P=0.008,P=0.027)。SI在兩夜的改變量無明顯差別。CRP、IL-6, TNF-α、VEGF、NO、ET-1等血清學(xué)指標(biāo)兩次測量結(jié)果無顯著性差異。 結(jié)論：利用音頻信號刺激誘發(fā)反復(fù)覺醒以模擬OSAHS中出現(xiàn)的反復(fù)覺醒可引起交感神經(jīng)活性升高,副交感神經(jīng)活性下降,且這種改變在覺醒停止后一段時間仍然存在,提示其效應(yīng)具有可累積性。反復(fù)覺醒導(dǎo)致晨起舒張壓增高,可能與睡眠結(jié)構(gòu)的改變有關(guān),但意義尚不明確。在OSAHS相關(guān)的心血管疾病的發(fā)生過程中,自主神經(jīng)系統(tǒng)狀態(tài)的改變有可能是早于血管內(nèi)皮功能紊亂的病理生理過程。
[Abstract]:Objective: This study aims to explore the effect of repeated awakening on the cardiovascular system of healthy subjects, and to identify the status of this pathophysiological process in the process of cardiovascular complications in patients with obstructive sleep apnea syndrome.
Methods: 20 young male healthy subjects (age 25 + 2.1 years old, BMI22.9 + 1.9kg m2) were monitored in the sleep laboratory for two night polysomnography. The first night was the basis control night, and no intervention was done on the subjects. Second night was used to stimulate the experimental night, and the subjects were repeatedly stimulated with audio signals to induce awakening, An audio signal stimulates the whole sleep process. The desired awakening index (arousal index, ArI) is expected to be 60 times per hour. The sleep structure of two nights, subjective sleep quality, blood pressure, heart rate variability, arterial hardness index, and specific serological indexes. Sleep structure indexes including total sleep time, N1, N2, N3, REM, and REM periods are also compared. The ratio and the Arl.St Mary's Hospital Sleep Questionnaire were used to evaluate the quality and continuity of sleep. In the control night before night (C1), after waking up (C2), at night before sleep (T1), after waking up (T2), the blood pressure was measured and the blood flow pulse (Digital volume pulse, DVP) was recorded in the state of sober calm and supine (digital volume pulse, DVP). The low frequency power in normalized unit (LF), the standardized high frequency power (high frequency power in normalized) and low frequency high frequency power ratio are obtained to evaluate the state of the autonomic nervous system. The blood flow pulse waveform was analyzed to obtain the arterial hardness index (stiffness index, SI) at the four time points. There was no significant difference in the above blood pressure, heart rate variability index and the change of the hardness index between the control night and the experimental night (i.e., whether there was a difference between T2-T1 and C2-C1). If there was a further analysis of these indexes, The changes of CRP, IL-6, TNF-, VEGF, NO, ET-1 in serum were measured before and after night and before and after the experiment night. There was no significant difference between two days and.Spearman correlation analysis was used to analyze the correlation between these indexes.
Results: the actual awakening index of the experimental night was 44 + 9 (27-55.2) per hour. In all sleep structure indexes, the difference of the two nights was statistically significant shorter than that of the control night (P=0.039), and the experimental night ArI was significantly higher than that of the control night (P0.001). The subjects were "awake after waking up". The experimental night was less than the control night (P=0.019), and the awakening times of the experimental night subjects were significantly more than that of the control night (P0.001). The diastolic pressure was significantly higher than that before sleep (P=0.003), and the degree of increase was statistically significant compared with that of the control night (P=0.026); the difference between the diastolic pressure change of the two night and the proportion of the two night N2 sleep The difference had a linear correlation (P=0.011). LF and LHR were significantly higher than before sleep (P0.001), HF was significantly lower than before sleep (P0.001), and the degree of these changes was statistically significant compared with that of the control night (P0.001); the change of HF in experimental night had a linear correlation with the time and proportion of REM sleep (P=0.003, P=0.006); experimental night LHR. There is also a linear correlation with REM sleep time and proportion (P=0.008, P=0.027), and there is no significant difference in the change of.SI at two nights,.CRP, IL-6, TNF- a, VEGF, NO, ET-1 and other serological indexes, there is no significant difference between the two measurements.
Conclusion: repeated awakening by using audio signal stimulation to simulate repeated awakening in OSAHS can cause the increase of sympathetic activity and the decrease of parasympathetic activity, and this change still exists in a period of time after the awakening, suggesting that the effect is accumulative. Repeated awakening leads to the increase of diastolic pressure in the morning, which may be associated with sleep. Structural changes are related, but the significance is not yet clear. In the process of OSAHS related cardiovascular disease, the changes in the state of the autonomic nervous system may be the pathophysiological process earlier than the vascular endothelial dysfunction.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2013
【分類號】：R766
本文編號：2123426
[Abstract]:Objective: This study aims to explore the effect of repeated awakening on the cardiovascular system of healthy subjects, and to identify the status of this pathophysiological process in the process of cardiovascular complications in patients with obstructive sleep apnea syndrome.
Methods: 20 young male healthy subjects (age 25 + 2.1 years old, BMI22.9 + 1.9kg m2) were monitored in the sleep laboratory for two night polysomnography. The first night was the basis control night, and no intervention was done on the subjects. Second night was used to stimulate the experimental night, and the subjects were repeatedly stimulated with audio signals to induce awakening, An audio signal stimulates the whole sleep process. The desired awakening index (arousal index, ArI) is expected to be 60 times per hour. The sleep structure of two nights, subjective sleep quality, blood pressure, heart rate variability, arterial hardness index, and specific serological indexes. Sleep structure indexes including total sleep time, N1, N2, N3, REM, and REM periods are also compared. The ratio and the Arl.St Mary's Hospital Sleep Questionnaire were used to evaluate the quality and continuity of sleep. In the control night before night (C1), after waking up (C2), at night before sleep (T1), after waking up (T2), the blood pressure was measured and the blood flow pulse (Digital volume pulse, DVP) was recorded in the state of sober calm and supine (digital volume pulse, DVP). The low frequency power in normalized unit (LF), the standardized high frequency power (high frequency power in normalized) and low frequency high frequency power ratio are obtained to evaluate the state of the autonomic nervous system. The blood flow pulse waveform was analyzed to obtain the arterial hardness index (stiffness index, SI) at the four time points. There was no significant difference in the above blood pressure, heart rate variability index and the change of the hardness index between the control night and the experimental night (i.e., whether there was a difference between T2-T1 and C2-C1). If there was a further analysis of these indexes, The changes of CRP, IL-6, TNF-, VEGF, NO, ET-1 in serum were measured before and after night and before and after the experiment night. There was no significant difference between two days and.Spearman correlation analysis was used to analyze the correlation between these indexes.
Results: the actual awakening index of the experimental night was 44 + 9 (27-55.2) per hour. In all sleep structure indexes, the difference of the two nights was statistically significant shorter than that of the control night (P=0.039), and the experimental night ArI was significantly higher than that of the control night (P0.001). The subjects were "awake after waking up". The experimental night was less than the control night (P=0.019), and the awakening times of the experimental night subjects were significantly more than that of the control night (P0.001). The diastolic pressure was significantly higher than that before sleep (P=0.003), and the degree of increase was statistically significant compared with that of the control night (P=0.026); the difference between the diastolic pressure change of the two night and the proportion of the two night N2 sleep The difference had a linear correlation (P=0.011). LF and LHR were significantly higher than before sleep (P0.001), HF was significantly lower than before sleep (P0.001), and the degree of these changes was statistically significant compared with that of the control night (P0.001); the change of HF in experimental night had a linear correlation with the time and proportion of REM sleep (P=0.003, P=0.006); experimental night LHR. There is also a linear correlation with REM sleep time and proportion (P=0.008, P=0.027), and there is no significant difference in the change of.SI at two nights,.CRP, IL-6, TNF- a, VEGF, NO, ET-1 and other serological indexes, there is no significant difference between the two measurements.
Conclusion: repeated awakening by using audio signal stimulation to simulate repeated awakening in OSAHS can cause the increase of sympathetic activity and the decrease of parasympathetic activity, and this change still exists in a period of time after the awakening, suggesting that the effect is accumulative. Repeated awakening leads to the increase of diastolic pressure in the morning, which may be associated with sleep. Structural changes are related, but the significance is not yet clear. In the process of OSAHS related cardiovascular disease, the changes in the state of the autonomic nervous system may be the pathophysiological process earlier than the vascular endothelial dysfunction.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2013
【分類號】：R766
【參考文獻】
相關(guān)期刊論文 前2條
1 鐘旭,肖毅,黃蓉,黃席珍;整夜完全睡眠剝奪對心血管自主神經(jīng)活動的影響[J];中華內(nèi)科雜志;2005年08期
2 Xu Zhong;Yi Xiao;Rong Huang;;Effects of Obstructive Sleep Apneas on Endothelial Function and Autonomic Modulation in Adult Man[J];Chinese Medical Sciences Journal;2012年04期
，本文編號：2123426
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