Abstract：
In our large-scale study, the correlation between obstructive sleep apnea (OSA) related to rapid eye movement (REM) sleep and cardiac autonomic dysfunction was assessed by standard polysomnography (PSG). Cardiac autonomic dysfunction was evaluated by the measurement of heart rate variability (HRV). The cardiovascular disease (CVD) risk was determined using the cross-sectional prevalence of CVD and its overall 10 year risk according to the Framingham risk score (FRS). 4152 individuals were included in the study. A higher apnea-hypopnea index during REM sleep (AHIREM ) was correlated with increased CVD risk. The adjusted odds ratios (95% CIs) for CVD prevalence and its high 10 year risk in participants having severe OSA during REM sleep (AHIREM ≥30 events/h) were 1.452 (1.012-2.084) and 1.904 (1.470-2.466) in the demographic adjusted model and 1.175 (0.810-1.704) and 1.716 (1.213-2.427) in the multivariate adjusted model, respectively, compared with the group with a AHIREM of <5 events/h. Fully adjusted multivariate linear regression models showed the independent association between AHIREM and a more elevated ratio of low-frequency and high-frequency (LF/HF) and LF in normalised units [LF (n.u.)] (P = 0.042, P = 0.027 in all participants and P = 0.033, P = 0.029 in participants with AHI during non-REM sleep <5 events/h, respectively). Mediation analysis demonstrated that OSA during REM sleep and CVD risk was significantly mediated by LF/HF and LF (n.u.). OSA during REM sleep may be a marker behind CVD risk because it promotes cardiac autonomic dysfunction.
摘要：
在我们的大规模研究中,通过标准多导睡眠图(PSG)评估了与快速眼动(REM)睡眠相关的阻塞性睡眠呼吸暂停(OSA)与心脏自主神经功能障碍之间的相关性.通过测量心率变异性（HRV）评估心脏自主神经功能障碍。根据Framingham风险评分（FRS），使用CVD的横断面患病率及其10年总体风险来确定心血管疾病（CVD）风险。4152人被纳入研究。REM睡眠期间较高的呼吸暂停低通气指数（AHIREM）与CVD风险增加相关。在REM睡眠期间（AHIREM≥30次事件/h）患有严重OSA的参与者中，CVD患病率及其高10年风险的校正比值比（95％CIs）在人口统计学校正模型中为1.452（1.012-2.084）和1.904（1.470-2.466），在多变量校正模型中为1.175（0.810-1.704）和1.716（1.213-2.427）。分别,与AHIREM<5事件/h的组相比。完全调整的多元线性回归模型显示了AHIREM与低频和高频（LF/HF）和标准化单位中LF的比率升高之间的独立关联[LF（n.u.）]（P=0.042，P=0.027在所有参与者中，P=0.033，P=0.029在非REM睡眠期间AHI<5事件/h的参与者中，分别)。中介分析表明，REM睡眠期间的OSA和CVD风险是由LF/HF和LF（n.u.）介导的。REM睡眠期间的OSA可能是CVD风险背后的标志，因为它促进心脏自主神经功能障碍。
