PDF(Pubmed)
Abstract：
Heart rate variability (HRV) measurements have emerged as a valuable tool for understanding the functioning of the autonomic nervous system (ANS) and assessing the health outcomes of obstructive sleep apnea (OSA) in patients. Sleep and the ANS exert a mutual influence on each other. Sleep promotes relaxation and recovery of the ANS. Conversely, ANS activity plays a role in regulating the onset and maintenance of sleep. The impact of continuous positive airway pressure (CPAP) therapy on patient recovery levels was investigated by assessing the restoration of ANS activity using HRV indicators. The study included patients with OSA who had been on CPAP for at least eight weeks. The patients were divided into two groups, namely the experimental group (CPAP-compliant) and the control group (CPAP-non-compliant). The study included a total of 38 patients, with 20 in the CPAP-compliant group and 18 in the CPAP-non-compliant group. The HRV analysis included time- and frequency-domain measures. Data was collected in various resting conditions, including lying down, standing, regular breathing, and under physiological stress induced by deep breathing and the Valsalva maneuver. After CPAP treatment, there was an increase in the average values for SDNN for deep breathing and Valsalva maneuvers. The mean changes in SDNN for CPAP-non-compliant versus CPAP-compliant groups for normal breathing increased from 32.50±5.33 to 42.40±8.03, while the values for Valsalva increased from 20.16±2.47 to 25.45±3.03. Despite the observed variations in SDNN, there was no significant change in the average change in heart rate (∆ HR), except during the Valsalva maneuver. Post-CPAP values for the Valsalva ratio were significantly decreased in deep breathing. The E:I ratio for the CPAP-compliant group during normal breathing was 1.08±.16 compared to 1.55±.09; t (36) =-11.15, p <0.001 in the CPAP-non-compliant group. During deep breathing, the ratio was 1.36±.15 versus 1.59±.24; t (36) =-3.578, p <0.001. The high frequency (HF)nu mean values for deep breathing were 34.06±5.546 compared to 35.00±6.358; t (36) = -.485, p=.630. For the Valsalva maneuver, the values were 29.94±4.721 versus 26.95±6.621; t (36) =1.589, p=.060. The HF/low frequency (LF) ratio was found to be significant only in supine, standing, and normal breathing. The utilization of CPAP therapy was found to be effective in achieving and sustaining autonomic balance during tasks like standing and engaging in regular breathing patterns. During activities that involve intense physical effort, like the Valsalva maneuver, the HRV metrics did not indicate any significant balance between sympathetic and parasympathetic activity. However, using CPAP therapy for a prolonged period can be beneficial in consistently improving the sympathovagal balance in these patients.
摘要：
心率变异性（HRV）测量已成为了解自主神经系统（ANS）功能和评估阻塞性睡眠呼吸暂停（OSA）患者健康结果的宝贵工具。睡眠和ANS相互影响。睡眠促进ANS的放松和恢复。相反，ANS活性在调节睡眠的开始和维持中起作用。通过使用HRV指标评估ANS活性的恢复，研究了持续气道正压（CPAP）治疗对患者恢复水平的影响。该研究包括接受CPAP治疗至少八周的OSA患者。将患者分为两组,即实验组（符合CPAP）和对照组（不符合CPAP）。该研究共纳入38名患者，符合CPAP的组中有20个，不符合CPAP的组中有18个。HRV分析包括时域和频域测量。在各种休息条件下收集数据，包括躺下,站立,有规律的呼吸,在深呼吸和Valsalva动作引起的生理压力下。CPAP治疗后,深呼吸和Valsalva动作的SDNN平均值增加.对于正常呼吸，不符合CPAP的组与符合CPAP的组的SDNN的平均变化从32.50±5.33增加到42.40±8.03，而Valsalva的值从20.16±2.47增加到25.45±3.03。尽管观察到SDNN的变化，心率的平均变化没有显着变化（ΔHR），除了在Valsalva演习期间.在深呼吸中，CPAP后的Valsalva比率值显着降低。在正常呼吸期间,CPAP依从性组的E:I比率为1.08±.16,而非CPAP依从性组的E:I比率为1.55±.09;t(36)=-11.15,p<0.001。深呼吸时,比值为1.36±.15和1.59±.24；t(36)=-3.578，p<0.001。深呼吸的高频（HF）nu平均值为34.06±5.546，而不是35.00±6.358；t（36）=-.485，p=.630。对于瓦尔萨尔瓦演习，这些值分别为29.94±4.721和26.95±6.621;t(36)=1.589,p=0.060.仅在仰卧时，HF/低频（LF）比率才显着。站立,正常呼吸。发现CPAP疗法的利用在诸如站立和参与常规呼吸模式的任务期间有效地实现和维持自主平衡。在涉及高强度体力的活动中，就像瓦尔萨尔瓦的演习,HRV指标未显示交感神经和副交感神经活动之间有任何显著平衡.然而,长期使用CPAP治疗有利于持续改善这些患者的交感神经平衡.
