Abstract：
OBJECTIVE: In light of the reported association between REM-related obstructive sleep apnoea (OSA) and heightened cardiovascular risk, this study aims to compare cardiac autonomic function in patients with REM-OSA and OSA independent of sleep stage. We hypothesized that REM-OSA patients would exhibit higher sympathetic cardiac modulation based on heart rate variability (HRV) profiles.
METHODS: HRV was compared between the OSA group (AHI ≥ 5 events/h, n = 252) and the REM-OSA group (AHI ≥ 5 events/h, AHIREM:AHINREM ≥ 2, n = 137). Time- and frequency-domain measures of HRV were analysed during N2 and REM sleep.
RESULTS: Clinical characteristics between the two test groups differed significantly, 45% of REM-OSA patients were female, with mild OSA (median, interquartile range (IQR)) AHI of 10 (7) events/h. Only 26% of the OSA cohort were female with moderate OSA (AHI = 17 (20) events/h, p < 0.001). Compared with the OSA group, the low frequency to high frequency ratio (LF:HF) and LF power were lower and HF power was higher in the REM-OSA group during N2 (LF:HF, p = 0.012; LF; p = 0.013; HF, p = 0.007) and in REM sleep (LF:HF, p = 0.002; LF, p = 0.004; HF, p < 0.001). Patient sex and OSA severity had a significant combined effect on average N to N interval, LF power, and LF:HF ratio during N2 and REM sleep (all p < 0.001).
CONCLUSIONS: Contrary to our hypothesis, REM-OSA patients demonstrated consistently higher cardiac vagal modulation, reflecting better cardiac autonomic adaptation. These results were attributed to differences in OSA severity and sex in these two groups, both independently affecting HRV. This study emphasises the need for future research into the underlying pathophysiology of REM-OSA and the potential implications of sex and OSA severity on cardiovascular risk.
METHODS: HRV was compared between the OSA group (AHI ≥ 5 events/h, n = 252) and the REM-OSA group (AHI ≥ 5 events/h, AHIREM:AHINREM ≥ 2, n = 137). Time- and frequency-domain measures of HRV were analysed during N2 and REM sleep.
RESULTS: Clinical characteristics between the two test groups differed significantly, 45% of REM-OSA patients were female, with mild OSA (median, interquartile range (IQR)) AHI of 10 (7) events/h. Only 26% of the OSA cohort were female with moderate OSA (AHI = 17 (20) events/h, p < 0.001). Compared with the OSA group, the low frequency to high frequency ratio (LF:HF) and LF power were lower and HF power was higher in the REM-OSA group during N2 (LF:HF, p = 0.012; LF; p = 0.013; HF, p = 0.007) and in REM sleep (LF:HF, p = 0.002; LF, p = 0.004; HF, p < 0.001). Patient sex and OSA severity had a significant combined effect on average N to N interval, LF power, and LF:HF ratio during N2 and REM sleep (all p < 0.001).
CONCLUSIONS: Contrary to our hypothesis, REM-OSA patients demonstrated consistently higher cardiac vagal modulation, reflecting better cardiac autonomic adaptation. These results were attributed to differences in OSA severity and sex in these two groups, both independently affecting HRV. This study emphasises the need for future research into the underlying pathophysiology of REM-OSA and the potential implications of sex and OSA severity on cardiovascular risk.
摘要：
目的：根据已报道的REM相关阻塞性睡眠呼吸暂停（OSA）与心血管风险升高之间的关联，本研究旨在比较REM-OSA和OSA患者的心脏自主神经功能,而不依赖于睡眠阶段.我们假设REM-OSA患者根据心率变异性（HRV）曲线表现出更高的交感神经心脏调制。
方法：比较OSA组的HRV（AHI≥5次事件/h，n=252）和REM-OSA组（AHI≥5次事件/h，AHIREM：AHINREM≥2，n=137）。在N2和REM睡眠期间分析HRV的时域和频域测量。
结果：两个试验组之间的临床特征有显著差异，45％的REM-OSA患者是女性，轻度OSA（中位数，四分位距（IQR））AHI为10（7）个事件/h。OSA队列中只有26%是女性中度OSA（AHI=17（20）事件/h，p<0.001)。与OSA组相比,在N2期间，REM-OSA组的低频与高频比（LF：HF）和LF功率较低，而HF功率较高（LF：HF，p=0.012;LF;p=0.013;HF,p=0.007）和REM睡眠（LF：HF，p=0.002;LF,p=0.004；HF，p<0.001)。患者性别和OSA严重程度对平均N到N间隔有显著的综合影响，低频功率,和在N2和REM睡眠期间的LF:HF比率(所有p<0.001)。
结论：与我们的假设相反，REM-OSA患者表现出持续较高的心脏迷走神经调制，反映更好的心脏自主神经适应。这些结果归因于这两组中OSA严重程度和性别的差异，两者都独立影响HRV。这项研究强调需要进一步研究REM-OSA的潜在病理生理学以及性别和OSA严重程度对心血管风险的潜在影响。
方法：比较OSA组的HRV（AHI≥5次事件/h，n=252）和REM-OSA组（AHI≥5次事件/h，AHIREM：AHINREM≥2，n=137）。在N2和REM睡眠期间分析HRV的时域和频域测量。
结果：两个试验组之间的临床特征有显著差异，45％的REM-OSA患者是女性，轻度OSA（中位数，四分位距（IQR））AHI为10（7）个事件/h。OSA队列中只有26%是女性中度OSA（AHI=17（20）事件/h，p<0.001)。与OSA组相比,在N2期间，REM-OSA组的低频与高频比（LF：HF）和LF功率较低，而HF功率较高（LF：HF，p=0.012;LF;p=0.013;HF,p=0.007）和REM睡眠（LF：HF，p=0.002;LF,p=0.004；HF，p<0.001)。患者性别和OSA严重程度对平均N到N间隔有显著的综合影响，低频功率,和在N2和REM睡眠期间的LF:HF比率(所有p<0.001)。
结论：与我们的假设相反，REM-OSA患者表现出持续较高的心脏迷走神经调制，反映更好的心脏自主神经适应。这些结果归因于这两组中OSA严重程度和性别的差异，两者都独立影响HRV。这项研究强调需要进一步研究REM-OSA的潜在病理生理学以及性别和OSA严重程度对心血管风险的潜在影响。
