Clinical Analysis Of Cardiac Arrhythmia In Patients With Obstructive Sleep Apnea-hypopnea Syndrome

Objective: The aim of this study was to analyze the incidence of cardiac arrhythmia in OSAHS patients and its possible mechanism.Method: A total of 87 patients who complained of snoring during sleeping came to Fujian Provincial Hospital cadre Clinic from March 2010 to March 2011. They were confirmed by polysomnography (PSG) and were analyzed by 24 hours Holter. According to the consequence of PSG we divided them into two groups : one was OSAHS group including 55 patients whose apnea hypopnea index(AHI)≥5, the other was control group including 32 patients who snored and the AHI <5.According to AHI ,we also divided the OSAHS patients into three subgroups: mild(5≤AHI≤20),moderate(21≤AHI≤40); severe(AHI>40). The number of three subgroups were 13,16and 26.We compared sleep-disordered breathing conditions in two groups and the incidence of arrhythmia, arrhythmia types in different degrees of OSAHS patients. We also tried to assess the state of autonomic nervous system in OSAHS patients by heart rate variability analysis and further explored the possible mechanism of arrhythmia in patients with OSAHS.Result: 1.OSAHS groups were almost middle-aged men. Body mass index ,the anatomic abnormalities of the upper respiratory tract and Epworth sleepiness scale were higher in OSAHS groups than control group (p <0.05) 2.OSAHS group was larger than control group in AHI and lower in LSPO₂ and ASPO₂,while longer in LAT, AAT, PSPO₂90 and TSPO₂ 90 (p<0.01). 3. The arousal index increased and the proportions N3 stage decreased in OSAHS group (p <0.05) . 4.The frequency of cardiac arrhythmis was 56.4 % in OSAHS group. Supraventricular and ventricular premature beats were the most common forms of tachyarrhythmia (47.3% and 23.6%); Bradyarrhythmias such as atrioventricular block, sinus arrest and escape rhythm were also found in severe OSAHS patients. Mixed arrhythmia occurred in 14.3% of all OSAHS patients.4. Frequency domain indices of heart rate variability including TP, VLF ,LF and HF at night were higher in OSAHS group than control group . Aslo, the whole day average heart rate was higher in OSAHS group than control group ( p <0.05) .Conclusion: 1.OSAHS patients had significant hypoxemia at night. Micro-arousals happened more frequently in OSAHS patients and the proportions of deep sleep decreased in sleep period time. Heart rate variability analysis suggested that the sympathetic and parasympathetic nerve activity were all enhanced in OSAHS group at night, the former was prior to the latter. 2.The incidence of arrhythmia in OSAHS patients was 56.4%. Supraventricular and ventricular premature beats were the most likely happened. Bradyarrhythmias were also found in severe OSAHS patients . The complexity and severity of the arrhythmia increased with the degree of OSAHS.3. The occurrence of arrhythmia might be associated with hypoxemia and dysfunction of autonomic nervous system.