The Research Of Cardiac Arrhythmia In Patients With Obstructive Sleep Apnoea- Related Hypertension

Background: Obstructive sleep apnoea syndrome(OSAS) is a common disease, which is characterized by recurrent apnoea,low ventilation and hypopnoea during sleeping. Due to the disorder of nocturnal sleep structure and recurrent arousals,people who suffer from sleep apnoea syndrome often have lots of symptoms such as irregular breath, apnoea, snoring, waking up again and again, headaches, increasing of nocturnal urine, daytime sleepiness and bad memory, even parts of severe patients come across serious traffic accidents. Now, increasing clinical studies suggest that Obstructive sleep apnoea syndrome is related closely to hypertension, metabolic syndrome, stroke, heart failure and coronary heart disease(CHD) and cardiac arrhythmia. The cardiac arrhythmia is a common complication such as sinus bradycardia, sinus arrest, atrioventricular block, sinoatrial block, atrial fibrillation, premature ventricular beats, atrial premature beats,even sudden cardiac death, the bradyarrhythmias are most common among all types. The mechanism related with sleep apnoea involves significantly in autonomic nerve dysfunction. People having sleep disorder always represent recurrent intermittent hypoxia, negative intrathoracic pressure swings and recurrent arousals, resulting in autonomic nerve dysfunction and imbalance between sympathetic nerve and parasympathetic nerve, eventually leading to cardiac arrhythmias. Accordingly, people,s life and health have been affected significantly, so doctors and patients should pay attention to the potential danger caused by OSAS.At present, the Heart rate variability(HRV) is a sensitive indicator that assesses autonomic nerve function,thus,we can evaluate autonomic nerve function by analysing heart rate variability. The article mainly explores the incidence of arrhythmia between Obstructive sleep apnoea-related hypertension(OSA-RH) group and essential hypertension(EHT) group by dynamic electrocardiogram(Holter), polysomnography(PSG) and ambulatory blood pressure monitoring(ABPM).Furthermore, accounting for the relationship between arrhythmia and sleep apnea of different severity. At last, we can provide patients with sleeping disorder with clinical evidence to help them with early diagnosis, early treat and intervention.Methods: According to the including and excluding criterion, we assess 150 patients with hypertension who were admitted to cardiovascular ward in the First Affiliated Hospital of Dalian Medical University from May 2013 to March 2015.All patients with hypertension evaluated by trial have completed polysomnography(PSG),24-hour ambulatory blood pressure monitoring(ABPM) and 24-hour dynamic electrocardiogram(Holter), besides, some indicators were collected such as height,weight, gender, ages, hs-CRP, MA/Cre, the number of red blood cell,lipid, blood sugar, creatinine,left atrial diameter,left ventricular diameter and so on. According to results of polysomnography(PSG),these patients were divided into two groups: OSA-RH group and EHT group,at the same time, OSA-RH group was divided into three subgroups according to the severity of OSAS. At last, SPSS 19.0 statistical software for processing and analyzing the data, Logistic regression analysis was used to find the relevant factors of incidence of arrhythmias in patients with OSAS.Results:1.GLU,TC,TG,HDL-C,LDL-C,hs-CRE,Serum, The number of red blood cell,Gender, Age between the two groups show no difference; But the clinical significance present on BMI, left atrial diameter,left ventricular diameter(P<0.01) and MA/Cre(P<0.05).Compared with control groups, OSA-RH groups have much higher AHI and lower oxygen saturation.2. The indicators reflecting HRV such as SDNN, LF,LF/HF increase significantly in OSA-RH group, there are statistical significance(P<0.01),and indicators reflecting BRV such as 24 hSSD,dSSD,nSSD rise obviously in OSA-RH group,there are statistical significance(P<0.01).3.The incidence of arrhythmias among OSA-RH groups and EHT groups is 69.5%,20.0% respectively. Besides, the incidence of arrhythmias among OSA-RH groups is different, that is, mild group accounts for 37.5%, moderate group is 52.2% and severe group is 85.7%. The common types of arrhythmias produced by OSAS were sinus bradycardia(49.5%) and occasional ventricular premature beat(41.1%).Compared with mild and moderate groups, severe group had higher incidence of arrhythmias in atrioventricular block, sinoatrial block, atrial fibrillation, atrial premature beats and NSVT.Conclusion:1. OSA-RH patients are often have higher BMI than EHT patients alone significantly.2. The incidence of arrhythmias among OSA-RH group is much higher than EHT group. Furthermore, cardiac arrhythmias is positively correlated with OSA severity,that is, with the increase of OSA severity, the AHI is on the rise while the oxygen saturation is on the decline, as a result,leading to the incidence of arrhythmias increase. The common types of arrhythmias produced by OSAS were sinus bradycardia and occasional ventricular premature beat. Compared with mild and moderate groups, severe group had higher incidence of bradyarrhythmias such as sinus bradycardia, atrioventricular block, sinoatrial block and rapid-arrhythmia such as premature ventricular beats, atrial fibrillation, atrial premature beats and NSVT.3. The heart rate variability(HRV) differs significantly among two groups, SDNN, LF,LF/HF increase obviously in OSA-RH group compared with essential hypertension(EHT), accordingly, the autonomic nerve dysfunction caused by OSAS may be a crucial factor that contributes to cardiac arrhythmias.