Relationship between Pulse Oxygen Desaturation Rate and Heart Rate Fluctuation Rate and Arrhythmias in Patients with Obstructive Sleep Apnea Hypopnea Syndrome

doi:10.12114/j.issn.1007-9572.2022.0333

Chinese General Practice ›› 2022, Vol. 25 ›› Issue (33): 4185-4190.DOI: 10.12114/j.issn.1007-9572.2022.0333

Special Issue: 睡眠研究最新文章合辑；睡眠问题专题研究

• Article • Previous Articles Next Articles

Relationship between Pulse Oxygen Desaturation Rate and Heart Rate Fluctuation Rate and Arrhythmias in Patients with Obstructive Sleep Apnea Hypopnea Syndrome

1.The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
2.Xinyi Hospital of Traditional Chinese Medicine, Xinyi 221499, China

Received:2022-07-11 Revised:2022-07-21 Published:2022-11-20 Online:2022-09-08
Contact: DING Ning
About author:
LI Y, WANG Y, CHEN X, et al. Relationship between pulse oxygen desaturation rate and heart rate fluctuation rate and arrhythmias in patients with obstructive sleep apnea hypopnea syndrome[J]. Chinese General Practice, 2022, 25 (33) : 4185-4190, 4195.

脉氧下降率和心率波动率与阻塞性睡眠呼吸暂停低通气综合征患者发生心律失常的关系研究

1.210029　江苏省南京市，南京医科大学第一附属医院
2.221499　江苏省新沂市中医医院

通讯作者: 丁宁
作者简介:
李勇，王颖，陈勋，等.脉氧下降率和心率波动率与阻塞性睡眠呼吸暂停低通气综合征患者发生心律失常的关系研究[J].中国全科医学，2022，25（33）：4185-4190，4195. [www.chinagp.net] 作者贡献：李勇、王颖、陈勋、林蔚负责研究过程的实施，包括病例基本信息的采集、各项临床指标的收集；张凯、丁宁负责统计学分析；李勇、王颖、陈勋、林蔚、张凯、丁宁负责论文起草、修改和最终版本修订；丁宁提出研究思路，设计研究方案，对论文负责。
基金资助:
国家自然科学基金面上项目(82070093); "511腾飞工程"青年医师项目(JSPH-511C-2018-10)

Abstract

Abstract:

Background

Arrhythmias are common complications in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) , however their occurrence and severity are not completely consistent with the severity of their disease per se. Our previous study found that pulse oxygen desaturation rate (ODR) was an independent predictor of the development of hypertension in OSAHS patients. We hypothesized that sleep apnea related ODR and heart rate fluctuation rate (HRFR) may predict the occurrence of arrhythmias in OSAHS patients.

Objective

To observe the correlation between ODR, HRFR and the occurrence of arrhythmias, and to explore the predictive value of ORD and HRFR on the occurrence of arrhythmias.

Methods

Polysomnography and Holter monitoring were performed on 36 patients who visited the sleep disordered breathing specialized outpatient clinic of the First Affiliated Hospital of Nanjing Medical University between January and June 2021, while basic clinical information of the patients was collected. Taking the median number of arrhythmic events as the cutoff value, the patients were divided into two groups: the patients with low incidence of arrhythmia group (<105 events) and with high incidence of arrhythmias group (≥105 events) . ODR and HRFR were analyzed for correlation with arrhythmias and Logistic regression was performed for analysing the predictors of arrhythmia.

Results

Compared with low incidence of arrhythmia group, the patients with high incidence of arrhythmias had higher ODR and HRFR (P<0.05) . Correlation analysis showed that the number of total arrhythmic events was positively correlated with ODR, mean heart rate fluctuation value, and HRFR (r_s=0.472, 0.719, 0.360, and 0.393, respectively, P<0.05) . Multivariate Logistic regression analysis showed that ODR〔OR=77.849, 95%CI (5.250, 1 154.301) , P<0.05〕and HRFR 〔OR=9.981, 95%CI (1.000, 105.600) , P=0.05〕were independent risk factors for arrhythmic events. The area under the receiver operator characteristic (AUC) of ODR and HRFR for predicting multiple arrhythmias were 0.932 〔95%CI (0.830, 0.941) 〕 and 0.753 〔95%CI (0.590, 0.916) , respectively.

Conclusion

ODR and HRFR are associated with the occurrence of arrhythmias and can be used for predicting the occurrence of arrhythmic events in patients with OSAHS.

Key words: Sleep apnea, obstructive, Cardiac dysrhythmia, Oxygen desaturation rate, Heart rate fluctuation rate, Root cause analysis, Forecasting

摘要：

背景

心律失常是阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的常见并发症，然而OSAHS患者心律失常的发生及严重程度与其疾病本身严重程度并不完全一致。本研究团队前期研究发现脉氧下降率（ODR）是OSAHS患者发生高血压的独立预测因素，推测呼吸暂停事件相关的ODR和心率波动率（HRFR）可能预测OSAHS患者心律失常的发生。

目的

探讨ODR及HRFR与OSAHS患者发生心律失常的相关性，ODR及HRFR对心律失常发生的预测价值。

方法

2021年1—6月对在南京医科大学第一附属医院睡眠呼吸障碍专病门诊就诊的36例患者行多导睡眠监测和动态心电图监测，同时收集患者基本临床资料信息。以心律失常事件数的中位数为截断值，把患者分为少发心律失常组（心律失常事件数<105次）和多发心律失常组（心律失常事件数≥105次）各18例。采用Spearman秩相关分析探究ODR、HRFR与心律失常发生的相关性，采用多因素Logistic回归分析探讨OSAHS患者发生心律失常的影响因素。

结果

多发心律失常组患者ODR和HRFR高于少发心律失常组（P<0.05）。相关性分析显示，总心律失常事件数与年龄、ODR、单位时间心率变化幅度（?HR）、HRFR呈正相关（r_s=0.472、0.719、0.360、0.393，P<0.05）；多因素Logistic回归分析显示ODR〔OR=77.849，95%CI（5.250，1 154.301），P<0.05〕和HRFR〔OR=9.981，95%CI（1.000，105. 600），P=0.05〕是OSAHS患者心律失常发生的影响因素。ODR和HRFR预测多发心律失常的受试者工作特征曲线下面积（AUC）分别为0.932〔95%CI（0.830，0.941）〕和0.753〔95%CI（0.590，0.916）〕。

结论

ODR和HRFR与OSAHS患者心律失常的发生具有相关性，能够预测OSAHS患者心律失常的发生。

关键词: 睡眠呼吸暂停, 阻塞性, 心律失常, 脉氧下降率, 心率波动率, 影响因素分析, 预测

LI Yong,WANG Ying,CHEN Xun, et al. Relationship between Pulse Oxygen Desaturation Rate and Heart Rate Fluctuation Rate and Arrhythmias in Patients with Obstructive Sleep Apnea Hypopnea Syndrome[J]. Chinese General Practice, 2022, 25(33): 4185-4190. DOI: 10.12114/j.issn.1007-9572.2022.0333.
李勇,王颖,陈勋等. 脉氧下降率和心率波动率与阻塞性睡眠呼吸暂停低通气综合征患者发生心律失常的关系研究[J]. 中国全科医学, 2022, 25(33): 4185-4190. DOI: 10.12114/j.issn.1007-9572.2022.0333.

Figures/Tables 6

References 25

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组别	例数	年龄〔M（P₂₅，P₇₅），岁〕	男性〔n（%）〕	BMI 〔M（P₂₅，P₇₅），kg/m²〕	ESS评分〔M（P₂₅，P₇₅），分〕
少发心律失常组	18	49（36，59）	14（77.8）	28.0（26.4，32.6）	13.0（7.0，16.0）
多发心律失常组	18	60（44，73）	18（100.0）	26.3（23.5，27.9）	14.0（6.0，18.0）
Z值		-1.615	—	-2.199	-0.444
P值		0.106	0.104	0.028	0.657
组别	AHI 〔M（P₂₅，P₇₅），次/h〕	平均SpO₂ 〔M（P₂₅，P₇₅），%〕	最低SpO₂ 〔M（P₂₅，P₇₅），%〕	T90% 〔M（P₂₅，P₇₅），%〕
少发心律失常组	15.8（9.6，37.1）	93.0（92.0，95.0）	80.0（69.0，84.0）	4.5（1.0，17.5）
多发心律失常组	20.1（9.4，46.3）	93.0（91.0，95.0）	78.0（68.0，86.0）	11.0（2.0，33.0）
Z值	-0.506	-0.830	-0.269	-0.888
P值	0.613	0.424	0.788	0.375
组别	∆S 〔M（P₂₅，P₇₅）〕	ODR 〔M（P₂₅，P₇₅）〕	∆HR 〔M（P₂₅，P₇₅）〕	HRFR 〔M（P₂₅，P₇₅）〕
少发心律失常组	15.0（10.0，20.0）	0.5（0.3，0.7）	9.0（5.0，15.0）	0.6（0.5，1.1）
多发心律失常组	14.0（9.0，21.0）	1.0（0.8，1.2）	14.0（12.0，18.0）	1.3（0.9，1.7）
Z值	-0.237	-4.430	-1.915	-2.595
P值	0.812	<0.001	0.055	0.009

组别	例数	年龄〔M（P₂₅，P₇₅），岁〕	男性〔n（%）〕	BMI 〔M（P₂₅，P₇₅），kg/m²〕	ESS评分〔M（P₂₅，P₇₅），分〕
少发心律失常组	18	49（36，59）	14（77.8）	28.0（26.4，32.6）	13.0（7.0，16.0）
多发心律失常组	18	60（44，73）	18（100.0）	26.3（23.5，27.9）	14.0（6.0，18.0）
Z值		-1.615	—	-2.199	-0.444
P值		0.106	0.104	0.028	0.657
组别	AHI 〔M（P₂₅，P₇₅），次/h〕	平均SpO₂ 〔M（P₂₅，P₇₅），%〕	最低SpO₂ 〔M（P₂₅，P₇₅），%〕	T90% 〔M（P₂₅，P₇₅），%〕
少发心律失常组	15.8（9.6，37.1）	93.0（92.0，95.0）	80.0（69.0，84.0）	4.5（1.0，17.5）
多发心律失常组	20.1（9.4，46.3）	93.0（91.0，95.0）	78.0（68.0，86.0）	11.0（2.0，33.0）
Z值	-0.506	-0.830	-0.269	-0.888
P值	0.613	0.424	0.788	0.375
组别	∆S 〔M（P₂₅，P₇₅）〕	ODR 〔M（P₂₅，P₇₅）〕	∆HR 〔M（P₂₅，P₇₅）〕	HRFR 〔M（P₂₅，P₇₅）〕
少发心律失常组	15.0（10.0，20.0）	0.5（0.3，0.7）	9.0（5.0，15.0）	0.6（0.5，1.1）
多发心律失常组	14.0（9.0，21.0）	1.0（0.8，1.2）	14.0（12.0，18.0）	1.3（0.9，1.7）
Z值	-0.237	-4.430	-1.915	-2.595
P值	0.812	<0.001	0.055	0.009

项目	年龄	BMI	高血压	ESS	AHI	平均SpO₂	最低SpO₂	T90%	∆S	ODR	∆HR	HRFR
r_s值	0.472	-0.390	-0.005	-0.044	0.025	-0.043	0.046	0.105	-0.050	0.719	0.360	0.393
P值	0.004	0.019	0.975	0.799	0.887	0.801	0.789	0.540	0.771	<0.001	0.031	0.018

项目	年龄	BMI	高血压	ESS	AHI	平均SpO₂	最低SpO₂	T90%	∆S	ODR	∆HR	HRFR
r_s值	0.472	-0.390	-0.005	-0.044	0.025	-0.043	0.046	0.105	-0.050	0.719	0.360	0.393
P值	0.004	0.019	0.975	0.799	0.887	0.801	0.789	0.540	0.771	<0.001	0.031	0.018

项目	赋值
性别	女=1，男=2
年龄	年龄<55岁=1，年龄≥55岁=2
BMI	BMI<27 kg/m²=1，BMI≥27 kg/m²=2
高血压	无=1，有=2
AHI	AHI<15次/h=1，AHI≥15次/h=2
平均SpO₂	平均SpO₂>90%=1，平均SpO₂≤90%=2
最低SpO₂	最低SpO₂>80%=1，最低SpO₂≤80%=2
T90%	T90%<10%=1，T90%≥10%=2
∆S	∆S<15=1，∆S≥15=2
ODR	ODR<0.8%=1，ODR≥0.8%=2
∆HR	∆HR<13=1，∆HR≥13=2
HRFR	HRFR<0.9%=1，HRFR≥0.9%=2

Relationship between Pulse Oxygen Desaturation Rate and Heart Rate Fluctuation Rate and Arrhythmias in Patients with Obstructive Sleep Apnea Hypopnea Syndrome

脉氧下降率和心率波动率与阻塞性睡眠呼吸暂停低通气综合征患者发生心律失常的关系研究

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变量	SE	β	P值	OR值	95%CI
ODR（以<0. 8为参考）	1. 376	4. 355	0. 002	77. 849	（5. 250，1 154. 301）
HRFR（以<0. 9为参考）	1. 204	2. 301	0. 050	9. 981	（1.000，105. 600）
常量	3. 126	-9. 367	0. 003	0	—

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