Clinical observation of polysomnography combined with 24 hour dynamic electrocardiogram

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Abstract: Objective To study the effect of obstructive sleep apnea syndrome () on myocardial ischemia induced by obstructive sleep apnea syn


Abstract: Objective To study the effect of obstructive sleep apnea syndrome () on myocardial ischemia induced by obstructive sleep apnea syndrome. Methods: in the past 3 years in our hospital in patients with sleep apnea and heart function of the patients with the above mentioned the 2 monitoring, a total of 53, before the monitoring of OSA related symptoms and cardiac function questionnaire. Dynamic electrocardiogram and PSG monitoring results were processed by SPSS10.0 software. Results: there were 457 myocardial ischemia, 77.5% in respiratory blocking events lasting more than 30 seconds, ST depression 93.5% heart rate increase, the night time of myocardial ischemia and ST segment depression was significantly higher than that in the daytime. Conclusion: obstructive sleep apnea syndrome can increase the degree of myocardial ischemia.

[Key words] OSA myocardial ischemia PSG dynamic electrocardiogram

Clinic investigation polysomnograpy combine 24 hours Zhanghaolian electrocardiogram, Yufeng. of Otorhinolaryngology, Twelve Hospital of Guangzhou, Guangzhou 510620, Department, of

[Abstract] Object Check the polysomnograpy and the electrocardiogram in the same 24 hours time, It is prove that obstructive sleep apnea will place a premium on angina. Methods 1n 2001~2003 There are combine OSAHS patient in 53 cardiopathy Our hospital, Check the two item in one day and night, Before it we will make a questionnaire with Epworth s "grade. Results are deal with SPSS Results There are 10. 457 cardiac muscle schema in the check-up, thereinto ischemia appear when breath obstructive affair 77.5% last for 30 minute or more 93.5% of S-T sect drive down, when cardiotach increment at the same time, cardiac muscle schema affair and S-T drive down are more in light than in day. Conclusion obstructive sleep apnea aggravate the de Gree of anoxic.

[Key word] Cardiac anoxia PSG OSA Electrocardiogram

Materials and methods

From March 2001 to December 2003 for 1 subjects sleep snoring, repeated breath, morning headaches, purple lips treatment, the Epworth score more than 10 points, in the sleep monitoring center of the twelfth people's Hospital of Guangzhou City, according to the 1997 International Society of Cardiology and the diagnostic standard of WHO [1] for evaluation of coronary heart disease, cardiac insufficiency patients, including 7 cases with arrhythmia, 17 cases of simple S T segment, and 6 cases with arrhythmia and S T segment of electrocardiogram, completely normal for 23 cases. According to the classification and classification of cardiac function, 1 cases of 44 cases of grade II in 8 patients. All cases in the 24 hour Holter monitoring on the same day to sleep at night by polysomnography (Polysomnography) monitoring, a total of 53 cases, male 48 cases, female 5 cases, age 33~66 years old, average age (51.1 + 7.2) years old, according to the "Chinese Otorhinolaryngology journal" in 2002 as the standard [2] distribution of nasopharynx 2 cases of nasal cavity, accounted for 3.77% of the palatine tonsil and level 34 cases, accounted for 64.2% of the tongue and epiglottis in 4 cases accounted for 7.55% of the above two parts or above had stenosis in 13 cases, accounting for 24.5%.

2 methods of using the United States Agilent Zyined Holret 1810 type instrument, composed of 3 channel switching of 12 lead ECG recording, playback computer analysis, detection time is 24h, the same day to sleep at night when using the United States Respironics Alice 4 type 32 sleep apnea monitoring, 6~8.5h monitoring. [2] criteria for the diagnosis of asymptomatic myocardial ischemia after 80ms: J point of ECG ST segment level or oblique shaped depression > 0.1mV, duration of more than 1min. and the other at a time interval of at least 1min.

3 statistical analysis: using SPSS10.0 software, the measurement data were expressed as + s, t test. Result

1 non nocturnal myocardial ischemia sleep, this group of 53 cases of obstructive sleep apnea syndrome in patients with myocardial ischemia were detected by day 35 times, including 34 cases of asymptomatic myocardial ischemia (97.1%), 1 cases of symptoms (2.9%), all 53 cases with an average value of S-T segment depression (STD) for 0.162 + 0.04 (0.1~0.4mV).

2 sleep at night and the various stages of myocardial ischemia, the group of 53 patients with myocardial ischemia were detected 314 times, including 1 period sleep myocardial ischemia 19 times (6%), 2 (24.2%), 76 times of sleep stage 3 sleep 1 times (0.3%), 4 sleep 0 times, 218 times (69.4% R sleep), M sleep 0 times, all of the 314 cases with the average value of S-T segment depression (STD) was 0.166 + 0.03 (0.1~0.4mV).

3 night sleep stage occurrence of obstructive apnea and hypopnea events, a total of 53 patients were detected for 8223 times, of which 1 obstructive sleep apnea and hypopnea 556 times (6.8%), 2 (32.4%), 2663 times of sleep stage 3 sleep 48 times (0.6%, 4) during sleep 10 (0.1%), R sleep 4946 times (60.1%), M sleep 0 times.

4 myocardial ischemia day and night rule: the peak time of myocardial ischemia occurred in 23:30~2:00 and 3:30~5:00, with a total of 225 times (71.7%), the highest proportion of myocardial ischemic attack and R sleep overlap (60.1%) ().

553 cases of patients with obstructive sleep apnea and hypopnea events were induced by myocardial ischemia in 269 (85.7%), low caused by obstructive apnea and hypopnea events after oxygen (SaO2 was down 4%) delay time was 16.57 + 4.37sec, and myocardial ischemia caused by delay time was 21.32 + 7.44sec. The P value is 0.05.

6 in the above myocardial ischemia, the X (min) and the Y (mV) of myocardial ischemia S-T segment were correlated with the duration of obstructive apnea and hypopnea events. The regression equation was: Y=0.16642425+3.56657254lnX.

7 in the above myocardial ischemia in 269 times, the average heart rate was 101 + / - 8.82 times, and sinus tachycardia was the same as the 232.

8 the comparison of myocardial ischemia between the longest and the shortest duration of respiratory obstruction was observed in 40 of the patients in table 2:

The longest blocking duration is the shortest duration P

Heart rate / times / min 91.35 + + 83.17 + 19.67 + 22.16 0.05

S-T segment depression / mV 0.19 + + 0.14 + 0.08 < 0.07 < 0.05


The main complications of obstructive sleep apnea hypopnea syndrome (OSAHS) in the circulatory system are arrhythmia and myocardial ischemia. Nocturnal hypoxia time (SaO2 = 90% = TST), which can lead to pulmonary hypertension ([4]), secondary right heart failure. OSAHS patient weight is high, the level of living, intake of excess nutrients can cause hyperlipidemia, coronary atherosclerosis and coronary heart disease can be induced by long-term [5] and OSAHS patients was only nocturnal hypoxia events, arterial oxygen saturation, myocardial blood flow did not change at the same time, the amount of oxygen intermittent decreased myocardial hypoxia but not myocardial infarction, myocardial hypoxia by increasing heart rate compensation, night long heart rate too fast can cause myocardial strain, heart failure, and cardiac hypertrophy, secondary myocardial oxygen demand increases, the vicious spiral of myocardial hypoxia. Myocardial ischemia showed circadian rhythms, this study showed that ischemia by 23:30~2:00 and 3:30~5:00 for two time periods are relatively concentrated, which may increase with nocturnal vagal tension, high blood viscosity, the blood flow is slow and other factors, so at night it is necessary to take anti myocardial ischemia treatment, application of slow-release nitrates is necessary. While night parasympathetic tone abnormality that given calcium antagonist. Myocardial ischemia and R sleep period may overlap the highest proportion in the excited state [6] and R sleep part of central cerebral cortex, pharyngeal muscles, palatine velum muscles, uvula and trapezius muscles relaxation reaction, easy to induce obstructive apnea and hypopnea events, decreased blood oxygen saturation caused by the tension of coronary reflex artery increased parasympathetic tone and abnormal increase, finally caused the relative coronary insufficiency. Arrhythmia mainly tachycardia for occasional ventricular premature beat and sinus, the study group found no syndrome type of arrhythmia node atrial fibrillation, atrioventricular block and sick sinus. Therefore, it was not proved that OSAHS could be complicated with arrhythmia. The initial obstructive apnea and hypopnea events generally associated with decreased heart rate, heart rate at the end of the event to minimize recovery due to inspiratory motor excitation of sympathetic nerve, heart rate increased rapidly to a blocking incident, the heart rate change cycle. Increased myocardial oxygen consumption, myocardial ischemia events increased.

The detection probability of obstructive apnea and hypopnea events and myocardial ischemia occurred in the sleep stage R was significantly higher than in other sleep stages, the reason may lie in the sleep stage R in the central nervous system in the excited state, the cerebellum and the limbic system relatively in the inhibitory state, make the whole body muscle tension drops further, tissue around the palate the muscle group and isthmicus more relaxed [7], induced by obstructive sleep apnea and hypopnea events induced by myocardial ischemia.

It is widely used in the diagnosis of nocturnal hypoxemia index is oxygen desaturation index, general critical value 10 times per hour [8], it can only reflect the total number and frequency of oxygen desaturation, but does not reflect the time duration of oxygen desaturation and hypoxia time. The best indicator of nighttime sleep hypoxia was SaO2 < 90% (or 85%), which accounted for the percentage of non waking sleep time. Another more common index to evaluate the severity of OSAHS is AHI, it does not completely assess the severity of OSAHS, blocking 15 seconds can be determined as a continuous block, blocking time lasted for 80 seconds is judged to be a block, often AHI index is similar, but the degree of hypoxia be quite different. This paper proposes a only 2 indicators can be assessed the severity of OSAHS methods: 1 AHI, 2 SaO2 < 90% sleep time percentage of non awakening period of sleep time, the reason is SaO2 < 90% (or 85%) percentage of time can comprehensively reflect the total time of apnea and respiratory obstruction to body harm of.


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