Impact of Sleep Apnea on Nocturnal Parasympathetic Activity in Atrial Fibrillation Patients After Catheter Ablation - Implications for Heart Rate Variability Analysis.
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引用次数: 0
Abstract
Background: The impact of sleep apnea (SA) on heart rate variability (HRV) in atrial fibrillation (AF) patients has not been investigated.
Methods and results: Of 94 patients who underwent AF ablation between January 2021 and September 2022, 76 patients who had a nocturnal Holter electrocardiography and polysomnography conducted simultaneously were included in the analysis. A 15-min duration of HRV, as determined by an electrocardiogram during apnea and non-apnea time, were compared between patients with and without AF recurrence at 12 months' postoperatively. Patients had a mean age of 63.4±11.6 years, 14 were female, and 20 had AF recurrence at 12 months' follow-up. The root mean square of the difference between consecutive normal-to-normal intervals (RMSSD, ms) an indicator of a parasympathetic nervous system, was more highly increased in patients with AF recurrence than those without, during both apnea and non-apnea time (apnea time: 16.7±4.5 vs. 13.5±3.3, P=0.03; non-apnea time: 20.9±9.5 vs. 15.5±5.9, P<0.01). However, RMSSD during an apneic state was decreased more than that in a non-apneic state in both groups of patients with and without AF recurrence (AF recurrence group: 16.7±4.5 vs. 20.9±9.5, P<0.01; non-AF recurrence group; 13.5±3.3 vs. 15.5±5.9, P=0.03). Consequently, the effect of AF recurrence on parasympathetic activity was offset by SA. Similar trends were observed for other parasympathetic activity indices; high frequency (HF), logarithm of HF (lnHF) and the percentage of normal-to-normal intervals >50 ms (pNN50).
Conclusions: Without considering the influence of SA, the results of nocturnal HRV analysis might be misinterpreted. Caution should be taken when using nocturnal HRV as a predictor of AF recurrence.
背景:尚未研究睡眠呼吸暂停(SA)对心房颤动(AF)患者心率变异性(HRV)的影响:在2021年1月至2022年9月期间接受房颤消融术的94名患者中,有76名患者同时接受了夜间Holter心电图和多导睡眠呼吸监测。在术后12个月时,通过呼吸暂停和非呼吸暂停时的心电图确定的15分钟心率变异持续时间在房颤复发和未复发患者之间进行了比较。患者的平均年龄为(63.4±11.6)岁,其中 14 人为女性,20 人在随访 12 个月时房颤复发。作为副交感神经系统的指标,房颤复发患者在呼吸暂停和非呼吸暂停时间内的连续正常间期与正常间期之差的均方根(RMSSD,毫秒)比未复发患者增加得更多(呼吸暂停时间:16.7±4.5 vs. 13.5±3.3,P=0.03;非呼吸暂停时间:20.9±9.5 vs. 15.5±5.9,P50毫秒(pNN50)):如果不考虑SA的影响,夜间心率变异分析的结果可能会被误解。在使用夜间心率变异预测房颤复发时应谨慎。
期刊介绍:
Circulation publishes original research manuscripts, review articles, and other content related to cardiovascular health and disease, including observational studies, clinical trials, epidemiology, health services and outcomes studies, and advances in basic and translational research.