正常人和无睡眠呼吸异常慢病患者睡眠期间的呼吸源性心率变异初步报告*

目的: 整体整合生理学医学新理论-呼吸循环代谢等系统一体化调控提出了呼吸为循环指标变异性起源的假说,我们对人睡眠期间的呼吸和心率变异分别分析,探索心率变异的起源。方法: 本研究回顾性分析了2014年以来行心肺运动试验（CPET）、多导睡眠图（PSG）鼻气流和心电图监测的8例无疾病诊断的正常人和10例无睡眠呼吸异常的慢性疾病患者,分析夜晚睡眠期间鼻气流的呼吸周期与心电图R-R间期心率变异周期的关系。一个完整的呼吸周期包括吸气过程和紧接着的呼气过程,分析计算呼吸周期数、平均呼吸周期时间等指标。心率由心电图的R-R间期计算获得,连续一次心率由最低点上升至最高点,再由最高点下降至最低点,为一个心率变异周期,计算心率变异周期数、平均心率变异时间、心率变异平均幅度等指标。比较同一人呼吸和心率变异指标之间的相互关系,以及两组人群之间的异同。结果: 正常人峰值摄氧量、无氧阈等CPET核心指标均显著优于无睡眠呼吸异常的慢性疾病患者（P<0.05）。正常人AHI（（1.7±1.3）次/小时）和无睡眠呼吸异常慢性疾病患者AHI（（2.9±1.2）次/小时）无差异（P>0.05）。正常人呼吸周期数与心率变异周期数（（6581.63±1411.90）次、（6638.38±1459.46）次）、平均呼吸周期时间与平均心率变异周期时间（（4.19±0.57）s、（4.16±0.62）s）均高度一致,无差异（P>0.05）。无睡眠呼吸异常的慢性疾病患者上述指标比较（（7354.50±1443.50）次与（7291.20±1399.31）次、（4.20±0.69）s与（4.23±0.68）s）也是高度一致,无统计学差异（P>0.05）。正常人呼吸周期数/心率变异周期数（0.993±0.027）与无睡眠呼吸异常的慢性疾病患者呼吸周期数/心率变异周期数（1.008±0.024）比值均接近1。正常人心率变化平均幅度（（5.74±3.21） bpm）略高于无睡眠呼吸异常的慢性疾病患者（（2.88±1.44） bpm,P<0.05）。结论: 正常人和无睡眠呼吸异常的慢性疾病患者无论功能状态如何,心率变异与呼吸存在极其相似的一致性,其心率变异的始发因素均为呼吸所致。

A preliminary report on the variation of respiratory heart rate during sleep in normal subjects and patients with chronic diseases without sleep apnea

Objective: The new theory of holistic integrative physiology and medicine, which describes the integrative regulation of respiratory, circulatory and metabolic systems in human body, generates the hypothesis of that breath is the origin of variability of circulatory parameters. We investigated the origin of heart rate variability by analyzing relationship between the breath and heart rate variability (HRV) during sleep. Methods: This retrospective study analyzed 8 normal subjects (NS) and 10 patients of chronic diseases without sleep apnea (CDs-no-SA). After signed the informed consent form, they performed cardiopulmonary exercise testing (CPET) in Fuwai Hospital and monitored polysomnography (PSG) and electrocardiogram (ECG) during sleep since 2014. We dominantly analyzed the correlation between the respiratory cycle during sleep and the heart rate variability cycle of the ECG R-R interval. The HRV cycle included the HR increase from the lowest to the highest and decrease from the highest to the lowest point. The number of HRV (HRV-n), average HRV time and other parameters were calculated. The breath cycle included complete inhalation and subsequent exhalation. The number of breath (B-n), average breath time and other breath parameters were analyzed and calculated. We analyzed each person's relationship between breath and HRV; and the similarities and differences between the NS and CDs-no-SA groups. Independent sample t test was used for statistical analysis, with P<0.05. Results: CPET core parameter such as Peak VO₂ (83.8±8.9)% in NS were significantly higher than that (70.1±14.9)% in patients of chronic diseases without sleep apnea (P<0.05), but there was no difference between their AHI (1.7±1.3) in NS and AHI (2.9±1.2) in CDs-no-SA (P>0.05). The B-n and the HRV-n (6581.63±1411.90 vs 6638.38±1459.46), the average B time and the average HRV time (4.19±0.57)s vs (4.16±0.62)s in NS were similar without significant difference (P>0.05). The comparison of the numbers in CDs-no-SA were the number (7354.50±1443.50 vs 7291.20±1399.31) and the average times ((4.20±0.69)s vs (4.23±0.68)s) of B and HRV were similar without significant difference (P>0.05). The ratios of B-n/HRV-n in NS and CDs-no-SA were (0.993±0.027 vs 1.008±0.024) and both were close to 1 and similar without significant difference (P>0.05). The average magnitude of HRV in NS ((5.74±3.21) bpm) was significantly higher than that in CDs-no-SA ((2.88±1.44) bpm) (P<0.05). Conclusion: Regardless of the functional status of NS and CDs-no-SA, there is a similar consistency between B and HRV. The origin of initiating factors of HRV is the respiration.