中年男性亞急性中風患者睡眠指標與心率變異度指標之探討

Association of Heart Rate Variability with Intracardiac Conduction Across Sleep Stages in Mid-aged Male Patients with Subacute Stroke

蔡劭均(TSAI, SHAO-JUN)

指導教授 ： 黃仁景

中山醫學大學/醫學科技學院/醫學影像暨放射科學系/碩士(2019年)

https://doi.org/10.6834/CSMU201900005

摘要

研究目的：雖然降低心率變異度指標，會伴隨增加中風的風險，然而心率變異度導致中風的病理機制目前還不是很清楚。本項研究透過睡眠多項生理監測儀，觀察中年男性亞急性中風病患，於整晚睡眠過程中，各睡眠期別的自主神經系統活性，是否影響心臟內部神經傳導，以及心電圖的訊號變化。

材料與方法：本項研究採用回溯性實驗設計，收集72名中年男性亞急性中風病患，以及72名年齡相符之公車司機和台鐵駕駛員作為正常組，進行睡眠多項生理檢查，並排任何遺失資料或心律不整的中風病患，進行各睡眠期別5分鐘之心率變異度指標、心電圖訊號、脈衝傳輸時間，以及去趨勢波動分析的斜率ALPHA，並且另外收集中年男性亞急性中風病患與正常組之血液檢查數據進行比較。

結果：所有受試者經過獨立樣本t檢定，比較人口統計學、血液檢查數據，和各睡眠別的心率變異度指標，可發現中年男性亞急性中風病患於睡前清醒期、第二期非快速動眼期、慢波睡眠以及快速動眼期結束前之睡眠時段，其自主神經系統活性明顯較正常組低，另外副交感神經系統活性於睡前清醒期、第二期非快速動眼期以及快速動眼期結束前之睡眠時段，和正常組相較之下明顯比較低，而交感神經系統活性於整晚睡期別當中，兩組之間皆無顯著差異。另外透過線性回歸分析之後，發現中年男性亞急性中風病患之自主神經系統活性，於第二期非快速動眼期，以及快速動眼期結束前之睡眠時段，和經心率校正之QT_c間期呈顯著負相關。

結論：中年男性亞急性中風病患之自主神經系統活性，於睡前清醒期，第二期快速動眼期睡眠、慢波睡眠，以及快速動眼期睡眠結束前，明顯低於正常組，特別是副交感神經活性降低，相對增加交感神經系統活性。而且中風病患之自主神經系統活性，會影響心臟內部的神經傳導。

關鍵字

亞急性中風 ； 心率變異度指標 ； 心電圖

並列摘要

Objective：Although low heart rate variability may increase the risk of stroke, the underlying mechanism is still unknown. This study observe subacute stroke middle age male patients by using a 12 channel polysomnography. We aim to investigate whether heart rate variability in each stage affect the intracardiac conduction and the electrocardiogram features.

Material and method：We use the retrospective study, recruit 72 subacute stroke middle age male patients, with 72 age-matched bus and train drivers as normal controls. In the polysomnography analysis, we exclude any missing data or arrhythmias in stroke patients, analyzing the heart rate variability, ECG signals, pulse transit time and detrended fluctuation analysis slope ALPHA in 5 minutes sleep stage. We also recruit each participants blood test data for further analysis.

Results：Subacute stroke patients’ autonomic nervous system activity in AWK1、N2。SWS and REM2 were lower than the normal controls. The parasympathetic activity in the subacute stroke patients’ in AWK1、N2 and REM2 are lower than the normal controls, while the sympathetic nervous system activity in each stage are not significant compared in both subacute stroke and normal control participants. We also found that the subacute stroke patients’ autonomic nervous system activity in N2 and REM2 are negatively correlated with the QT_c intervals.

Conclusion：The autonomic nervous system activity in subacute stroke patients, is lower in AWK1、N2。SWS and REM2, compared with the normal controls, and the Subacute stroke patients’ autonomic nervous system activity do not affect the intracardiac conduction in night.

並列關鍵字

subacute stroke ； heart rate variability ； electrocardiogram

參考文獻

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