Značaj određivanja indeksa apneje u snu analizom holter EKG-a kod bolesnika sa poremećajima srčanog ritma

  • Aleksandra Grdinić Clinic of Cardiology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Zoran Stajić Clinic of Cardiology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Aleksandar G. Grdinić Clinical Center of Montenegro, Podgorica, Montenegro
  • Žarko Vučinić Clinic of Cardiology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Violeta Randjelović Krstić Clinic of Cardiology, Military Medical Academy, Belgrade, Serbia
  • Dragan Drobnjak Clinic of Cardiology, Military Medical Academy, Belgrade, Serbia
  • Predrag Bogdanović Clinic of Cardiology, Military Medical Academy, Belgrade, Serbia
  • Predrag Djurić Clinic of Cardiology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Angelina Stevanović Institute of Occupational Health of Serbian Railways; Belgrade, Serbia
  • Milanko Rakonjac Institute of Aviation Medicine, , Military Medical Academy, Belgrade, Serbia
  • Stanko Petrović Clinic of Gastroenterology, Military Medical Academy, Belgrade, Serbia
  • Ognjen Gudelj Clinic of Cardiology, Military Medical Academy, Belgrade, Serbia
  • Radomir Matunović Clinic of Cardiology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
DOI: https://doi.org/10.2298/3971
Ključne reči: sleep apnea syndromes||, ||apneja, spavanje poremećaji, sindromi, arrhythmias, cardiac||, ||aritmija, electrocardiography, ambulatory||, ||elektrokardiografija, ambulantna,

Sažetak


Uvod/Cilj. Jedan od mogućih uzroka malignih poremećaja ritma srca na koji se ne obraća dovoljno pažnja je sindrom poremećaja disanja u toku spavanja poznat kao sleep apnea (periodični prekid disanja u toku spavanja duži od 10 sekundi). Noviji softverski sistemi holter EKG-a imaju mogućnost određivanja apneja indeksa (AI) na osnovu promene voltaže QRS kompleksa. Cilj ovog rada bio je utvrđivanje značaja određivanja AI u rutinskoj  analizi holter EKG-a na uzorku od 12 bolesnika. Metode. Prikazana je grupa od 12 uzastopnih bolesnika sa prethodno dokazanim aritmijama i istorijom poremećaja disanja tokom noći. Svi su bili podvrgnuti 24 h holter EKG analizi (Medilog 12 plus Darwin) koja omogućava određivanje AI. Rezultati. Prikazali smo seriju od 12 bolesnika, 8 muškaraca i 4 žene, prosečne starosti 58,75 godina i prosečnog AI od 5,78. U celokupnoj grupi postojao je trend povećanja učestalosti kompleksnih poremećaja ritma sa povećanjem AI i učestalosti aritmije u noćnoj fazi u odnosu na dnevnu fazu. Zaključak. S obzirom na mogućnost lečenja apneje u snu kao etiološkog ili doprinosećeg faktora u nastanku i pogoršanju aritmija, određivanje AI rutinskom primenom holter EKG-a od velikog je značaja.

Reference

de Chazal P, Penzel T, Heneghan C. Automated detection of ob-structive sleep pneaa at different time scales using the electro-cardiogram. Physiol Meas 2004; 25(4): 967−83.

Guilleminault C, Connolly SJ, Winkle RA. Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome. Am J Cardiol 1983; 52(5): 490−4.

Porthan KM, Melin JH, Kupila JT, Venho KK, Partinen MM. Prevalence of sleep apnea syndrome in lone atrial fibrillation: a case-control study. Chest 2004; 125(3): 879−85.

Wolk R, Kara T, Somers VK. Sleep-disordered breathing and cardiovascular disease. Circulation 2003; 108(1): 9−12.

Bsoul M, Minn H, Tamil L. Apnea MedAssist: real-time sleep apnea monitor using single-lead ECG. IEEE Trans Inf Tech-nol Biomed 2011; 15(3): 416−27.

Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardio-vascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: An observational study. Lancet 2005; 365(9464): 1046−53.

Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto JF, et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep 2008; 31(8): 1071−8.

Javaheri S. Effects of continuous positive airway pressure on sleep apnea and ventricular irritability in patients with heart failure. Circulation 2000; 101(4): 392−7.

Narkiewicz K, van de Borne PJ, Cooley RL, Dyken ME, Somers VK. Sympathetic activity in obese subjects with and without ob-structive sleep apnea. Circulation 1998; 98(8): 772−6.

Penzel T, McNames J, de Chazal P, Raymond B, Murray A, Moody G. Systematic comparison of different algorithms for apnoea detection based on electrocardiogram recordings. Med Biol Eng Comput 2002; 40(4): 402−7.

Shouldice RB, O'Brien LM, O'Brien C, de Chazal P, Gozal D, Heneghan C. Detection of obstructive sleep apnea in pediatric subjects using surface lead electrocardiogram features. Sleep 2004; 27(4): 784−92.

Associazione Italiana di Medicina del Sonno. Aggiornamento monografico: Russamento ed apnea ostruttiva da sonno. [cited 2002 January]. Available from: web.cinc.org/archives/2003/pdf/613.pd

Iber C, Ancoli-Israel S, Chesson A, Quan S. The AASM manual for the scoring of sleep and associated events: Rules, terminology and technical specifications, 1st ed. Westchester, IL: American Academy of Sleep Medicine; 2007.

Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardio-vascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005; 365(9464): 1046−53.

Lopez-Jimenez F, Sert KF, Gami A, Somers VK. Obstructive sleep apnea: implications for cardiac and vascular disease. Chest 2008; 133(3): 793−804.

Somers VK. Sleep: a new cardiovascular frontier. N Engl J Med 2005; 353(19): 2070−3.

Quan SF, Gersh BJ. Cardiovascular consequences of sleep-disordered breathing: past, present and future: report of a workshop from the National Center on Sleep Disorders Re-search and the National Heart, Lung, and Blood Institute. Cir-culation 2004; 109(8): 951−7.

Objavljeno
2015/04/24
Broj časopisa
Vol. 71 Br. 11 (2014)
Rubrika
Kratko saopštenje