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中华诊断学电子杂志 ›› 2020, Vol. 08 ›› Issue (01) : 52 -56. doi: 10.3877/cma.j.issn.2095-655X.2020.01.012

所属专题: 文献

临床研究

快速动眼睡眠相关缓慢性心律失常综合征的诊断学特征分析
林林1, 李婵1, 林晶如2, 徐瑞3,()   
  1. 1. 261053 潍坊医学院;250014 济南,山东第一医科大学第一附属医院(山东省千佛山医院)心内科
    2. 250031 济南,山东省立第三医院心内科
    3. 250014 济南,山东第一医科大学第一附属医院(山东省千佛山医院)心内科
  • 收稿日期:2019-08-19 出版日期:2020-02-26
  • 通信作者: 徐瑞
  • 基金资助:
    山东省重点研发计划项目(2018GSF118009); 济南市科技计划项目(201805060)

Diagnostic features analysis of rapid eye movement sleep-related bradyarrhythmia syndrome

Lin Lin1, Chan Li1, Jingru Lin2, Rui Xu3,()   

  1. 1. Weifang Medical University, Weifang 261053, China; Department of Cardiology, the First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan 250014, China
    2. Department of Cardiology, Shandong Provincial Third Hospital, Jinan 250031, China
    3. Department of Cardiology, the First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan 250014, China
  • Received:2019-08-19 Published:2020-02-26
  • Corresponding author: Rui Xu
  • About author:
    Corresponding author: Xu Rui, Email:
引用本文:

林林, 李婵, 林晶如, 徐瑞. 快速动眼睡眠相关缓慢性心律失常综合征的诊断学特征分析[J]. 中华诊断学电子杂志, 2020, 08(01): 52-56.

Lin Lin, Chan Li, Jingru Lin, Rui Xu. Diagnostic features analysis of rapid eye movement sleep-related bradyarrhythmia syndrome[J]. Chinese Journal of Diagnostics(Electronic Edition), 2020, 08(01): 52-56.

目的

探讨快速动眼睡眠相关缓慢性心律失常综合征的诊断学特征与治疗。

方法

回顾性分析山东省千佛山医院心内科2017年9月14日收治的1例快速动眼睡眠相关缓慢性心律失常综合征患者的临床资料,并复习相关文献。

结果

24 h动态心电图提示:窦性心动过速;窦性停搏,窦性停搏大于2.0 s的为525次,最长停搏3.13 s;一度、二度Ⅰ型、二度Ⅱ型房室传导阻滞;偶发室上性早搏。窦性心动过速主要发生于白天运动后,窦性停搏及房室传导阻滞主要发生于24∶00~7∶00 am。心脏心率变异性:窦性心搏RR间期的标准差为121 ms,峰值出现在夜间,其24 h最快心率169次/min,无ST-T改变。心肌酶、心脏彩超、胸片未见异常。给予去交感神经兴奋诱因后,患者夜间缓慢性心律失常较前明显好转。

结论

白天交感神经过度兴奋可能是快速动眼睡眠相关缓慢性心律失常的诱因之一。

Objective

To explore the diagnostic features and treatment of rapid eye movement (REM) sleep-related bradyarrhythmia syndrome.

Methods

The clinical data of the patient with bradyarrhythmia syndrome related to REM sleep admitted to Cardiology Department of Shandong Provincial Qianfoshan Hospital on September 14, 2017 were analyzed retrospectively, and the relevant literatures were reviewed.

Results

The results of 24-hour holter showed sinus tachycardia, sinus arrest (sinus arrest was more than 2.0 s for 525 times, and the longest stop was 3.13 s), first degree, second degree Ⅰ, second degree Ⅱ atrioventricular block and occasional supraventricular premature beat. Sinus tachycardia mainly occured in daytime after movement, sinus arrest and atrioventricular block mainly occured from 24∶00 to 7∶00 am. Heart rate variability showed the standard deviation of RR interval of sinus heart beat was 121 ms, the peak appeared at night, the fastest heart rate was 169 times/min within 24 hours, no ST-T change. No abnormality was found in myocardial enzyme, doppler echocardiography and chest radiograph. After removing the inducement of sympathetic nerve excitation, the patient′s arrhythmia at night was significantly improved.

Conclusion

The hyperactivity of the sympathetic during the day maybe one of the causes of the bradyarrhythmia related to REM sleep.

图1 快速动眼睡眠相关缓慢性心律失常综合征患者入院动态心电图
图2 快速动眼睡眠相关缓慢性心律失常综合征患者出院后第1个月复查SDNN 24 h动态变化
[1]
Janssens W, Willems R, Pevernagie D.REM sleep-related brady-arrhythmia syndrome[J]. Sleep Breath,2007,11(3):195-199.
[2]
Jakutis G, Juknevičius V, Barysiene· J,et al.A rare case of REM sleep-related bradyarrhythmia syndrome with concomitant severe hypertension:a case report and a review of literature[J]. Acta Med Litu,2018,25(1):1-6.
[3]
Gula LJ, Krahn AD, Skanes AC,et al.Clinical relevance of arrhythmias during sleep:guidance for clinicians[J].Heart,2004,90(3):347-352.
[4]
Brodsky M, Wu D, Denes P,et al.Arrhythmias documented by 24 hour continuous electrocardiographic monitoring in 50 male medical students without apparent heart disease[J]. Am J Cardiol,1977,39(3):390-395.
[5]
Guilleminault C, Pool P, Motta J,et al.Sinus arrest during REM sleep in young adults [J]. N Engl J Med,1984,311(16):1006-1010.
[6]
韩容,赵媛,蒋成刚.孕期焦虑、失眠的临床特征及失眠的认知行为治疗疗效分析[J/CD].中华诊断学电子杂志,2019,7(3):173-178.
[7]
马佳,张韶伟,刘文斌,等.上海市杨浦区某社区老年轻度认知障碍患者抑郁焦虑状况及影响因素研究[J/OL].中国全科医学,2019:1-6[2019-11-11].

URL    
[8]
全国心率变异性分析多中心研究协作组.心率变异性正常值及其重复性的多中心研究[J].中华心律失常学杂志,2000,4(3):165-169.
[9]
吴霞英,吴建祥.心脏植物神经功能紊乱的临床心电图诊断分析[J].中国慢性病预防与控制,2013,21(2):222-223.
[10]
Holty JE, Guilleminault C.REM-related bradyarrhythmia syndrome[J].Sleep Med Rev,2011,15(3):143-151.
[11]
Serafini A, Dolso P, Gigli GL,et al.Rem sleep brady-arrhythmias:an indication to pacemaker implantation?[J].Sleep Med,2012,13(6):759-762.
[12]
Coccagna G, Capucci A, Pierpaoli S. A case of sinus arrest and vagal overactivity during REM sleep[J]. Clin Auton Res,1999,9(3):135-138.
[13]
Sanna N, Della Marca G, Bianco M,et al.Prolonged asystolia in a young athlete:a case of sinus arrest during REM sleep[J].Int J Sports Med,2004,25(6):457-460.
[14]
Carley S.Are you an evidence based emergency physician?[J]. Emerg Med J,2007,24(9):611-613.
[15]
Osuna E, Patino G.REM sleep-related complete heart block:is it a specific sleep-related disorder? [J].Sleep Med,2006,7(4):387-388.
[16]
Stallmeyer B, Kuβ J, Kotthoff S,et al.A mutation in the G-protein gene causes familial sinus node and atrioventricular conduction dysfunction[J].Circ Res,2017,120(10):e33-e44.
[17]
Ewy GA. Sick sinus syndrome:synopsis[J]. J Am Coll Cardiol,2014,64(6): 539-540.
[18]
Ramar K, Olson EJ.Management of common sleep disorders[J]. Am Fam Physician,2013,88(4):231-238.
[19]
Barriuso B, Martin L, Sevilla C,et al.Self-setup of home respiratory polygraphy for the diagnosis of sleep apnea syndrome:cost-efficiency study[J]. Sleep Breath,2019.[Epub ahead of print]
[20]
Baharav A, Kotagal S, Gibbons V,et al.Fluctuations in autonomic nervous activity during sleep displayed by power spectrum analysis of heart rate variability[J].Neurology,1995,45(6):1183-1187.
[21]
Elsenbruch S, Harnish MJ, Orr WC.Heart rate variability during waking and sleep in healthy males and females[J].Sleep,1999,22(8):1067-1071.
[22]
李慧娟.HRV改变对植物神经功能紊乱的诊断价值分析[J].中国实用神经疾病杂志,2010,13(13):60-61.
[23]
孙明辉,雷旭,李金科,等. "一元论"病因诊断在心率矛盾反应中的临床应用[J/CD].中华诊断学电子杂志,2019,7(1):59-62.
[24]
Epstein AE, Dimarco JP, Ellenbogen KA,et al.ACC/AHA/HRS 2008 Guidelines for device-based therapy of cardiac rhythm abnormalities[J].Heart Rhythm,2008,5(6):934-955.
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