Obstrüktif Uyku Apne Sendromunda Sol Ventrikül Kitlesi ve Diyastolik Fonksiyonlar

Yıl 2020, Cilt: 10 Sayı: 3, 442 - 446, 30.09.2020

Yücel Yılmaz , İsmet Sarıkaya Namık Eryol

https://doi.org/10.16899/jcm.683392

Öz

Amaç; Bu çalışmanın amacı; Obstrüktif uyku apne sendromu (OUAS) olan hastalarda, 2-boyutlu ve pulse dalga doppler (PDD) ekokardiyografi teknikleri kullanılarak SV fonksiyonlarının değerlendirilmesidir.
Yöntem; Çalışmaya polisomnografi ile OUAS tanısı konulan ve henüz tedavi uygulanmamış 40 hasta ve 28 sağlıklı birey kontrol grubu olarak alındı. Hastalara M-mod, 2- boyutlu ve PDD ekokardiyografi incelemeleri yapıldı.
Bulgular; Gruplar arasında M-mode ölçümleri ile elde edilen SV sistolik ve diyastolik çapları, ejeksiyon fraksiyonları açısından fark saptanmadı. OUAS’ li grupta SV kitle ve kitle indeksi ve SV diyastolik duvar kalınlıkları, kontrol grubuna göre anlamlı olarak daha fazla tespit edildi. Transmitral diyastolik doluş parametrelerinin PDD ekokardiyografi ile yapılan incelemesinde; OUAS grupta erken diyastolik doluma ait E dalga hızında, E/A oranlarında anlamlı azalma izlendi. E dalga deselerasyon zamanı ve izovolümetrik gevşeme zamanının OUAS’ lı grupta anlamlı olarak daha uzun saptandı. Apne-hipopne indeksi ile SV diyastolik parametreler arasında ilişki saptanmadı.
Sonuç; OUAS, altta yatan herhangi bir kalp hastalığı olmasa da SV kitlesini etkileyen ve hastalığın şiddetinden bağımsız olarak SV diyastolik fonksiyonlarını bozan bir durumdur. Bu nedenle OSAS hastaları kardiyak açıdan da mutlaka değerlendirilmelidir.

Anahtar Kelimeler

obstrüktif uyku apne sendromu, ekokardiyografi, sol ventrikül kitlesi

Left Ventricular Mass and Diastolic Functions in Obstructive Sleep Apnea Syndrome

Öz

Objective; The aim of this study is to evaluate SV functions in two-dimensional and pulse wave doppler (PDD) echocardiography functions with obstructive sleep apnea syndrome (OSAS).
Methods; Forty patients who were diagnosed with OSAS by polysomnography (not yet treated) and 28 healthy individuals were included as control group. The patients underwent M-mode, 2-dimensional and PDD echocardiography examinations.
Results; There was no difference between the two groups in terms of SV systolic and diastolic diameters and ejection fractions obtained by M-mode measurements. SV mass and mass index and SV diastolic interventricular and posterior wall thicknesses were significantly higher in the the OSAS group than the control group. In the examination of the transmitral diastolic flow parameters by PDD echocardiography, there was a significant decrease in E wave velocity and E/A ratios in the OSAS group. E wave deceleration time and isovolumetric relaxation time were significantly prolonged in the OSAS group. No relation was found between apnea-hypopnea index and SV diastolic parameters.
Conclusion; OSAS is a condition that affects the SV mass and impairs SV diastolic functions, regardless of the severity of the disease, even if there is no coexistent heart disease. Therefore, OSAS patients should be evaluated from the heart.

Anahtar Kelimeler

obstructive sleep apnea syndrome, echocardiography, left ventricular mass

Kaynakça

• 1. Guilleminault C, Tilkian A, Dement WC. The sleep apnea syndromes. Ann Rev Med 1976; 27: 465–484
• 2. Young T, Palta M, Dempsey J and et al. Theoccurrence of sleep-disordered breathing among middle-agedadults. N Engl J Med 1993;328:1230—5.
• 3. Young T, Peppard PE, Taheri S. Excess weight and sleep-disordered breathing. J Appl Physiol 2005;99:1592—9.
• 4. Duran J, Esnaola S, Rubio R, Iztueta A. Obstructive sleep apnea-hypopnea and related clinical features in a population-basedsample of subjects aged 30 to 70 yr. Am J Respir Crit Care Med 2001;163:685—9.
• 5. Mooe T, Franklin KA, Holmström K and et al. Sleep disordered breathing and coronary artery disease: long-term prognosis. Am J Respir Crit Care Med 2001; 164: 1910-3.
• 6. Saito T, Yoshikawa T, Sakamoto Y and et al. Sleep apnea in patients with acute myocardial infarction. Crit Care Med 1991; 19: 938-41.
• 7. Gottlieb DJ, Yenokyan G, Newman AB and et al. Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: The Sleep Heart Health Study. Circulation 2010; 122: 352-60.
• 8. Hrynkiewicz-Szymanska A, Szymanski FM, Filipiak KJ and et al. Can obstructive sleep apnea be a cause of in-stent thrombosis? Sleep Breath 2011; 15: 607-9.
• 9. Carlson JT, Hedner J, Elam M and et al. Augmented resting sympathetic activity in awake patients withobstructive sleep apnea. Chest 1993;103:1763—8.
• 10. Somers VK, Dyken ME, Clary MP, Abboud FM. Sympatheticneural mechanisms in obstructive sleep apnea. J Clin Invest 1995;96:1897—904.
• 11. Schulz R, Mahmoudi S, Hattar K, et al. Enhanced release ofsuperoxide from polymorphonuclear neutrophils in obstructivesleep apnea. Impact of continuous positive airway pressuretherapy. Am J Respir Crit Care Med 2000;162:566—70.
• 12. Lavie L. Oxidative stress inflammation and endothelial dys-function in obstructive sleep apnea. Front Biosci (Elite Ed) 2012;4:1391—403.
• 13. Nieto FJ, Herrington DM, Redline S and et al. Sleep apnea and markers of vascular endothelial function in alarge community sample of older adults. Am J Respir Crit CareMed 2004;169:354—60.
• 14. Fletcher EC, Bao G, Li R. Renin activity and blood pres-sure in response to chronic episodic hypoxia. Hypertension 1999;34:309—14.
• 15. Moller DS, Lind P, Strunge B, Pedersen EB. Abnormal vasoactive hormones and 24-hour blood pressure in obstructive sleepapnea. Am J Hypertens 2003;16:274—80.
• 16. Berry RB, Budhiraja R, Gottlieb DJ and et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2012;8:597–619.
• 17. Qaseem A, Holty JE, Owens DK and et al. Management of obstructive sleep apnea in adults: A clinical practice guideline from the American College of Physicians. Ann Intern Med 2013;159:471–83
• 18. Lang RM, Badano LP, Mor-Avi V and et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015;28:1–39.e14.
• 19. Nagueh SF, Appleton CP, Gillebert TC and et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 2009;22:107–33.
• 20. Devereux RB, Alonso DR, Lutas EM and et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986;57:450–8.
• 21. Koshino Y, Villarraga HR, Orban M and et al. Changes in left and right ventricular mechanics during the Mueller maneuver in healthy adults: a possible mechanism for abnormal cardiac function in patients with obstructive sleep apnea. Circ Cardiovasc Imaging 2010;3:282–9.
• 22. Ljunggren M, Lindahl B, Theorell-Haglöw J, Lindberg E. Association between obstructive sleep apnea and elevated levels of type B natriuretic peptide in a community-based sample of women. Sleep 2012;35:1521–7.
• 23. Kylintireas I, Craig S, Nethononda R and et al. Atherosclerosis and arterial stiffness in obstructive sleep apnea--a cardiovascular magnetic resonance study. Atherosclerosis 2012;222:483–9.
• 24. Akyüz A, Akkoyun DÇ, Değirmenci H, Alp R. Atrial Fibrillation Is Associated With Increased Mean Platelet Volume and Apnea Hypopnea Index in Patients With Obstructive Sleep Apnea. Angiology 2015;66:525–30.
• 25. Bodez D, Lang S, Meuleman C and et al. Left ventricular diastolic dysfunction in obstructive sleep apnoea syndrome by an echocardiographic standardized approach: An observational study. Arch Cardiovasc Dis 2015;108:480–90.
• 26. Lauer MS, Anderson KM, Kannel WB, Levy D. The impact of obesity on left ventricular mass and geometry. The Framingham Heart Study. JAMA 1991; 266: 231–236.
• 27. Jain A, Avendano G, Dharamsey S and et al. Left ventricular diastolic function in hypertension and role of plasma glucose and insulin. Circulation 1996; 93: 1392–1396.
• 28. Lee M, Gardin JM, Lynch JC, et al. Diabetes mellitus and echocardiographic left ventricular function in free-living elderly men and women: The Cardiovascular Health Study. Am Heart J 1997; 133: 36–43.
• 29. Kraiczi H, Peker Y, Caidahl K and et al. Blood pressure, cardiac structure and severity of obstruc-tive sleep apnea in a sleep clinic population. J Hypertens 2001;19:2071—8.
• 30. Varol E, Akcay S, Ozaydin M and et al. Influence of obstructive sleep apnea on left ventricular massand global function: sleep apnea and myocardial performance index. Heart Vessels 2010;25:400—4.
• 31. Aslan K, Deniz A, Cayli M and et al. Early left ventricular functional alterations in patients with obstructive sleep apnea syndrome. Cardiol J 2013;20:519—25.
• 32. Davies RJ, Crosby J, Prothero A, Stradling JR. Ambulatory blood pressure and left ventricular hypertrophy in subjects with untreated obstructive sleep apnoea and snoring, com-pared with matched control subjects, and their response totreatment. Clin Sci (Lond) 1994;86:417—24.
• 33. Hanly P, Sasson Z, Zuberi N, Alderson M. Ventricular functionin snorers and patients with obstructive sleep apnea. Chest1992;102:100—5.
• 34. Baguet JP, Nadra M, Barone-Rochette G and et al. Early cardiovascular abnormalities in newly diagnosed obstructive sleep apnea. Vasc Health Risk Manag 2009;5:1063—73.
• 35. Chami HA, Devereux RB, Gottdiener JS, et al. Leftventricular morphology and systolic function in sleep-disordered breathing: the Sleep Heart Health Study. Circulation 2008;117:2599—607.
• 36. Cioffi G, Russo TE, Stefenelli C, et al. Severe obstructive sleep apnea elicits concentric left ventricular geometry. J Hypertens 2010;28:1074—82.
• 37. Koga S, Ikeda S, Nakata T and et al. Effects ofnasal continuous positive airway pressure on left ventricular concentric hypertrophy in obstructive sleep apnea syndrome. Intern Med 2012;51:2863—8.
• 38. Avelar E, Cloward TV, Walker JM, et al. Left ventricular hypertrophy in severe obesity: interactions among blood pressure, nocturnal hypoxemia, and body mass. Hypertension 2007;49:34—9.
• 39. Pujante P, Abreu C, Moreno J, et al. Obstructive sleep apnea severity is associated with left ventricular mass independent of other cardiovascular risk factors in morbid obesity. J ClinSleep Med 2013;9:1165—71
• 40. Usui Y, Takata Y, Inoue Y, et al. Coexistence of obstructive sleepapnoea and metabolic syndrome is independently associated with left ventricular hypertrophy and diastolic dysfunction.Sleep Breath 2012;16:677—84.
• 41. Drager LF, Bortolotto LA, Figueiredo AC and et al. Obstructive sleep apnea, hypertension, and their interaction on arterial stiffness and heart remodeling. Chest 2007;131:1379—86.
• 42. Niroumand M, Kuperstein R, Sasson Z, Hanly PJ. Impact ofobstructive sleep apnea on left ventricular mass and diastolicfunction. Am J Respir Crit Care Med 2001;163:1632—6.
• 43. Grandi AM, Laurita E, Marchesi C, et al. OSA, metabolic syndrome and CPAP: effect on cardiac remodeling in subjects withabdominal obesity. Respir Med 2012;106:145—52.
• 44. Hedner J, Ejnell H, Caidahl K. Left ventricular hypertrophy independent of hypertension in patients with obstructive sleep apnoea. J Hypertens. 1990 Oct;8(10):941-6.
• 45. Arias MA, Garcia-Rio F, Alonso-Fernandez A and et al. Obstructive sleep apnea syndrome affects left ventricular diastolic function: effects of nasal continuous positive airway pressure in men. Circulation 2005;112:375—83.
• 46. Baguet JP, Barone-Rochette G, Levy P, et al. Left ventricular diastolic dysfunction is linked to severity of obstructive sleep apnoea. Eur Respir J 2010;36:1323—9.
• 47. Fung JW, Li TS, Choy DK, et al. Severe obstructive sleep apneais associated with left ventricular diastolic dysfunction. Chest 2002;121:422—9.
• 48. Wachter R, Lüthje L, Klemmstein D and et al. Impact of obstructive sleep apnoea on diastolic function. Eur Respir J 2013;41:376–83.
• 49. Lisi E, Faini A, Bilo G and et al. Diastolic dysfunction in controlled hypertensive patients with mild-moderate obstructive sleep apnea. Int J Cardiol 2015;187:686–92
• 50. Dursunoglu D, Dursunoglu N, Evrengul H, et al. Impact of obstructive sleep apnoea on left ventricular mass and global function. Eur Respir J 2005;26:283—8.
• 51. Butt M, Dwivedi G, Shantsila A and et al. Left ventricu-lar systolic and diastolic function in obstructive sleep apnea:impact of continuous positive airway pressure therapy. Circ Heart Fail 2012;5:226—33.
• 52. Kepez A, Niksarlioglu EY, Hazirolan T, et al. Early myocardial functional alterations in patients with obstructive sleep apnea syndrome. Echocardiography 2009;26:388—96.
• 53. Altıparmak İH, Erkuş ME, Polat M and et al. Relation of elastic properties of pulmonary artery with left ventricular abnormalities and aortic stiffness in patients with moderate to severe obstructive sleep apnea: A cross-sectional echocardiographic study. Turk Kardiyol Dern Ars. 2016 Jun;44(4):289-99
• 54. Chen YL, Su MC, Liu WH and et al. Influence and predicting variables of obstructive sleep apnea on cardiac function and remodeling in patients without congestive heart failure. J Clin Sleep Med 2014;10:57–64.
• 55. Cicek D, Lakadamyali H, Yağbasan BD and et al. Obstructive sleep apnoea and its association with left ventricular function and aortic root parameters in newly diagnosed, untreated patients: a prospective study. J Int Med Res 2011;39:2228–38
• 56. Tavil Y, Kanbay A, Sen N and et al. The relationship between aortic stiffness and cardiac function in patients with obstructive sleep apnea, independently from systemic hypertension. J Am Soc Echocardiogr 2007;20:366–72
• 57. Shivalkar B, Van de Heyning C, Kerremans M, et al. Obstruc-tive sleep apnea syndrome: more insights on structural and functional cardiac alterations, and the effects of treatment with continuous positive airway pressure. J Am Coll Cardiol2006;47:1433—9.