Nursel DİKMEN, Sebahat GENÇ, Adnan AKÇAY

Obez ve nonobez obstrüktif uyku apne sendromlu hastalarda sağ kalp fonksiyonlarının ekokardiyografi ve Doppler ekokardiyografi ile değerlendirilmesi

Amaç: Çalışmamızın amacı, obez ve nonobez obstrüktif uyku apne sendromu (OUAS) hastalarında; doku doppler (DD) ekokardiyografi ile sağ ventrikül sistolik ve diyastolik fonksiyonlarının ve pulmoner arter basınçlarını (PAB) karşılaştırmaktı. Gereç ve Yöntem: Çalışmamıza Uyku Laboratuarında polisomnografik inceleme yapılmış ve orta ya da ağır OUAS tanısı konmuş 35 nonobez ve 34 obez olmak üzere 69 hasta alındı. Tüm hastalarda M-mode, iki boyutlu inceleme, renkli akım Doppler ve Doku Dopler yardımıyla sol ventrikül ve sağ ventrikül boyutları, sol atrium (LA) ve sağ atrium (RA) boyutları, sol ventrikül ve sağ ventrikül sistolik ve diyastolik fonksiyonları ve sistolik PAB’ ları ölçüldü. Bulgular: Her iki grupta da RV diyastolik fonksiyonlarında bozulma saptanmış olup, obez grupta anlamlı olarak daha fazla bozulma saptanmıştır (lateral triküspit annuler bölge geç diyastolik miyokardial hız A’a: nonobez hastalarda 0.13 ±0.03 ve obez hastalarda 0.11±0.04). Obez grupta ortalama sistolik PAB anlamlı olarak daha yüksek bulunmuştur (Sırasıyla 31.2±5.6 ve 27.1±5.8). Sonuç: Obstrüktif Uyku Apne Sendromu kardiyovasküler morbidite ve mortaliteyi arttırır. Çalışmamızda orta ve ağır OUAS hastalarında doku doppler incelemesi ile SV ve RV diyastolik fonksiyonlarında bozulma saptanmıştır. Obezite OUAS‟tan bağımsız olarak bu bozukluğa katkıda bulunmaktadır.

Evaluation of right heart functions by echocardiography and tissue Doppler imaging echocardiography in obese and non-obese patients with obstructive sleep apnea

Purpose: The aim of our study was to compare the right ventricular systolic and diastolic functions and pulmonary artery pressure (PAP) in obese and non-obese patients with obstructive sleep apnea syndrome (OSAS) by tissue Doppler imaging (TDI) echocardiography. Materials and Methods: This study was conducted with 69 patients, 34 obese and 35 non-obese, diagnosed moderate or severe OSAS by an overnight polysomnographic sleep study. In all patients, LV (left ventricle) and RV (right ventricle) size, left atial (LA) and RA (right atrial) dimensions, LV and RV systolic and diastolic functions and systolic PAPs were measured by M-mode, two-dimensional analysis, color flow Doppler and TDI. Results: RV diastolic dysfunction was detected in both groups; this impairment was significantly higher in the obese group (lateral tricuspid late diastolic myocardial annular zone velocity A'a: 0.13 ± 0.03 in non-obese patients and 0.11 ± 0.04 in obese patients). The mean systolic PAP was significantly higher in obese patients (31.2±5.6, 27.1±5.8, respectively) Conclusion: Obstructive Sleep Apnea Syndrome increases cardiovascular morbidity and mortality. In our study,left ventricul and right ventricul diastolic dysfunction was determined by tissue Doppler imaging in patients with moderate and severe Obstructive Sleep Apnea Syndrome. Obesity contributes to this impairment regardless of Obstructive Sleep Apnea Syndrome .

Keywords:

obesity, obstructive sleep apnea, echocardiography,

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1. Hung J, Whitford EG, Parsons RW, Hillman DR. Association of sleep apnea with myocardial infarction in men. Lancet. 1990;336:261–64.
2. Mooe T, Franklin KA, Wiklund U, Rubben T, Holmström K. Sleep-disordered breathing and myocardial ischemia in patients with coronary artery disease. Chest. 2000;117:1597–602.
3. Wolk R, Somers VK. Obesity-related cardiovascular disease: implications of obstructivesleep apnea. Diabetes Obes Metab. 2006;8:250-260
4. Carskadon MA, Dement WC. Normal human sleep: An overview. In: Kryger MH, Roth T, Dement WC (eds). Principles and Practice of Sleep Medicine. 3rd Ed. Philadelphia, W.B. Saunders Company. 2000;15- 25.
5. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230–5.
6. Berman E.J, DiBenedetto R.J, Causey DE, Mims T, Conneff M, Goodman LS. et al. Right ventricular hypertrophy detected by echocardiography in patients with newly diagnosed obstructive sleep apnea. Chest. 1991:100:347-350.
7. Rechtschaffen A, Kales A. A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. NIH Publication No. 204. Washington, U.S. Government Printing Office. 1968.
8. Iber C, Ancoli-Israel S, Chesson A, Quan S.; for the American Academy of Sleep Medicine. 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
9. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K et al. Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography Endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23:685-713.
10. Carskadon MA, Dement WC. Normal human sleep: An overview. In: Kryger MH, Roth T, Dement WC (eds). Principles and Practice of Sleep Medicine. 3rd Ed. Philadelphia, W.B. Saunders Company. 2000;15- 25.
11. Young T, Shahar E, Nieto FJ, Redline S, Newman AB, Gottlieb DJ et al , for the Sleep Heart Health Study Research Group. Predictors of sleep-disordered breathing in community-dwelling adults: The Sleep Heart Health Study. Arch Intern Med. 2002;162:893– 900.
12. Peppard PE, Young T, Patla M. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284:3015-21.
13. Lattimore JD, Celermajer DS, Wilcox I. Obstructive sleep apnea and cardiovascular disease. J Am Coll Cardiol. 2003;41:1429-37.
14. Tolle FA, Judy WV, Yu P , Markand ON. Reduced stroke volume related to pleural pressure in obstructive sleep apnea. J Appl Physiol. 1983;55:1718- 24.
15. Hanlon CE, Binka E, Garafano JS, Sterni LM, Brady TM. The association of Obstructive Sleep Apnea and Left Ventrıculer Hypertrophy in Obese and Overwight Children with History of Elevated Blood Pressure.J Clin Hypertens (Greenwich). 2019;21:984- 90.
16. Strollo PJ, Sanders MH. Sleep disorders. Clin Chest Med. 1998;19:1-32.
17. Malone S, Liu PP, Holloway R, Rutherford R, Xie A, Bradlet TD. Obstructive sleep apnoea in patients with idiopathic dilated cardiomyopathy: Effects of continuous positive airway pressure. Lancet. 1991;338:1480-4.
18. Hanly P, Sasson Z, Zuberi N, Alderson M. Ventricular function in snores and patients with obstructive sleep apnea. Chest. 1992;102:100-5.
19. Guidry UC, Mendes LA, Evans JC, Levy D, O’Connor GT, Larson MG., et al. Echocardiographic features of the right heart in sleep-disordered breathing:the Framingham Heart Study. Am J Respir Crit Care Med. 2001;164:933-8.
20. Maripov A, Mamazhakypov A, Sartmyrzaeva M, Akunov A, Uulu KM, Duishobaev M et al. Right ventrıculer remodeling and dysfunction in obstructive sleep apnea; a systematic review of the literature and meta-analysis. Can Respir J. 2017;2017:1587865.
21. Tavil Y, Kanbay A, Sen N, Ulukavak Ciftci T, Abaci A, Yalçın MR 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.
22. Karaçaglar E, Bal U, Eroğlu S, Çolak A, Bozbaş S, Müderrisoglu H. Pulmonary artery distensibility is worsened in obstructive sleep apnea syndrome. Acta Cardiol Sin. 2019;35:501-507.
23. Willens HJ, Chakko SC, Lowery MH, Byers P, Labrador E, Gallagher A et al. Tissue Doppler imaging of the right and left ventricle in severe obesity. Am J Cardiol. 2004;94:1087-90.
24. Wong CY, O'Moore-Sullivan T, Leano R, Hukins C, Jenkins C, Marwick TH. Association of subclinical right ventricular dysfunction with obesity. J Am Coll Cardiol. 2006;47:611-6.
25. Li J, Wang Z, Li Y, Meng Y ,Li R, Wang W, et al. Assessment of regional right ventricular systolic function in patients with obstructive sleep apnea syndrome using velocity vector imaging. Medicine. 2016:95:37.
26. Mitra N, Rafael K, Zion S, Patrick J. Impact of obstructive sleep on left ventricular mass and diastolic function. Am J Respir Crit Care. 2001;163:1632-36.
27. Kim SH, Cho GY, Shin C, Lim HE, Kim YH, Song WH et al. Impact of obstructive sleep apnea on left ventricular diastolic function. Am J Cardiol. 2008;101:1663-8.
28. Papanikolaou J, Ntalapascha M, Makris D, Koukoubani T, Tsolaki V, Zakynthinos G et al. Diastolic dysfunction in men with severe obstructive sleep apnea syndrome but without cardiovasculer or oxidative strees-releated comorbidities.Ther Adv Respir. 2019;13:1-15.
29. Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a largecommunity-based study. Sleep Heart Health Study. JAMA. 2000;283:1829-36.
30. Grote L, Ploch T, Heitmann J, Knaack L, Penzel T, Peter JH. Sleep-related breathing disorder is an independent risk factor for systemic hypertension. Am J Respir Crit Care Med. 1999;160:1875-82.
31. Wang S,Niu X, Zhang P, Su D, Zhang J, Liu W. Analysis of OSAS incidence factors in middle aged and elderly patients with hypertension. Minerva Medica. 2019;110:115-20.
32. Peterson L, Waggoner AD, Schechtman KB, Meyer T, Gropler RJ, Barzilai B et al. Alterations in left ventricular structure and function in young healthy obese women. J Am Coll Cardiol. 2004;43:1399-404.
33. Kessler R, Chaouat A, Weitzenblum E, Oswald M, Ehrhart M, Apprill M, et al. Pulmonary hypertension in the obstructive sleep apnoea syndrome: prevalence, causes and therapeutic consequences. Eur Respir J. 1996;9:787-94.
34. Chaoat A, Weitzenblum E, Krieger J, Oswald M, Kessler R. Pulmonary hemodynamics in the obstructive sleep apnea syndrome: results in 220 consecutive patients. Chest. 1996;109:380-6.
35. Sajkov D, Cowie RJ, Thornton AT, Espinoza HA, McEvor RD. Pulmonary hypertension and hypoxemia in obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 1994;149:416-22.