Savaş Sarıkaya, Şafak Şahin, Lütfi Akyol, Turan Aktaş, Yavuz İntepe, Elif Börekçi, Yunus Yılmaz

UYKU APNE SENDROMU OLAN HASTALARDA KARDİYOVASKÜLER HASTALIĞIN BİR GÖSTERGESİ OLAN AORTİK SERTLİĞİN EKOKARDİYOGRAFİ İLE DEĞERLENDİRİLMESİ

Amaç: Uyku apne sendromu; uyku boyunca üsthava yollarının tekrarlayıcı şekilde tıkanıklığı ileseyreden ve gün boyunca aşırı uyuklama şikayetineneden olan bir hastalıktır. Arteriyel sertlik olumsuzkardiyovasküler olaylarla ilişki olup birçokçalışmada kardiyovasküler olaylara bağlı gelişenmortalite ve morbiditenin erken belirleyicisi olarakkullanılmaktadır.Biz bu çalışmamızda uyku apnesendromlu hastalarda arteriyel sertliğin göstergesiolan aort gerilimi ve esneyebilirliğiniekokardiyografi yöntemi değerlendirmeyiamaçladık.Gereç ve yöntemler: Çalışmaya uyku apnesendromu olup eşlik eden hastalığı olmayan 30hasta ve 30 sağlıklı kontrol alındı. Tüm hastalara,aortik sertlik hesaplanmak üzere ekokardiyografiyapıldı ve değerler gruplar arasında karşılaştırıldı.Bulgular: Hastaların yaş ve cinsiyetleri arasındaİstatiksel fark saptanmadı. Hastalarınekokardiyografik parametrelerinden ejeksiyonfraksiyonu, interventriküler septum ve posteriorduvar kalınlığı arasında gruplar arasında istatikselfark saptanmadı. Aort gerilimi UAS’u olanhastalarda kontrol grubuna göre daha yüksek olaraksaptandı (8.64±3.41 ve 5.92±2.43, p=0.024).Ayrıca, aort esneyebilirliği uyku apne sendromuolan hastalarda kontrol grubuna göre daha düşükolarak saptandı (2.30±1.98 ve 3.35±1.38, p=0.021).Sonuç: Uyku apne sendromu olup eşlik edenhastalığı olmayan hastalarda aortik sertlik artmış veaortik esneyebilirlik azalmıştır. Uyku apnesendromu olan hastalarda transtorasikekokardiyografi arteriyel sertlik kolaycadeğerlendirilebilir ve risk faktörlerine yönelik dahayoğun tedavi ile kardiyovasküler hastalıklar vemortalitede azalma sağlanabilir.

Anahtar Kelimeler:

Uyku apne sendromu, aort sertliği, kardiyovasküler hastalık

Assesment of Aortic Stiffness as an Indicator of Cardiovascular Disease in Patients with Obstructive Sleep Apnea by using Echocardiography

Aim:Obstructive characterized with intermittant obstruction of upper air tracts and leading to somnolence during all day. Aortic stiffness is associated with poor cardiovascular outcome and an early indicator of mortality and morbidity. In the present study we aimed to investigate aortic stiffness and aortic dispensability in OSAS patients. Material and methods: We selected 30 obstructive apnea syndrome patients without co-morbidities and 30 healthy individuals. All patients underwent echocardiography to measure aortic stiffness and compared to between groups. Results: There is no difference in term of age and sex in two groups. There were no difference in ejection fraction, thickness of interventiculer septum and posterior wall in between groups. Aortic strain was higher in OSAS patients compared to healthy individuals (8.64±3.41 and 5.92±2.43, p=0.024). Also, aortic dispensability was lower in OSAS patients than those with control groups (2.30±1.98 and 3.35±1.38, p=0.021). Conclusion: Aortic stiffness was increased where as aortic dispensability was decreased in obstructive sleep apnea patients without co-morbidities. Arterial stiffness could be easily evaluated by transthoracic echocardiography in OSAS patients and these patients should be evaluated in detail to follow up and threat in terms of cardiovascular disease

Keywords:

Obstructive sleep apnea, aortic stiffness, cardiovascular disease,

PDF

___

Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in
men with obstructive sleep apnoea-hypopnoea with or without treatment with
continuous positive airway pressure: an observational study. Lancet. 2005 Mar 19-
;365(9464):1046-53.
Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Nieto FJ, et al. Sleepdisordered
breathing and cardiovascular disease: cross-sectional results of the Sleep
Heart Health Study. Am J Respir Crit Care Med. 2001 Jan;163(1):19-25.
Peker Y, Hedner J, Norum J, Kraiczi H, Carlson J. Increased incidence of
cardiovascular disease in middle-aged men with obstructive sleep apnea: a 7-year
follow-up. Am J Respir Crit Care Med. 2002 Jul 15;166(2):159-65.
Peker Y, Carlson J, Hedner J. Increased incidence of coronary artery disease in sleep
apnoea: a long-term follow-up. Eur Respir J. 2006 Sep;28(3):596-602.
Arzt M, Young T, Finn L, Skatrud JB, Bradley TD. Association of sleep-disordered
breathing and the occurrence of stroke. Am J Respir Crit Care Med. 2005 Dec
;172(11):1447-51.
Ip MS, Tse HF, Lam B, Tsang KW, Lam WK. Endothelial function in obstructive
sleep apnea and response to treatment. Am J Respir Crit Care Med. 2004 Feb
;169(3):348-53.
Pepperell JC, Ramdassingh-Dow S, Crosthwaite N, Mullins R, Jenkinson C, Stradling
JR, et al. Ambulatory blood pressure after therapeutic and subtherapeutic nasal
continuous positive airway pressure for obstructive sleep apnoea: a randomised
parallel trial. Lancet. 2002 Jan 19;359(9302):204-10.
Kohler M, Pepperell JC, Casadei B, Craig S, Crosthwaite N, Stradling JR, et al. CPAP
and measures of cardiovascular risk in males with OSAS. Eur Respir J. 2008
Dec;32(6):1488-96.
Cruickshank JK, Rezailashkajani M, Goudot G. Arterial stiffness, fatness, and
physical fitness: ready for intervention in childhood and across the life course?
Hypertension. 2009 Apr;53(4):602-4.
Wada T, Kodaira K, Fujishiro K, Maie K, Tsukiyama E, Fukumoto T, et al.
Correlation of ultrasound-measured common carotid artery stiffness with pathological
findings. Arterioscler Thromb. 1994 Mar;14(3):479-82.
Phillips CL, Butlin M, Wong KK, Avolio AP. Is obstructive sleep apnoea causally
related to arterial stiffness? A critical review of the experimental evidence. Sleep Med
Rev. 2013 Feb;17(1):7-18.
Lacombe F, Dart A, Dewar E, Jennings G, Cameron J, Laufer E. Arterial elastic
properties in man: a comparison of echo-Doppler indices of aortic stiffness. Eur Heart
J. 1992 Aug;13(8):1040-5.
Executive Summary of The Third Report of The National Cholesterol Education
Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High
Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001 May
;285(19):2486-97.
Heart rate variability. Standards of measurement, physiological interpretation, and
clinical use. Task Force of the European Society of Cardiology and the North
American Society of Pacing and Electrophysiology. Eur Heart J. 1996 Mar;17(3):354-
-
Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L, et al. Aortic stiffness
is an independent predictor of all-cause and cardiovascular mortality in hypertensive
patients. Hypertension. 2001 May;37(5):1236-41.
Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of cardiovascular events and
all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am
Coll Cardiol. 2010 Mar 30;55(13):1318-27.
Mitchell GF, Hwang SJ, Vasan RS, Larson MG, Pencina MJ, Hamburg NM, et al.
Arterial stiffness and cardiovascular events: the Framingham Heart Study. Circulation.
Feb 2;121(4):505-11.
Ross R. Atherosclerosis--an inflammatory disease. N Engl J Med. 1999 Jan
;340(2):115-26.
Shimokawa H. Primary endothelial dysfunction: atherosclerosis. J Mol Cell Cardiol.
Jan;31(1):23-37.
Celermajer DS, Sorensen KE, Gooch VM, Spiegelhalter DJ, Miller OI, Sullivan ID, et
al. Non-invasive detection of endothelial dysfunction in children and adults at risk of
atherosclerosis. Lancet. 1992 Nov 7;340(8828):1111-5.
Schachinger V, Britten MB, Zeiher AM. Prognostic impact of coronary vasodilator
dysfunction on adverse long-term outcome of coronary heart disease. Circulation.
Apr 25;101(16):1899-906.