The correlation of ECHO findings of right cardiac pathologies with BNP, uric acid, and CRP in OSAS
Right cardiac pathologies develop in patients with obstructive sleep apnea syndrome (OSAS) and in most patients there are no symptoms in the early stages of right cardiac disorders. We aimed to evaluate a possible relationship between B-type natriuretic peptide (BNP), blood uric acid, C-reactive protein (CRP), and the right cardiac pathologies in patients with OSAS, and the role of these parameters in the management of patients with OSAS. Materials and methods: A total of 98 subjects, 31 (31.6%) controls and 67 (68.4%) with OSAS, were included in the study. All the subjects underwent polysomnography, and standard and tissue Doppler echocardiography (ECHO) examinations. BNP, CRP, and blood uric acid levels were measured in all patients. Results: Upon evaluating the relationship between BNP and ECHO parameters, BNP levels were found to positively correlate with such ECHO parameters as pulmonary artery pressure. As for the association between CRP and ECHO findings, RV diameter exhibited a statistically significant positive correlation with them. Moreover, uric acid was found to statistically correlate positively with right atrium dimensions. Conclusion: BNP, CRP, and blood uric acid levels can be used as adjunctive parameters in the early diagnosis and follow-up of right heart pathologies in patients with OSAS.
The correlation of ECHO findings of right cardiac pathologies with BNP, uric acid, and CRP in OSAS
Right cardiac pathologies develop in patients with obstructive sleep apnea syndrome (OSAS) and in most patients there are no symptoms in the early stages of right cardiac disorders. We aimed to evaluate a possible relationship between B-type natriuretic peptide (BNP), blood uric acid, C-reactive protein (CRP), and the right cardiac pathologies in patients with OSAS, and the role of these parameters in the management of patients with OSAS. Materials and methods: A total of 98 subjects, 31 (31.6%) controls and 67 (68.4%) with OSAS, were included in the study. All the subjects underwent polysomnography, and standard and tissue Doppler echocardiography (ECHO) examinations. BNP, CRP, and blood uric acid levels were measured in all patients. Results: Upon evaluating the relationship between BNP and ECHO parameters, BNP levels were found to positively correlate with such ECHO parameters as pulmonary artery pressure. As for the association between CRP and ECHO findings, RV diameter exhibited a statistically significant positive correlation with them. Moreover, uric acid was found to statistically correlate positively with right atrium dimensions. Conclusion: BNP, CRP, and blood uric acid levels can be used as adjunctive parameters in the early diagnosis and follow-up of right heart pathologies in patients with OSAS.
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- 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: 1230–1235.
- Shamsuzzaman AS, Gersh BJ, Somers VK. Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA 2003; 290: 1906–1914.
- Bradley TD, Rutherford R, Grossman RF, Lue F, Zamel N, Moldofsky H, Phillipson EA. Role of daytime hypoxemia in the pathogenesis of right heart failure in the obstructive sleep apnea syndrome. Am Rev Respir Dis 1985; 131: 835–839.
- Berman E, DiBenedefto R, Causey D, Mims T, Conneff M, Goodman L, Rollings RC. Right ventricular hypertrophy detected by echocardiography in patients with obstructive sleep apnea. Am Rev Respir Dis 1991; 100: 347–350.
- Fung JW, Li TS, Choy DK. Severe obstructive sleep apnea is associated with left ventricular diastolic dysfunction. Chest 2002; 121: 422–429.
- Kepez A, Niksarlioglu EY, Hazirolan T, Ranci O, Kabul HK, Demir AU, Kaya EB, Kocabas U, Aytemir K, Sahin A et al. Early myocardial functional alterations in patients with obstructive sleep apnea syndrome. Echocardiography 2009; 26: 388–396.
- McCord JM. The evolution of free radicals and oxidative stress. Am J Med 2000; 108: 652–659.
- Meier-Ewert HK, Ridker PM, Rifai N, Regan MM, Price NJ, Dinges DF, Mullington JM. Effect of sleep loss on CRP, an inflammatory marker of cardiovascular risk. J Am Coll Cradiol 2004; 43: 678–683.
- Ruiz GA, Sánchez AA, Luque CE, García AD, Romero FA, Carmona BC, Capotea F. Blood uric acid levels in patients with sleep-disordered breathing. Archivos de Bronconeumologia 2006; 42: 492–500 (article in Spanish with an abstract in English).
- Ryan S, Nolan GM, Hannigan E, Cunningham S, Taylor C, McNicholas WT. Cardiovascular risk markers in obstructive sleep apnoea syndrome and correlation with obesity. Thorax 2007; 62: 509–514.
- Kokturk O, Ciftci TU, Mollarecep E, Ciftci B. Elevated C-reactive protein levels and increased cardiovascular risk in patients with obstructive sleep apnea syndrome. Int Heart J 2005; 46: 801–809.
- Vasan RS, Benjamin EJ, Larson MG, Leip EP, Wang TJ, Wilson PW, Levy D. Plasma natriuretic peptides for community screening for left ventricular hypertrophy and systolic dysfunction: the Framingham heart study. JAMA 2002; 288: 1252–1259.
- Krishnaswamy P, Lubien E, Clopton P, Koon J, Kazanegra R, Wanner E, Gardetto N, Garcia A, DeMaria A, Maisel AS. Utility of B-natriuretic peptide levels in identifying patients with left ventricular systolic or diastolic dysfunction. Am J Med 2001; 111: 274–279.
- de Groote P, Dagorn J, Soudan B, Lamblin N, McFadden E, Bauters C. B-type natriuretic peptide and peak exercise oxygen consumption provide independent information for risk stratification in patients with stable congestive heart failure. J Am Coll Cardiol 2004; 43: 1584–1589.
- Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver EM et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009; 5: 263–276.
- Ruehland WR, Rochford PD, O’Donoghue FJ, Pierce RJ, Singh P, Thornton AT. The new AASM criteria for scoring hypopneas: impact on the apnea hypopnea index. Sleep 2009; 32: 150–157.
- Simmons LA, Weidemann F, Sutherland GR, D’hooge J, Bijnens B, Sergeant P, Wouters PF. Doppler tissue velocity, strain, and strain rate imaging with transesophageal echocardiography in the operating room: a feasibility study. J Am Soc Echocardiogr 2002; 15: 768–776.
- Sahn DJ, DeMaria A, Kisslo J, Weyman A. The committee on M-mode standardization of the American Society of Echocardiography: Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 1978; 58: 1072– 1083.
- Bradley TD. Right and left ventricular functional impairment and sleep apnea. Clin Chest Med 1992; 13: 459–479.
- Chaouat 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: 380–386.
- Fletcher EC, Schaaf JW, Miller J, Fletcher JC. Long-term cardiopulmonary sequelae in patients with sleep apnea and chronic lung disease. Am Rev Respir Dis 1987; 135: 525–533.
- Fernández Fabrellas E, Almenar Bonet L, Ponce Pérez S, Moro López JA, Blanquer Olivas R, Salvador Sanz A. Usefulness of the N-terminal fraction of brain natriuretic peptide for deciding when to refer patients with sleep apnea-hypopnea syndrome to the cardiologist. Arch Bronconeumol 2009; 45: 173–180.
- Arias MA, García-Río F, Alonso-Fernández A, Martínez I, Villamor J. Pulmonary hypertension in obstructive sleep apnoea: Effects of continuous positive airway pressure: A randomized, controlled cross-over study. Eur Heart J 2006; 27: 1106–1113.
- Taheri S, Austin D, Lin L, Nieto FJ, Young T, Mignot E. Correlates of serum C-reactive protein (CRP) – no association with sleep duration or sleep disordered breathing. Sleep 2007; 30: 991–996.
- Malakasioti G, Alexopoulos E, Befani C, Tanou K, Varlami V, Ziogas D, Liakos P, Gourgoulianis K, Kaditis AG. Oxidative stress and inflammatory markers in the exhaled breath condensate of children with OSA. Sleep Breath 2012; 16: 703– 708.
- McCord JM. Oxygen-derived free radicals in postischemic tissue injury. N Engl J Med 1985; 312: 159–163.
- Araz O, Pulur D, Ucar EY, Meral M, Gorguner AM, Akgun M. Does apnea–hypopnea index alone reflect obstructive sleep apnea severity? Turk J Med Sci 2013; 43: 63–69.
- Levine DJ. Diagnosis and management of pulmonary arterial hypertension: Implications for respiratory care. Respir Care 2006; 51: 368–381.