Laaban Jean-Pierre, Pascal-Sebaoun Sophie, Bloch Evelyne, Orvoën-Frija Elizabeth, Oppert Jean-Michel, Huchon Gérard
Department of Pneumology, Hotel-Dieu Hospital, 1 place du Parvis Notre-Dame, 75181 Paris Cedex 04, France.
Chest. 2002 Oct;122(4):1133-8. doi: 10.1378/chest.122.4.1133.
Conflicting results have been reported regarding the effects of obstructive sleep apnea syndrome (OSAS) on daytime left ventricular (LV) systolic function. This study aimed to assess the prevalence and causes of LV systolic dysfunction, using radionuclide angiography, in a large group of patients with OSAS.
A prospective study in the pneumology department of a university medical center.
One hundred sixty-nine consecutive patients with OSAS diagnosed by polysomnography, hospitalized for the administration of nasal continuous positive airway pressure. Patients with a known cardiac disease were excluded.
LV ejection fraction (LVEF) was measured in all patients, using radionuclide ventriculography with multiple-gated equilibrium cardiac imaging. Myocardial scintigraphy with a dipyridamole stress test and echocardiography were performed in those patients with LV systolic dysfunction, defined by a LVEF < 50%, to detect silent heart disease, especially coronary artery disease.
LV systolic dysfunction was observed in 7.7% (13 of 169 patients). In these 13 patients, the mean +/- SD LVEF was 42 +/- 6%, the lowest value of LVEF was 32%, and no silent cardiac disease was revealed. Age, body mass index, apnea-hypopnea index, parameters of nocturnal oxyhemoglobin desaturation, and prevalence of systemic hypertension did not significantly differ between patients with LVEF < 50% and those with LVEF > 50%. In seven patients with LV dysfunction, LVEF was measured following treatment of OSAS and reached normal values.
OSAS may be a direct cause of daytime LV systolic dysfunction that can resolve following reversal of nocturnal apneas.
关于阻塞性睡眠呼吸暂停综合征（OSAS）对日间左心室（LV）收缩功能的影响，已有相互矛盾的研究结果报道。本研究旨在通过放射性核素血管造影术，评估一大组OSAS患者左心室收缩功能障碍的患病率及病因。
在一所大学医学中心的呼吸内科进行的一项前瞻性研究。
169例经多导睡眠图诊断为OSAS的连续患者，因接受鼻持续气道正压通气治疗而住院。排除已知患有心脏病的患者。
对所有患者采用放射性核素心室造影术及多门控平衡心脏成像技术测量左心室射血分数（LVEF）。对LVEF<50%定义为左心室收缩功能障碍的患者进行双嘧达莫负荷试验心肌显像及超声心动图检查，以检测隐匿性心脏病，尤其是冠状动脉疾病。
观察到7.7%（169例患者中的13例）存在左心室收缩功能障碍。在这13例患者中，LVEF的均值±标准差为42±6%，LVEF最低值为32%，未发现隐匿性心脏病。LVEF<50%的患者与LVEF>50%的患者在年龄、体重指数、呼吸暂停低通气指数、夜间氧合血红蛋白去饱和参数及系统性高血压患病率方面无显著差异。7例左心室功能障碍患者在OSAS治疗后测量LVEF，结果恢复正常。
OSAS可能是日间左心室收缩功能障碍的直接原因，夜间呼吸暂停逆转后该功能障碍可得到缓解。
