Arias Miguel A, García-Río Francisco, Alonso-Fernández Alberto, Mediano Olga, Martínez Isabel, Villamor José
Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
Circulation. 2005 Jul 19;112(3):375-83. doi: 10.1161/CIRCULATIONAHA.104.501841. Epub 2005 Jul 11.
The purpose of this study was to determine the role of obstructive sleep apnea syndrome (OSAS) as an independent risk factor for the development of left ventricular diastolic abnormalities. Moreover, we tested the hypothesis that nasal continuous positive airway pressure (nCPAP) improves such alterations in OSAS patients by eliminating apneic events.
In this prospective, randomized, placebo-controlled, double-blind crossover study, 27 consecutive newly diagnosed middle-aged OSAS men with neither controllable factors nor conditions affecting left ventricular diastolic function and 15 healthy control subjects were selected. OSAS patients were randomized to 12 weeks on sham nCPAP and 12 weeks on effective nCPAP application. Echocardiographic parameters, blood pressure recordings, and urinary catecholamine levels were obtained at baseline and after both treatment modalities. At baseline, an abnormal left ventricular filling pattern was present in 15 of the 27 OSAS patients and only in 3 of the 15 control subjects (P=0.020). Impaired relaxation was by far the most common abnormal pattern in both groups (11 and 3 patients, respectively). In OSAS patients, 12 weeks on effective nCPAP induced a significant increase in E/A ratio (P<0.01), as well as reductions in mitral deceleration (P<0.01) and isovolumic relaxation (P<0.05) times.
OSAS can affect left ventricular diastolic function independently of other possible factors. Chronic application of nCPAP could avoid the progression of diastolic abnormalities, and indeed, it might reverse these alterations, at least in the initial stages before severe structural changes can be developed.
本研究旨在确定阻塞性睡眠呼吸暂停综合征（OSAS）作为左心室舒张功能异常发生的独立危险因素的作用。此外，我们检验了以下假设：经鼻持续气道正压通气（nCPAP）通过消除呼吸暂停事件改善OSAS患者的此类改变。
在这项前瞻性、随机、安慰剂对照、双盲交叉研究中，连续选取27例新诊断的中年OSAS男性患者及15名健康对照者，这些OSAS患者既无可控因素，也无影响左心室舒张功能的疾病。OSAS患者被随机分为接受12周假nCPAP治疗组和12周有效nCPAP治疗组。在基线及两种治疗方式结束后，获取超声心动图参数、血压记录及尿儿茶酚胺水平。基线时，27例OSAS患者中有15例左心室充盈模式异常，而15名对照者中仅有3例异常（P = 0.020）。舒张功能受损是两组中最常见的异常模式（分别为11例和3例患者）。在OSAS患者中，12周的有效nCPAP治疗使E/A比值显著升高（P < 0.01），同时二尖瓣减速时间（P < 0.01）和等容舒张时间（P < 0.05）缩短。
OSAS可独立于其他可能因素影响左心室舒张功能。长期应用nCPAP可避免舒张功能异常的进展，实际上，至少在严重结构改变发生之前的初始阶段，它可能逆转这些改变。
