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阻塞性睡眠呼吸暂停、高血压及其对动脉僵硬度和心脏重塑的相互作用。

Obstructive sleep apnea, hypertension, and their interaction on arterial stiffness and heart remodeling.

作者信息

Drager Luciano F, Bortolotto Luiz A, Figueiredo Adelaide C, Silva Bruno Caldin, Krieger Eduardo M, Lorenzi-Filho Geraldo

机构信息

Hypertension Unit, Heart Institute (InCor), University of São Paulo Medical School, Av. Dr Enéas Carvalho de Aguiar 44, CEP 05403-904, São Paulo, Brazil.

出版信息

Chest. 2007 May;131(5):1379-86. doi: 10.1378/chest.06-2703.

Abstract

STUDY OBJECTIVES

Obstructive sleep apnea (OSA) and hypertension are independently associated with increased stiffness of large arteries that may contribute to left ventricular (LV) remodeling. We sought to investigate the impact of OSA, hypertension, and their association with arterial stiffness and heart structure.

DESIGN

We studied 60 middle-aged subjects classified into four groups according to the absence or presence of severe OSA with and without hypertension. All participants were free of other comorbidities. The groups were matched for age, sex, and body mass index.

MEASUREMENTS AND RESULTS

Full polysomnography, pulse-wave velocity (PWV), and transthoracic echocardiography were performed in all participants. Compared with normotensive subjects without OSA, PWV, left atrial diameter, interventricular septal thickness, LV posterior wall thickness, LV mass index, and percentage of LV hypertrophy had similar increases in normotensive OSA and patients with hypertension and no OSA (p < 0.05 for all comparisons), with a significant further increase in PWV, LV mass index, and percentage of LV hypertrophy in subjects with OSA and hypertension. Multivariate regression analysis showed that PWV was associated with systolic BP (p < 0.001) and apnea-hypopnea index (p = 0.002). The only independent variable associated with LV mass index was PWV (p < 0.0001).

CONCLUSIONS

Severe OSA and hypertension are associated with arterial stiffness and heart structure abnormalities of similar magnitude, with additive effects when both conditions coexist. Increased large arterial stiffness contributes to ventricular afterload and may help to explain heart remodeling in both OSA and hypertension.

摘要

研究目的

阻塞性睡眠呼吸暂停(OSA)和高血压均与大动脉僵硬度增加独立相关,这可能导致左心室(LV)重塑。我们旨在研究OSA、高血压及其与动脉僵硬度和心脏结构的关联所产生的影响。

设计

我们研究了60名中年受试者,根据是否存在伴有或不伴有高血压的严重OSA将其分为四组。所有参与者均无其他合并症。各组在年龄、性别和体重指数方面相匹配。

测量与结果

对所有参与者进行了全夜多导睡眠监测、脉搏波速度(PWV)和经胸超声心动图检查。与无OSA的血压正常受试者相比,血压正常的OSA患者以及患有高血压但无OSA的患者的PWV、左心房直径、室间隔厚度、左心室后壁厚度、左心室质量指数和左心室肥厚百分比均有相似程度的增加(所有比较的p<0.05),而OSA合并高血压的受试者的PWV、左心室质量指数和左心室肥厚百分比则进一步显著增加。多变量回归分析显示,PWV与收缩压(p<0.001)和呼吸暂停低通气指数(p = 0.002)相关。与左心室质量指数相关的唯一独立变量是PWV(p<0.0001)。

结论

严重OSA和高血压与相似程度的动脉僵硬度和心脏结构异常相关,当两种情况并存时具有叠加效应。大动脉僵硬度增加会导致心室后负荷增加,这可能有助于解释OSA和高血压患者的心脏重塑。

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