Moro José A, Almenar Luis, Fernández-Fabrellas Estrella, Ponce Silvia, Blanquer Rafael, Salvador Antonio
Fundación para la Investigación, Hospital Universitario La Fe, Valencia, España.
Rev Esp Cardiol. 2008 Jan;61(1):49-57.
Sleep apnea-hypopnea syndrome (SAHS) is associated with significant effects on the heart, which can be assessed using noninvasive methods such as transthoracic echocardiography. However, it is not clear whether these effects are due to the condition itself or are influenced by associated factors, such as high blood pressure (HBP). The objective of this study was to investigate the echocardiographic alterations observed in SAHS patients and how they are affected by the presence of concomitant HBP.
The study involved 103 consecutive patients (49 with HBP and 54 without) with SAHS and an indication for continuous positive airways pressure treatment and 24 controls matched for age and body mass index. Doppler echocardiography was performed in a blinded manner. Both morphology (i.e., wall thickness, and diameters) and function (i.e., ejection fraction, peak E and A wave velocities, mitral deceleration time, and Tei index) were assessed. Results were compared using ANOVA and Bonferroni's test.
Hypertensive patients had larger morphological changes characteristic of left ventricular hypertrophy (i.e., increased septal and posterior wall thicknesses) than nonhypertensive patients, who in turn had larger changes than controls (septal thickness: HBP-SAHS, 12 [2] mm; non-HBP SAHS, 11 [2] mm, and controls, 9.5 [5] mm; 1 vs. 2, P=.038; 1 vs. 3, P=.0001, 2 vs. 3, P=.034) (posterior wall thickness: HBP-SAHS, 11 [2] mm; non-HBP SAHS, 10 [1] mm, and controls, 9 [1.5] mm; 1 vs. 2, P=.5; 1 vs. 3, P=.0001; 2 vs. 3, P=.001). In addition, there were also greater changes in ventricular filling patterns on the left (HBP-SAHS, 92%; non-HBP SAHS, 72%, controls, 29%; P=.0001) and on the right (HBP-SAHS, 72%; non-HBP SAHS, 58%; controls, 25%; P=.001). There was a trend towards a larger left ventricular Tei index (HBP-SAHS, 0.56 [0.2]; non-HBP SAHS, 0.54 [0.12]; controls, 0.5 [0.1]; 1 vs. 2, P=.8; 1 vs. 3, P=.09; 2 vs. 3, P=.7).
From the time of diagnosis, SAHS was associated with left ventricular hypertrophy and impaired biventricular filling, even in the absence of concomitant HBP. The abnormalities observed were more severe when HBP was present.
睡眠呼吸暂停低通气综合征（SAHS）对心脏有显著影响，可通过经胸超声心动图等无创方法进行评估。然而，尚不清楚这些影响是由于该病症本身所致，还是受诸如高血压（HBP）等相关因素的影响。本研究的目的是调查SAHS患者中观察到的超声心动图改变，以及这些改变如何受到合并HBP的影响。
该研究纳入了103例连续的SAHS患者（49例有HBP，54例无HBP），这些患者均有持续气道正压通气治疗指征，并选取了24例年龄和体重指数相匹配的对照。采用盲法进行多普勒超声心动图检查。评估了形态学指标（即室壁厚度和内径）和功能指标（即射血分数、E峰和A峰峰值速度、二尖瓣减速时间和Tei指数）。使用方差分析和Bonferroni检验比较结果。
高血压患者的左心室肥厚特征性形态学改变（即室间隔和后壁厚度增加）比非高血压患者更明显，而非高血压患者的改变又比对照组更明显（室间隔厚度：HBP-SAHS组为12 [2] mm；非HBP SAHS组为11 [2] mm，对照组为9.5 [5] mm；1组与2组比较，P = 0.038；1组与3组比较，P = 0.0001；2组与3组比较，P = 0.034）（后壁厚度：HBP-SAHS组为11 [2] mm；非HBP SAHS组为10 [1] mm，对照组为9 [1.5] mm；1组与2组比较，P = 0.5；1组与3组比较，P = 0.0001；2组与3组比较，P = 0.001）。此外，左心室（HBP-SAHS组为92%；非HBP SAHS组为72%，对照组为29%；P = 0.0001）和右心室（HBP-SAHS组为72%；非HBP SAHS组为58%；对照组为25%；P = 0.001）的心室充盈模式改变也更大。左心室Tei指数有增大趋势（HBP-SAHS组为0.56 [0.2]；非HBP SAHS组为0.54 [0.12]；对照组为0.5 [0.1]；1组与2组比较，P = 0.8；1组与3组比较，P = 0.09；2组与3组比较，P = 0.7）。
从诊断之时起，即使没有合并HBP，SAHS也与左心室肥厚和双心室充盈受损有关。当存在HBP时，观察到的异常更为严重。
