Çukurova University, Faculty of Medicine, Depar tment of Neurology, Adana, Turkey.
Cardiol J. 2013;20(5):519-25. doi: 10.5603/CJ.2013.0043.
The knowledge regarding myocardial alterations in patients with obstructive sleep apnea syndrome (OSAS) in the absence of any known cardiovascular disorders including hypertension is limited. The aim of this study was to assess the early alterations of left ventricular (LV) functions caused by OSAS before the development of hypertension and other cardiovascular manifestations of OSAS.
Eighty consecutive patients who underwent polysomnography (PSG) were enrolled in the study. Patients with hypertension, diabetes mellitus or any other known cardiac diseases were excluded from the study. Subjects were separated into two groups by their apnea/hypopnea index (AHI) (group 1: AHI < 15, and group 2: AHI ≥ 15). Fourty-three patients with normal polysomnographic examination or mild OSAS (group 1) and 37 patients with moderate to severe OSAS (group 2) were compared. After PSG examination, LV functions were assessed by using the conventional and tissue Doppler echocardiographic methods.
The mean age was similar between the groups. The ratio of male patients was higher in group 2 (male/female: 31/12 in group 1 vs. 34/3 in group 2, p = 0.04). Body mass index was higher in group 2 (p = 0.05). Conventional echocardiography showed that interventricular septum thickness was 9.5 ± 1.1 mm in group 1, and 10.5 ± 1.4 mm in group 2 (p = 0.02). Mean left atrial diameter was 35.6 ± 4.1 mm in group 2, and 33.8 ± 3.1 mm in group 1 (p = 0.04). Ratio of early to late transmitral diastolic velocities was lower in group 2 (p = 0.01), indicating that impairment of diastolic function was more frequent in moderate to severe OSAS patients. Tissue Doppler echocardiography showed that early diastolic myocardial velocity was lower ingroup 2 (21.1 ± 5.6 cm/s in group 1 vs. 18.3 ± 5.3 cm/s in group 2, p = 0.01).
Left ventricular diastolic dysfunction, LV hypertrophy and left atrial dilatationoccur in patients with OSAS even before the development of hypertension and other cardiovascular diseases.
在没有任何已知心血管疾病（包括高血压）的情况下，阻塞性睡眠呼吸暂停综合征（OSAS）患者的心肌改变的知识是有限的。本研究的目的是评估 OSAS 在发展为高血压和 OSAS 的其他心血管表现之前引起的左心室（LV）功能的早期改变。
80 例连续接受多导睡眠图（PSG）检查的患者纳入本研究。患有高血压、糖尿病或任何其他已知心脏病的患者被排除在研究之外。根据呼吸暂停/低通气指数（AHI）将患者分为两组（组 1：AHI<15，组 2：AHI≥15）。43 例 PSG 检查正常或轻度 OSAS 患者（组 1）和 37 例中重度 OSAS 患者（组 2）进行比较。PSG 检查后，采用常规和组织多普勒超声心动图方法评估 LV 功能。
两组间的平均年龄相似。组 2 中男性患者的比例较高（男性/女性：组 1 为 31/12，组 2 为 34/3，p=0.04）。组 2 的体重指数较高（p=0.05）。常规超声心动图显示，组 1 的室间隔厚度为 9.5±1.1mm，组 2 为 10.5±1.4mm（p=0.02）。组 2 的左心房直径均值为 35.6±4.1mm，组 1 为 33.8±3.1mm（p=0.04）。组 2 的早期到晚期二尖瓣舒张速度比降低（p=0.01），表明中重度 OSAS 患者的舒张功能障碍更为常见。组织多普勒超声心动图显示，组 2 的早期舒张心肌速度较低（组 1 为 21.1±5.6cm/s，组 2 为 18.3±5.3cm/s，p=0.01）。
即使在发生高血压和其他心血管疾病之前，OSAS 患者也会出现左心室舒张功能障碍、LV 肥厚和左心房扩张。
