Güvenç Tolga Sinan, Hüseyinoğlu Nergiz, Özben Serkan, Kul Şeref, Çetin Rengin, Özen Kaya, Doğan Coşkun, Balci Bahattin
Umraniye Training and Research Hospital, Istanbul, Turkey.
Kafkas University School of Medicine, Kars, Turkey.
Sleep Breath. 2016 Mar;20(1):5-13. doi: 10.1007/s11325-015-1175-1. Epub 2015 Apr 19.
Repetitive obstruction of larynx during sleep can lead to daytime pulmonary hypertension and alterations in right ventricular morphology and function in a small fraction of obstructive sleep apnea syndrome (OSAS) patients. Environmental effects, particularly high altitude, can modify the effects of OSAS on pulmonary circulation, since altitude-related hypoxia is related with pulmonary vasoconstriction. This potential interaction, however, was not investigated in previous studies.
A total of 41 newly diagnosed OSAS patients were included in this study after pre-enrolment screening. Two-dimensional, three-dimensional, and Doppler echocardiographic data were collected after polysomnographic verification of OSAS. Three-dimensional echocardiograms were analyzed to calculate right ventricular volumes, volume indices, and ejection fraction.
Systolic pulmonary artery pressure (38.35 ± 8.60 vs. 30.94 ± 6.47 mmHg; p = 0.002), pulmonary acceleration time (118.36 ± 16.36 vs. 103.13 ± 18.42 ms; p = 0.001), right ventricle (RV) end-diastolic volume index (48.15 ± 11.48 vs. 41.48 ± 6.45 ml; p = 0.009), and RV end-systolic volume index (26.50 ± 8.11 vs. 22.15 ± 3.85; p = 0.01) were significantly higher in OSAS patients, with similar RV ejection fraction (EF) between groups. No significant differences were noted in other two-dimensional, Doppler or speckle-tracking strain, measurements. Both RVEF and pulmonary acceleration time were predictors of disease severity.
A greater degree of RV structural remodeling and higher systolic pulmonary pressure were observed in OSAS patients living at high altitude compared to healthy highlanders. The reversibility of these alterations with treatment remains to be studied.
睡眠期间喉部反复阻塞可导致一小部分阻塞性睡眠呼吸暂停综合征（OSAS）患者出现日间肺动脉高压以及右心室形态和功能改变。环境因素，尤其是高海拔，可改变OSAS对肺循环的影响，因为与海拔相关的缺氧与肺血管收缩有关。然而，以往研究并未对这种潜在相互作用进行调查。
经预入选筛查后，本研究共纳入41例新诊断的OSAS患者。在通过多导睡眠图验证OSAS后，收集二维、三维和多普勒超声心动图数据。分析三维超声心动图以计算右心室容积、容积指数和射血分数。
OSAS患者的收缩期肺动脉压（38.35±8.60 vs. 30.94±6.47 mmHg；p = 0.002）、肺动脉加速时间（118.36±16.36 vs. 103.13±18.42 ms；p = 0.001）、右心室（RV）舒张末期容积指数（48.15±11.48 vs. 41.48±6.45 ml；p = 0.009）和RV收缩末期容积指数（26.50±8.11 vs. 22.15±3.85；p = 0.01）显著更高，两组间RV射血分数（EF）相似。在其他二维、多普勒或斑点追踪应变测量中未发现显著差异。RVEF和肺动脉加速时间均为疾病严重程度的预测指标。
与健康的高海拔居民相比，居住在高海拔地区的OSAS患者右心室结构重塑程度更高，收缩期肺动脉压更高。这些改变经治疗后的可逆性仍有待研究。
