Sforza Emilia, Sabri Mouhamed, DaCosta Antoine, Isaaz Karl, Barthélémy Jean Claude, Roche Frédéric
Service de Physiologie Clinique et de l'Exercice (Pole Hospitalier NOL), CHU Nord, Faculté de Médecine Jacques Lisfranc, Université Jean Monnet, Saint-Etienne, France.
Service de Cardiologie CHU Nord, Faculté de Médecine Jacques Lisfranc, Université Jean Monnet, Saint-Etienne, France.
J Clin Sleep Med. 2015 Sep 15;11(9):975-80. doi: 10.5664/jcsm.5006.
Sleep disordered breathing (SDB) is associated with cardiovascular disease such as hypertension and left ventricular hypertrophy in middle-aged patients; however, this association is not well described in the elderly. The aim of this study was to evaluate the impact of unrecognized SDB on cardiac function and remodeling in a population-based sample of healthy elderly without cardiac disease.
A total of 405 healthy elderly (age ≥ 65 years) were examined by echocardiography and respiratory polygraphy. According to the apnea-hypopnea index (AHI), subjects were stratified in four categories: snorers (AHI < 5), mild (AHI: 5-15), moderate (AHI: 15-30), and severe (AHI > 30) cases.
Comparative analysis between snorers and SDB cases revealed that left atrial (LA) diameter and surface increased according to SDB severity (p < 0.05) without differences in LA mass index. In subjects with an AHI > 30, an increase was found for LV end-diastolic and end-systolic dimension (p < 0.001), as well as for LV mass (p < 0.03) and LV index (p < 0.05). The current study showed a weak but significant correlation between altered LA and LV measurements versus AHI and hypoxemia indices (p < 0.001). In the regression analysis, AHI and hypoxemia had a minimal effect, body mass index and male gender being the most significant predictors.
In a population of healthy elderly with SDB, slight changes in left atrial and ventricular measurements occur in severe cases (AHI > 30). Irrespective of the lack of a strong association between SDB and cardiac dysfunction, the presence of slight cardiac pathology in severe SDB cases might be considered.
NCT 00759304 and NCT 00766584.
睡眠呼吸紊乱（SDB）与中年患者的心血管疾病如高血压和左心室肥厚相关；然而，这种关联在老年人中尚未得到充分描述。本研究的目的是评估未被识别的SDB对无心脏病的健康老年人群样本中心脏功能和重构的影响。
共有405名健康老年人（年龄≥65岁）接受了超声心动图和呼吸多导睡眠图检查。根据呼吸暂停低通气指数（AHI），受试者被分为四类：打鼾者（AHI<5）、轻度（AHI：5-15）、中度（AHI：15-30）和重度（AHI>30）病例。
打鼾者与SDB病例之间的比较分析显示，左心房（LA）直径和面积根据SDB严重程度增加（p<0.05），而LA质量指数无差异。在AHI>30的受试者中，左心室舒张末期和收缩末期内径增加（p<0.001），左心室质量（p<0.03）和左心室指数（p<0.05）也增加。当前研究显示，LA和LV测量值的改变与AHI和低氧血症指数之间存在微弱但显著的相关性（p<0.001）。在回归分析中，AHI和低氧血症的影响最小，体重指数和男性性别是最显著的预测因素。
在患有SDB的健康老年人群中，严重病例（AHI>30）的左心房和心室测量值会出现轻微变化。尽管SDB与心脏功能障碍之间缺乏强关联，但在严重SDB病例中存在轻微心脏病变仍可能需要考虑。
NCT 00759304和NCT 00766584。
