Dobrowolski Piotr, Florczak Elżbieta, Klisiewicz Anna, Prejbisz Aleksander, Rybicka Justyna, Śliwiński Paweł, Januszewicz Andrzej, Hoffman Piotr
Pol Arch Med Wewn. 2016 Apr 29;126(4):222-9. doi: 10.20452/pamw.3388.
INTRODUCTION The effect of obstructive sleep apnea (OSA) on right ventricular (RV) function and pulmonary circulation parameters is unclear. OBJECTIVES The aim of this study was to determine whether newly diagnosed OSA and its severity has any impact on RV performance and echocardiographic parameters of pulmonary circulation in patients with true resistant hypertension. PATIENTS AND METHODS The study included 155 patients (93 men and 62 women; mean age, 47.5 ±10 years). The apnea-hypopnea index (AHI), end-diastolic and end-systolic area of the right ventricle, main pulmonary artery diameter (MPAd) at diastole, acceleration time (AccT), tricuspid annular systolic velocity wave, and tricuspid annular plane systolic excursion were evaluated. RESULTS Patients were divided into 4 groups: without OSA (AHI <5; n = 43), with mild OSA (AHI = 5-15; n = 45), moderate OSA (AHI = 15-30; n = 27), and severe OSA (AHI >30; n = 40). There were no differences in RV systolic function between the groups. Patients with severe OSA had a wider MPAd (26.0 ±2.6 vs 23.1 ±3.7 mm; P <0.0001) and shorter AccT (114.2 ±15.7 vs 133.4 ±22.1 ms; P <0.001) in comparison with patients without OSA. The cut-off for the best predictive value of severe OSA was an MPAd of 25 mm or higher with a sensitivity of 63.6% and specificity of 78.9%. The area under the receiver operating characteristic curve for severe OSA in relation to an MPAd of 25 mm or higher was 0.766 (95% confidence interval, 0.673-0.859; P <0.0001). Factors independently associated with an MPAd of 25 mm or higher were severe OSA and nighttime diastolic blood pressure levels. CONCLUSIONS Our study showed a relationship between pulmonary artery dilation and the presence of newly diagnosed severe OSA. Among the parameters studied, an MPAd of 25 mm or higher turned out to be the most useful parameter in identifying patients with severe OSA.
引言 阻塞性睡眠呼吸暂停（OSA）对右心室（RV）功能和肺循环参数的影响尚不清楚。
目的 本研究旨在确定新诊断的OSA及其严重程度是否对真性难治性高血压患者的RV功能和肺循环超声心动图参数有任何影响。
患者与方法 该研究纳入了155例患者（93例男性和62例女性；平均年龄47.5±10岁）。评估了呼吸暂停低通气指数（AHI）、右心室舒张末期和收缩末期面积、舒张期主肺动脉直径（MPAd）、加速时间（AccT）、三尖瓣环收缩期速度波和三尖瓣环平面收缩期位移。
结果 患者分为4组：无OSA（AHI<5；n=43）、轻度OSA（AHI=5-15；n=45）、中度OSA（AHI=15-30；n=27）和重度OSA（AHI>30；n=40）。各组之间RV收缩功能无差异。与无OSA的患者相比，重度OSA患者的MPAd更宽（26.0±2.6对23.1±3.7mm；P<0.0001），AccT更短（114.2±15.7对133.4±22.1ms；P<0.001）。重度OSA最佳预测值的临界值为MPAd 25mm或更高，敏感性为63.6%，特异性为78.9%。重度OSA与MPAd 25mm或更高相关的受试者工作特征曲线下面积为0.766（95%置信区间，0.673-0.859；P<0.0001）。与MPAd 25mm或更高独立相关的因素是重度OSA和夜间舒张压水平。
结论 我们的研究表明肺动脉扩张与新诊断的重度OSA的存在之间存在关联。在所研究的参数中，MPAd 25mm或更高是识别重度OSA患者最有用的参数。
