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夜间低氧血症对阻塞性睡眠呼吸暂停患者右心室舒张功能的影响:一项回顾性观察研究。

Nocturnal Hypoxemia Impacts Right Ventricle Diastolic Function in Obstructive Sleep Apnea: A Retrospective Observational Study.

作者信息

Scotti Carla, Porta Roberto, Olivares Adriana, Comini Laura, Cinelli Angelo, Scalvini Simonetta, Vitacca Michele

机构信息

Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Lumezzane, 25065 Lumezzane (BS), Italy.

Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, 25065 Lumezzane (BS), Italy.

出版信息

J Clin Med. 2020 Jan 7;9(1):162. doi: 10.3390/jcm9010162.

Abstract

Obstructive sleep apnea (OSA), although a growing healthcare problem and documented risk factor for cardiovascular diseases, is still under-diagnosed in cardiac patients. To investigate the correlation between OSA and echocardiographic parameters of right ventricle diastolic (RVD) dysfunction, in particular trans-tricuspid E-wave deceleration time (EDT), we retrospectively analyzed data of 103 pure (comorbidity-free) OSA patients with comprehensive echocardiographic examination (ETT). Apnea/hypopnea index (AHI), oxygen desaturation index (ODI), mean nighttime oxyhemoglobin saturation (SpO), time elapsed with SpO < 90% (T90) and mean peak desaturation of nocturnal events (Mdes, graded as mild, medium or severe) were compared with echocardiographic parameters. We found RVD dysfunction present in 58.3% of patients. Altered EDT correlated significantly with mean SpO, T90, and Mdes (p < 0.01, all). Nocturnal desaturators had a significantly worse EDT than non-desaturators (p = 0.027) and a higher risk of prolonged EDT (odds ratio, OR = 2.86). EDT differed significantly according to Mdes severity (p = 0.005) with a higher risk of prolonged EDT in medium/severe vs. mild Mdes (OR = 3.44). EDT detected the presence of RVD dysfunction in 58.3% of our pure OSA patients. It correlated poorly with AHI severity but strongly with nocturnal desaturation severity, independently of age. This ETT marker may be useful for deciding appropriate diagnostic and therapeutic strategies.

摘要

阻塞性睡眠呼吸暂停(OSA)虽然是一个日益严重的医疗问题,且已被证明是心血管疾病的危险因素,但在心脏病患者中仍未得到充分诊断。为了研究OSA与右心室舒张功能障碍(RVD)的超声心动图参数之间的相关性,特别是经三尖瓣E波减速时间(EDT),我们回顾性分析了103例进行了全面超声心动图检查(ETT)的单纯(无合并症)OSA患者的数据。将呼吸暂停/低通气指数(AHI)、氧饱和度下降指数(ODI)、夜间平均氧合血红蛋白饱和度(SpO)、SpO<90%的持续时间(T90)以及夜间事件的平均峰值饱和度下降(Mdes,分为轻度、中度或重度)与超声心动图参数进行比较。我们发现58.3%的患者存在RVD功能障碍。EDT的改变与平均SpO、T90和Mdes显著相关(均为p<0.01)。夜间出现氧饱和度下降的患者的EDT明显比未出现氧饱和度下降的患者差(p = 0.027),且EDT延长的风险更高(比值比,OR = 2.86)。根据Mdes严重程度,EDT有显著差异(p = 0.005),中度/重度Mdes患者EDT延长的风险高于轻度Mdes患者(OR = 3.44)。在我们的单纯OSA患者中,EDT检测出58.3%的患者存在RVD功能障碍。它与AHI严重程度的相关性较差,但与夜间氧饱和度下降的严重程度密切相关,与年龄无关。这个ETT指标可能有助于确定合适的诊断和治疗策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fbf9/7019852/9cc513b46427/jcm-09-00162-g001.jpg

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