Tadic Marijana, Cuspidi Cesare, Grassi Guido, Mancia Giuseppe
University Hospital "Dr. Dragisa Misovic - Dedinje" Department of Cardiology, Heroja Milana Tepica 1, 11000, Belgrade, Serbia.
University of Milan-Bicocca, Milan, Italy.
Heart Fail Rev. 2021 Jul;26(4):937-945. doi: 10.1007/s10741-020-09924-0.
Obstructive sleep apnea (OSA) syndrome is the most common sleep-breathing disorder, which is associated with increase cardiovascular morbidity and mortality. OSA increases risk of resistant arterial hypertension, coronary artery disease, heart failure, pulmonary hypertension, and stroke. Studies showed the significant relationship between OSA and cardiac remodeling. The majority of investigations were focused on the left ventricle and its hypertrophy and function. Fewer studies investigated right ventricular structure and function revealing deteriorated diastolic and systolic function. Data regarding left and right ventricular mechanics in OSA patients are scarce and controversial. The results of the studies that were focused on the influence of continuous positive airway pressure and weight reduction on cardiac remodeling revealed favorable effect on left and right ventricular structure and function. Recently published analyses confirmed positive effect of treatment on cardiac mechanics. Deterioration of left and right ventricular mechanics occurs before functional and structural cardiac impairments in the cascade of cardiac remodeling and therefore the assessment of left and right ventricular strain may represent a cornerstone in detection of subtle cardiac changes that develop significantly before other, often irreversible, alterations. Considering the fact that left and right ventricular strains have important predictive value in wide range of cardiovascular diseases, one should consider the evaluation of left and right ventricular strains in the routine echocardiographic assessment at all stages of disease-from diagnosis, during follow-up and evaluation of therapeutic effects. The main aim of this review is to provide the current overview of cardiac mechanics in OSA patients before and after (during) therapy, as well as mechanisms that could be responsible for cardiac changes.
阻塞性睡眠呼吸暂停（OSA）综合征是最常见的睡眠呼吸障碍，与心血管疾病发病率和死亡率的增加相关。OSA会增加顽固性动脉高血压、冠状动脉疾病、心力衰竭、肺动脉高压和中风的风险。研究表明OSA与心脏重塑之间存在显著关系。大多数研究集中在左心室及其肥厚和功能方面。较少有研究调查右心室结构和功能，结果显示其舒张和收缩功能均恶化。关于OSA患者左、右心室力学的数据稀缺且存在争议。那些聚焦于持续气道正压通气和减重对心脏重塑影响的研究结果显示，其对左、右心室结构和功能具有有益作用。最近发表的分析证实了治疗对心脏力学的积极影响。在心脏重塑过程中，左、右心室力学的恶化发生在心脏功能和结构受损之前，因此评估左、右心室应变可能是检测在其他往往不可逆转的改变之前就已显著发生的细微心脏变化的基石。鉴于左、右心室应变在广泛的心血管疾病中具有重要的预测价值，在疾病的各个阶段——从诊断、随访到治疗效果评估——的常规超声心动图检查中，都应考虑对左、右心室应变进行评估。本综述的主要目的是提供OSA患者治疗前后（期间）心脏力学的当前概述，以及可能导致心脏变化的机制。
