Clinica Medica 3, Department of Medicine - DIMED, University of Padova, Italy.
A.O. San Camillo-Forlanini, Rome, Italy.
Sleep Med. 2023 Mar;103:180-186. doi: 10.1016/j.sleep.2023.02.004. Epub 2023 Feb 10.
Obstructive sleep apnea (OSA) is associated with heart derangements detected at echocardiography as higher left ventricular mass index (LVMI), higher left ventricular end-diastolic diameter, lower left ventricular ejection fraction (LVEF), and impaired diastolic function. However, the currently used parameter to define OSA diagnosis and severity, the apnea/hypopnea index (AHI), poorly predicts cardiovascular damage, cardiovascular events, and mortality. Our study aimed to assess if other polygraphic indices of OSA presence and severity, in addition to AHI, might better predict echocardiographic cardiac remodeling.
We enrolled two cohorts of individuals referred for suspected OSA to the outpatient facilities of the IRCCS Istituto Auxologico Italiano, Milano, and of the Clinica Medica 3, Padova. All patients underwent home sleep apnea testing and echocardiography. Based on the AHI the cohort was divided into no-OSA (AHI<15 events/hour) and moderate-severe OSA (AHI≥15 events/hour). We recruited 162 patients and found that compared to patients with no-OSA, those with moderate-severe OSA showed higher LV remodeling [left ventricular end-diastolic volume (LVEDV) 48.4 ± 11.5 ml/m2 vs. 54.1 ± 14.0 ml/m2, respectively, p = 0.005] and lower LVEF (65.3 ± 5.8% vs. 61.6 ± 7.8%, respectively, p = 0.002), whereas we could not find any difference in LVMI and early and late ventricular filling velocity ratio (E/A). At multivariate linear regression analysis two polygraphic hypoxic burden-related markers were independent predictors of LVEDV and E/A, i.e., the percentage of time with O2 saturation below 90% (β = 0.222) and ODI (β = -0.422), respectively.
Our study shows that nocturnal hypoxia-related indexes were associated with left ventricular remodeling and diastolic dysfunction in OSA patients.
阻塞性睡眠呼吸暂停（OSA）与超声心动图检查中发现的心脏紊乱有关，表现为左心室质量指数（LVMI）升高、左心室舒张末期直径增大、左心室射血分数（LVEF）降低以及舒张功能受损。然而，目前用于定义 OSA 诊断和严重程度的参数，即呼吸暂停/低通气指数（AHI），并不能很好地预测心血管损伤、心血管事件和死亡率。我们的研究旨在评估除 AHI 之外，OSA 存在和严重程度的其他多导睡眠图指数是否可以更好地预测超声心动图心脏重构。
我们招募了两个队列的个体，这些个体因疑似 OSA 而被转诊到米兰的意大利综合研究协会（IRCCS）辅助研究所和帕多瓦的 3 号临床医学诊所的门诊设施。所有患者均接受家庭睡眠呼吸暂停测试和超声心动图检查。根据 AHI，将队列分为无 OSA（AHI<15 次/小时）和中重度 OSA（AHI≥15 次/小时）。我们招募了 162 名患者，发现与无 OSA 的患者相比，中重度 OSA 患者的左心室重构程度更高[左心室舒张末期容积（LVEDV）分别为 48.4±11.5 ml/m2和 54.1±14.0 ml/m2，p=0.005]，左心室射血分数（LVEF）更低[分别为 65.3±5.8%和 61.6±7.8%，p=0.002]，而左心室质量指数和早期和晚期心室充盈速度比（E/A）没有差异。多元线性回归分析显示，两种多导睡眠图缺氧负荷相关标志物是 LVEDV 和 E/A 的独立预测因子，即氧饱和度低于 90%的时间百分比（β=0.222）和 ODI（β=-0.422）。
我们的研究表明，夜间缺氧相关指标与 OSA 患者的左心室重构和舒张功能障碍有关。
