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Obez ve nonobez obstrüktif uyku apne sendromlu hastalarda sağ kalp fonksiyonlarının ekokardiyografi ve Doppler ekokardiyografi ile değerlendirilmesi

Year 2020, Volume: 45 Issue: 4, 1291 - 1301, 27.12.2020
https://doi.org/10.17826/cumj.665994

Abstract

Amaç: Çalışmamızın amacı, obez ve nonobez obstrüktif uyku apne sendromu (OUAS) hastalarında; doku doppler (DD) ekokardiyografi ile sağ ventrikül sistolik ve diyastolik fonksiyonlarının ve pulmoner arter basınçlarını (PAB) karşılaştırmaktı.
Gereç ve Yöntem: Çalışmamıza Uyku Laboratuarında polisomnografik inceleme yapılmış ve orta ya da ağır OUAS tanısı konmuş 35 nonobez ve 34 obez olmak üzere 69 hasta alındı. Tüm hastalarda M-mode, iki boyutlu inceleme, renkli akım Doppler ve Doku Dopler yardımıyla sol ventrikül ve sağ ventrikül boyutları, sol atrium (LA) ve sağ atrium (RA) boyutları, sol ventrikül ve sağ ventrikül sistolik ve diyastolik fonksiyonları ve sistolik PAB’ ları ölçüldü.
Bulgular: Her iki grupta da RV diyastolik fonksiyonlarında bozulma saptanmış olup, obez grupta anlamlı olarak daha fazla bozulma saptanmıştır (lateral triküspit annuler bölge geç diyastolik miyokardial hız A’a: nonobez hastalarda 0.13 ±0.03 ve obez hastalarda 0.11±0.04). Obez grupta ortalama sistolik PAB anlamlı olarak daha yüksek bulunmuştur (Sırasıyla 31.2±5.6 ve 27.1±5.8).
Sonuç: Obstrüktif Uyku Apne Sendromu kardiyovasküler morbidite ve mortaliteyi arttırır. Çalışmamızda orta ve ağır OUAS hastalarında doku doppler incelemesi ile SV ve RV diyastolik fonksiyonlarında bozulma saptanmıştır. Obezite OUAS‟tan bağımsız olarak bu bozukluğa katkıda bulunmaktadır.

References

  • REFERENCES 1. Hung J, Whitford EG, Parsons RW, et al. Association of sleep apnea with myocardial infarction in men. Lancet 1990; 336: 261–264 2. Mooe T, Franklin KA, Wiklund U, et al. Sleep-disordered breathing and myocardial ischemia in patients with coronary artery disease. Chest 2000; 117: 1597–1602 3. Wolk R, Somers VK. Obesity-related cardiovascular disease: implications of obstructivesleep apnea. Diabetes, Obesity and Metabolism 2006; 8: 250-260 4. Carskadon MA, Dement WC. Normal human sleep: An overview. In: Kryger MH, Roth T, Dement WC (eds). Principles and Practice of Sleep Medicine. 3rd Ed. Philadelphia, W.B. Saunders Company, 2000; 15-25 5. Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993; 328: 1230–1235 6. Berman E.J, DiBenedetto R.J, Causey DE et al. Right ventricular hypertrophy detected by echocardiography in patients with newly diagnosed obstructive sleep apnea. Chest 1991: 100 (2): 347-350. 7. Rechtschaffen A, Kales A. A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. NIH Publication No. 204. Washington, U.S. Government Printing Office:1968. 8. Iber C, Ancoli-Israel S, Chesson A, Quan S.; for the American Academy of Sleep Medicine. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. 1st ed. Westchester, IL: American Academy of Sleep Medicine;2007 9. Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography Endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. Lawrence G. Rudski, Wyman W. Lai, Jonathan Afilalo, Lanqi Hua, Mark D. Handschumacher, BSc, Krishnaswamy Chandrasekaran, Scott D. Solomon, Eric K. Louie, and Nelson B. Schiller. J Am Soc Echocardiogr 2010;23:685-713. 10. Carskadon MA, Dement WC. Normal human sleep: An overview. In: Kryger MH, Roth T, Dement WC (eds). Principles and Practice of Sleep Medicine. 3rd Ed. Philadelphia, W.B. Saunders Company, 2000; 15-25. 11. Young T, Shahar E, Nieto FJ, Redline S, Newman AB, Gottlieb DJ, Walsleben JA, Finn L, Enright P, Samet JM, for the Sleep Heart Health Study Research Group. Predictors of sleep-disordered breathing in community-dwelling adults: The Sleep Heart Health Study. Arch Intern Med 2002; 162: 893–900 12. Peppard PE, Young T, Patla M. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 2000; 284: 3015-2021. 13. Lattimore JD, Celermajer DS, Wilcox I. Obstructive sleep apnea and cardiovascular disease. J Am Coll Cardiol 2003;41:1429-37. 14. Tolle FA, Judy WV, Yu P et al. Reduced stroke volume related to pleural pressure in obstructive sleep apnea. J Appl Physiol. 1983;55:1718-1724 15. Strollo PJ , Sanders MH. Sleep disorders. Clin Chest Med 1998;19(1):1-32 16. Malone S, Liu PP, Holloway R et al. Obstructive sleep apnoea in patients with idiopathic dilated cardiomyopathy: Effects of continuous positive airway pressure.Lancet 1991;338:1480-1484. 17. Arias MA, Garcia-Rio, F, Alonso-Fernandez A et al. Pulmonary hypertension in obstructive sleep apnoea: effects of continuous positive airway pressure: a randomized, controlled cross-over study. Eur Heart J. 2006;27(9):1106-1113 18. Hanly P, Sasson Z, Zuberi N. et al. Ventricular function in snorers and patients with obstructive sleep apnea. Chest 1992;102(1):100-105. 19. Guidry UC, Mendes LA, Evans JC et al. Echocardiographic features of the right heart in sleep-disordered breathing: the Framingham Heart Study. Am J Respir Crit Care Med. 2001;164(6):933-938. 20. Tavil Y, Kanbay A, Sen N, Ulukavak Ciftci T, Abaci A, Yalçın MR, Köktürk O, Cengel A. The relationship between aortic stiffness and cardiac function in patients with Obstructive sleep apnea, independently from systemic hypertension. J Am Soc Echocardiogr. 2007;20.366-72 21. Willens HJ, Chakko SC, Lowery MH, Byers P, Labrador E, Gallagher A, Castrillon JC, Myerburg RJ.Tissue Doppler imaging of the right and left ventricle in severe obesity. Am J Cardiol. 2004 Oct 15;94(8):1087-90. 22. Wong CY, O'Moore-Sullivan T, Leano R, Hukins C, et al. Association of subclinical right ventricular dysfunction with obesity. J Am Coll Cardiol 2006; 47: 611-616. 23. Mitra N, Rafael K, Zion S, and Patrick J. Impact of Obstructive Sleep on Left Ventricular Mass and Diastolic Function. Am J Respir Crit Care 2001. Vol 163. pp 1632-36. 24. Kim SH, Cho GY, Shin C, Lim HE, Kim YH, Song WH, Shim WJ, Ahn JC. Impact of obstructive sleep apnea on left ventricular diastolic function. Am J Cardiol. 2008 101(11): 1663-8 25. Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, D'Agostino RB.Association of sleep-disordered breathing, sleep apnea, and hypertension in a largecommunity-based study. Sleep Heart Health Study. JAMA 2000; 283: 1829-1836. 26. Grote L, Ploch T, Heitmann J, Knaack L, Penzel T, Peter JH. Sleep-related breathing disorder is an independent risk factor for systemic hypertension. Am J Respir Crit Care Med 1999; 160: 1875-1882 27. Peterson L, Waggoner AD, Schechtman KB, Meyer T, Gropler RJ. Et all. Alterations in Left Ventricular Structure and Function in Young Healthy Obese Women J Am Coll Cardiol 2004; 43:1399-404 28. Kessler R, Chaouat A, Weitzenblum E, Oswald M, Ehrhart M, Apprill M, et al. Pulmonary hypertension in the obstructive sleep apnoea syndrome: prevalence, causes and therapeutic consequences. Eur Respir J 1996; 9:787-94 29. Chaoat A, Weitzenblum E, Krieger J, Oswald M, Kessler R. Pulmonary hemodynamics in the obstructive sleep apnea syndrome: results in 220 consecutive patients. Chest 1996; 109: 380-6 30. Sajkov D, Cowie RJ, Thornton AT, et al. Pulmonary hypertension and hypoxemia in obstructive sleep apnea syndrome. Am J Respir Crit Care Med 1994; 149: 416-22

Evaluation of right heart functions by echocardiography and tissue Doppler imaging echocardiography in obese and non-obese patients with obstructive sleep apnea

Year 2020, Volume: 45 Issue: 4, 1291 - 1301, 27.12.2020
https://doi.org/10.17826/cumj.665994

Abstract

Purpose: The aim of our study was to compare the right ventricular systolic and diastolic functions and pulmonary artery pressure (PAP) in obese and non-obese patients with obstructive sleep apnea syndrome (OSAS) by tissue Doppler imaging (TDI) echocardiography.
Materials and Methods: This study was conducted with 69 patients, 34 obese and 35 non-obese, diagnosed moderate or severe OSAS by an overnight polysomnographic sleep study. In all patients, LV (left ventricle) and RV (right ventricle) size, left atial (LA) and RA (right atrial) dimensions, LV and RV systolic and diastolic functions and systolic PAPs were measured by M-mode, two-dimensional analysis, color flow Doppler and TDI.
Results: RV diastolic dysfunction was detected in both groups; this impairment was significantly higher in the obese group (lateral tricuspid late diastolic myocardial annular zone velocity A'a: 0.13 ± 0.03 in non-obese patients and 0.11 ± 0.04 in obese patients). The mean systolic PAP was significantly higher in obese patients (31.2±5.6, 27.1±5.8, respectively)
Conclusion: Obstructive Sleep Apnea Syndrome increases cardiovascular morbidity and mortality. In our study,left ventricul and right ventricul diastolic dysfunction was determined by tissue Doppler imaging in patients with moderate and severe Obstructive Sleep Apnea Syndrome. Obesity contributes to this impairment regardless of Obstructive Sleep Apnea Syndrome .

References

  • REFERENCES 1. Hung J, Whitford EG, Parsons RW, et al. Association of sleep apnea with myocardial infarction in men. Lancet 1990; 336: 261–264 2. Mooe T, Franklin KA, Wiklund U, et al. Sleep-disordered breathing and myocardial ischemia in patients with coronary artery disease. Chest 2000; 117: 1597–1602 3. Wolk R, Somers VK. Obesity-related cardiovascular disease: implications of obstructivesleep apnea. Diabetes, Obesity and Metabolism 2006; 8: 250-260 4. Carskadon MA, Dement WC. Normal human sleep: An overview. In: Kryger MH, Roth T, Dement WC (eds). Principles and Practice of Sleep Medicine. 3rd Ed. Philadelphia, W.B. Saunders Company, 2000; 15-25 5. Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993; 328: 1230–1235 6. Berman E.J, DiBenedetto R.J, Causey DE et al. Right ventricular hypertrophy detected by echocardiography in patients with newly diagnosed obstructive sleep apnea. Chest 1991: 100 (2): 347-350. 7. Rechtschaffen A, Kales A. A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. NIH Publication No. 204. Washington, U.S. Government Printing Office:1968. 8. Iber C, Ancoli-Israel S, Chesson A, Quan S.; for the American Academy of Sleep Medicine. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. 1st ed. Westchester, IL: American Academy of Sleep Medicine;2007 9. Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography Endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. Lawrence G. Rudski, Wyman W. Lai, Jonathan Afilalo, Lanqi Hua, Mark D. Handschumacher, BSc, Krishnaswamy Chandrasekaran, Scott D. Solomon, Eric K. Louie, and Nelson B. Schiller. J Am Soc Echocardiogr 2010;23:685-713. 10. Carskadon MA, Dement WC. Normal human sleep: An overview. In: Kryger MH, Roth T, Dement WC (eds). Principles and Practice of Sleep Medicine. 3rd Ed. Philadelphia, W.B. Saunders Company, 2000; 15-25. 11. Young T, Shahar E, Nieto FJ, Redline S, Newman AB, Gottlieb DJ, Walsleben JA, Finn L, Enright P, Samet JM, for the Sleep Heart Health Study Research Group. Predictors of sleep-disordered breathing in community-dwelling adults: The Sleep Heart Health Study. Arch Intern Med 2002; 162: 893–900 12. Peppard PE, Young T, Patla M. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 2000; 284: 3015-2021. 13. Lattimore JD, Celermajer DS, Wilcox I. Obstructive sleep apnea and cardiovascular disease. J Am Coll Cardiol 2003;41:1429-37. 14. Tolle FA, Judy WV, Yu P et al. Reduced stroke volume related to pleural pressure in obstructive sleep apnea. J Appl Physiol. 1983;55:1718-1724 15. Strollo PJ , Sanders MH. Sleep disorders. Clin Chest Med 1998;19(1):1-32 16. Malone S, Liu PP, Holloway R et al. Obstructive sleep apnoea in patients with idiopathic dilated cardiomyopathy: Effects of continuous positive airway pressure.Lancet 1991;338:1480-1484. 17. Arias MA, Garcia-Rio, F, Alonso-Fernandez A et al. Pulmonary hypertension in obstructive sleep apnoea: effects of continuous positive airway pressure: a randomized, controlled cross-over study. Eur Heart J. 2006;27(9):1106-1113 18. Hanly P, Sasson Z, Zuberi N. et al. Ventricular function in snorers and patients with obstructive sleep apnea. Chest 1992;102(1):100-105. 19. Guidry UC, Mendes LA, Evans JC et al. Echocardiographic features of the right heart in sleep-disordered breathing: the Framingham Heart Study. Am J Respir Crit Care Med. 2001;164(6):933-938. 20. Tavil Y, Kanbay A, Sen N, Ulukavak Ciftci T, Abaci A, Yalçın MR, Köktürk O, Cengel A. The relationship between aortic stiffness and cardiac function in patients with Obstructive sleep apnea, independently from systemic hypertension. J Am Soc Echocardiogr. 2007;20.366-72 21. Willens HJ, Chakko SC, Lowery MH, Byers P, Labrador E, Gallagher A, Castrillon JC, Myerburg RJ.Tissue Doppler imaging of the right and left ventricle in severe obesity. Am J Cardiol. 2004 Oct 15;94(8):1087-90. 22. Wong CY, O'Moore-Sullivan T, Leano R, Hukins C, et al. Association of subclinical right ventricular dysfunction with obesity. J Am Coll Cardiol 2006; 47: 611-616. 23. Mitra N, Rafael K, Zion S, and Patrick J. Impact of Obstructive Sleep on Left Ventricular Mass and Diastolic Function. Am J Respir Crit Care 2001. Vol 163. pp 1632-36. 24. Kim SH, Cho GY, Shin C, Lim HE, Kim YH, Song WH, Shim WJ, Ahn JC. Impact of obstructive sleep apnea on left ventricular diastolic function. Am J Cardiol. 2008 101(11): 1663-8 25. Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, D'Agostino RB.Association of sleep-disordered breathing, sleep apnea, and hypertension in a largecommunity-based study. Sleep Heart Health Study. JAMA 2000; 283: 1829-1836. 26. Grote L, Ploch T, Heitmann J, Knaack L, Penzel T, Peter JH. Sleep-related breathing disorder is an independent risk factor for systemic hypertension. Am J Respir Crit Care Med 1999; 160: 1875-1882 27. Peterson L, Waggoner AD, Schechtman KB, Meyer T, Gropler RJ. Et all. Alterations in Left Ventricular Structure and Function in Young Healthy Obese Women J Am Coll Cardiol 2004; 43:1399-404 28. Kessler R, Chaouat A, Weitzenblum E, Oswald M, Ehrhart M, Apprill M, et al. Pulmonary hypertension in the obstructive sleep apnoea syndrome: prevalence, causes and therapeutic consequences. Eur Respir J 1996; 9:787-94 29. Chaoat A, Weitzenblum E, Krieger J, Oswald M, Kessler R. Pulmonary hemodynamics in the obstructive sleep apnea syndrome: results in 220 consecutive patients. Chest 1996; 109: 380-6 30. Sajkov D, Cowie RJ, Thornton AT, et al. Pulmonary hypertension and hypoxemia in obstructive sleep apnea syndrome. Am J Respir Crit Care Med 1994; 149: 416-22
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Details

Primary Language English
Subjects Respiratory Diseases
Journal Section Research
Authors

Nursel Dikmen 0000-0002-5923-400X

Sebahat Genç This is me 0000-0003-0967-9622

Adnan Akçay 0000-0002-6745-861X

Publication Date December 27, 2020
Acceptance Date July 16, 2020
Published in Issue Year 2020 Volume: 45 Issue: 4

Cite

MLA Dikmen, Nursel et al. “Evaluation of Right Heart Functions by Echocardiography and Tissue Doppler Imaging Echocardiography in Obese and Non-Obese Patients With Obstructive Sleep Apnea”. Cukurova Medical Journal, vol. 45, no. 4, 2020, pp. 1291-0, doi:10.17826/cumj.665994.