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Tıkayıcı uyku apnesi olan hastalarda ekokardiyografik değerlendirme polisomnografi için daha doğru hasta seçimi sağlayabilir: Ekokardiyografi ile hastalığın şiddetini tahmin etme

Year 2020, Volume: 4 Issue: 2, 113 - 121, 12.07.2020
https://doi.org/10.30565/medalanya.654444

Abstract

Amaç: Tıkayıcı uyku apnesi (TUA) çeşitli mekanizmalarla kalp fonksiyonunu etkileyebilir. Bu çalışmanın amacı, TUA'nın sol ve sağ kalp fonksiyonu üzerindeki etkisini değerlendirmek ve TUA'nın ciddiyetini öngörmede yardımcı olabilecek ekokardiyografik parametreleri belirlemektir.

Yöntemler: Bu kesitsel analizde Ocak ve Haziran 2017 ayları arasında TUA şüphesi olan 60 hasta polisomnografi öncesi transtorasik ekokardiyografi ile değerlendirildi. Apne-hipopne indeksine (AHİ) dayanarak, hastalar ağır olmayan (AHI <30) (n=30) ve ağır (AHI≥30) TUA (n=30) olarak sınıflandırıldı. Ekokardiyografik parametreler ile apne-hipopne indeksi (AHİ) / Epworth Uykululuk Skalası (ESS) arasındaki korelasyon değerlendirildi. Regresyon analizi ile TUA ciddiyetini ön gördürebilecek model araştırıldı.

Sonuçlar: Sol ventrikül (LV) ekokardiyografik parametreler ile ilgili olarak; sol ventrikül çıkış akımı (LVOT) proksimal çapı, sol ventrikül kitle indeksi, arka duvar diyastol sonu çapı (ADDSÇ) ve interventriküler septum diastol sonu çapı (IVSDSÇ) ağır OSA hastalarında anlamlı olarak yüksek bulundu. Sağ ventrikül (RV) fonksiyonel parametrelerine göre; Sağ ventrikül fraksiyonel alan değişimi (SağVFAC) ve miyokardiyal performans indeksi (MPI) değerleri ağır OSA hastalarında anlamlı olarak yüksek bulundu. AHI ve LVOT proksimal çapı, IVSDSÇ, SağVMPI, SağV E ve A hızları, vücut kitle indeksi, boyun çevresi ve ESS arasında anlamlı pozitif korelasyon bulundu. “ADDSÇ, LVOT çapı ve SağV A hızı” ile oluşturulan modeli kullanarak, hastaların çoğunu polisomnografi öncesi doğru şekilde tahmin etmeyi başardık.

Sonuç: TUA şüphesi olan hastalarda ekokardiyografi kullanarak hastalığın ciddiyetini tahmin etmek mümkün olabilir.

References

  • 1. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999;22:667-89. PMID: 10450601.
  • 2. Maripov A, Mamazhakypov A, Sartmyrzaeva M, Akunov A, Muratali Uulu K, Duishobaev M, et al. Right Ventricular Remodeling and Dysfunction in Obstructive Sleep Apnea: A Systematic Review of the Literature and Meta-Analysis. Can Respir J. 2017;2017:1587865. PMID: 28814913. PMCID: 5549475.
  • 3. Kendzerska T, Gershon AS, Hawker G, Leung RS, Tomlinson G. Obstructive sleep apnea and risk of cardiovascular events and all-cause mortality: a decade-long historical cohort study. PLoS Med. 2014;11:e1001599. PMID: 24503600. PMCID: 3913558.
  • 4. Kasikcioglu HA, Karasulu L, Tartan Z, Kasikcioglu E, Cuhadaroglu C, Cam N. Occult cardiac dysfunction in patients with obstructive sleep apnea syndrome revealed by tissue Doppler imaging. Int J Cardiol. 2007;118:203-5. PMID: 16997399.
  • 5. Grunig E, Peacock AJ. Imaging the heart in pulmonary hypertension: an update. Eur Respir Rev. 2015;24:653-64. PMID: 26621979.
  • 6. Vonk Noordegraaf A, Haddad F, Bogaard HJ, Hassoun PM. Noninvasive imaging in the assessment of the cardiopulmonary vascular unit. Circulation. 2015;131:899-913. PMID: 25753343.
  • 7. Lattimore JD, Celermajer DS, Wilcox I. Obstructive sleep apnea and cardiovascular disease. J Am Coll Cardiol. 2003;41:1429-37. PMID: 12742277.
  • 8. Practice parameters for the indications for polysomnography and related procedures. Polysomnography Task Force, American Sleep Disorders Association Standards of Practice Committee. Sleep. 1997;20:406-22. PMID: 9302725.
  • 9. Fleetham J, Ayas N, Bradley D, Ferguson K, Fitzpatrick M, George C, et al. Canadian Thoracic Society guidelines: diagnosis and treatment of sleep disordered breathing in adults. Can Respir J. 2006;13:387-92. PMID: 17036094.
  • 10. Izci B, Ardic S, Firat H, Sahin A, Altinors M, Karacan I. Reliability and validity studies of the Turkish version of the Epworth Sleepiness Scale. Sleep Breath. 2008;12:161-8. PMID: 17922157.
  • 11. de Simone G, Devereux RB, Ganau A, Hahn RT, Saba PS, Mureddu GF, et al. Estimation of left ventricular chamber and stroke volume by limited M-mode echocardiography and validation by two-dimensional and Doppler echocardiography. Am J Cardiol. 1996;78:801-7. PMID: 8857486.
  • 12. Devereux RB, Lutas EM, Casale PN, Kligfield P, Eisenberg RR, Hammond IW, et al. Standardization of M-mode echocardiographic left ventricular anatomic measurements. J Am Coll Cardiol. 1984;4:1222-30. PMID: 6238987.
  • 13. Du Bois D, Du Bois EF. A formula to estimate the approximate surface area if height and weight be known. 1916. Nutrition. 1989;5:303-11; discussion 12-3. PMID: 2520314.
  • 14. Wang AY, Wang M, Lam CW, Chan IH, Zhang Y, Sanderson JE. Left ventricular filling pressure by Doppler echocardiography in patients with end-stage renal disease. Hypertension. 2008;52:107-14. PMID: 18474835.
  • 15. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. 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. J Am Soc Echocardiogr. 2010;23:685-713; quiz 86-8. PMID: 20620859.
  • 16. Anavekar NS, Skali H, Bourgoun M, Ghali JK, Kober L, Maggioni AP, et al. Usefulness of right ventricular fractional area change to predict death, heart failure, and stroke following myocardial infarction (from the VALIANT ECHO Study). Am J Cardiol. 2008;101:607-12. PMID: 18308007.
  • 17. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2012;8:597-619. PMID: 23066376.
  • 18. Altay H, Altın C, Coner A, Muderrisoglu H, Giray S. Parathyroid hormone and ischemic cerebrovascular event. Endoc Metab Immune Drug Targets. 2019; 19: 1134-1140. PMID: 30806331
  • 19. Stewart, S. A., Skomro, R., Reid, J., Penz, E., Fenton, M., Gjevre, J., & Cotton, D. (2015). Improvement in obstructive sleep apnea diagnosis and management wait times: A retrospective analysis of a home management pathway for obstructive sleep apnea. Canadian respiratory journal, 22(3), 167-170. DOI: 10.1155/2015/516580
  • 20. Altintas N, Aslan E, Helvaci A, Malhotra A. Relationship between obstructive sleep apnea severity index and left ventricular function and volume. Ann Saudi Med. 2012;32:384-90. PMID: 22705609.
  • 21. Xie S, Deng Y, Pan YY, Ren J, Jin M, Wang Y, et al. Chronic intermittent hypoxia induces cardiac hypertrophy by impairing autophagy through the adenosine 5'-monophosphate-activated protein kinase pathway. Arch Biochem Biophys. 2016;606:41-52. PMID: 27412517.
  • 22. Yu L, Li H, Liu X, Fan J, Zhu Q, Li J, et al. Left ventricular remodeling and dysfunction in obstructive sleep apnea : Systematic review and meta-analysis. Herz. 2019. DOI: 10.1007/s00059-019-04850-w
  • 23. Hedner J, Ejnell H, Caidahl K. Left ventricular hypertrophy independent of hypertension in patients with obstructive sleep apnoea. J Hypertens. 1990;8:941-6. PMID: 2174947.
  • 24. Kou S, Caballero L, Dulgheru R, Voilliot D, De Sousa C, Kacharava G, et al. Echocardiographic reference ranges for normal cardiac chamber size: results from the NORRE study. Eur Heart J Cardiovasc Imaging. 2014;15:680-90. PMCID: 4402333.
  • 25. Sajkov D, McEvoy RD. Obstructive sleep apnea and pulmonary hypertension. Prog Cardiovasc Dis. 2009;51:363-70. DOI: 10.1016/j.pcad.2008.06.001
  • 26. Dobrowolski P, Florczak E, Klisiewicz A, Prejbisz A, Rybicka J, Sliwinski P, et al. Pulmonary artery dilation indicates severe obstructive sleep apnea in patients with resistant hypertension: the Resist-POL Study. Pol Arch Med Wewn. 2016;126:222-9. PMID: 27129085.
  • 27. Dobrowolski P, Klisiewicz A, Florczak E, Prejbisz A, Bielen P, Sliwinski P, et al. Independent association of obstructive sleep apnea with left ventricular geometry and systolic function in resistant hypertension: the RESIST-POL study. Sleep Med. 2014;15:1302-8. PMID: 25260432.
  • 28. Vitarelli A, Terzano C, Saponara M, Gaudio C, Mangieri E, Capotosto L, et al. Assessment of Right Ventricular Function in Obstructive Sleep Apnea Syndrome and Effects of Continuous Positive Airway Pressure Therapy: A Pilot Study. Can J Cardiol. 2015;31:823-31. PMID: 25980631.
  • 29. Shivalkar B, Van de Heyning C, Kerremans M, Rinkevich D, Verbraecken J, De Backer W, et al. Obstructive sleep apnea syndrome: more insights on structural and functional cardiac alterations, and the effects of treatment with continuous positive airway pressure. J Am Coll Cardiol. 2006;47:1433-9. PMID: 16580533

Echocardiographic evaluation may provide more accurate patient selection for polysomnography in patients with obstructive sleep apnea: Predicting the severity of disease by echocardiography

Year 2020, Volume: 4 Issue: 2, 113 - 121, 12.07.2020
https://doi.org/10.30565/medalanya.654444

Abstract

Aim: Obstructive sleep apnea (OSA) may influence the cardiac function by several mechanisms. The aim of the present study was to evaluate the impact of OSA on left and right cardiac function and determine the echocardiographic parameters which can help to predict the severity of OSA. 

Methods: In this cross-sectional analysis, 60 patients with suspected OSA were evaluated with transthoracic echocardiography before polysomnography between January and June 2017. On the basis of apnea-hypopnea index (AHI), the patients were classified into non-severe (AHI<30) (n = 30) and severe (AHI≥30) OSA (n = 30). The correlation between echocardiographic parameters and the apnea-hypopnea index (AHI) / Epworth Sleepiness Scale (ESS) was assessed.

Results: Regarding left ventricular (LV) echocardiographic parameters: left ventricular outflow (LVOT) proximal diameter, left ventricular mass index, posterior wall enddiastolic diameter (PWEDD) and interventricular septum enddiastolic diameter (IVSEDD) were significantly higher in severe OSA patients. With respect to right ventricular (RV) functional parameters: RV fractional area change (RVFAC) and myocardial performance index (MPI) values were significantly higher in severe OSA patients. We found significant positive correlations between AHI and LVOT proximal diameter, IVSEDD, RVMPI, RV E and A velocities, body mass index, neck circumference and ESS. By using the model created with ‘PWEDD, LVOT diameter and RV A velocity’ we were able to predict most of the patients’ group correctly before polysomnography.

Conclusion: We conclude that we can predict the severity of the disease in patients with suspected OSA by using echocardiography.

References

  • 1. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999;22:667-89. PMID: 10450601.
  • 2. Maripov A, Mamazhakypov A, Sartmyrzaeva M, Akunov A, Muratali Uulu K, Duishobaev M, et al. Right Ventricular Remodeling and Dysfunction in Obstructive Sleep Apnea: A Systematic Review of the Literature and Meta-Analysis. Can Respir J. 2017;2017:1587865. PMID: 28814913. PMCID: 5549475.
  • 3. Kendzerska T, Gershon AS, Hawker G, Leung RS, Tomlinson G. Obstructive sleep apnea and risk of cardiovascular events and all-cause mortality: a decade-long historical cohort study. PLoS Med. 2014;11:e1001599. PMID: 24503600. PMCID: 3913558.
  • 4. Kasikcioglu HA, Karasulu L, Tartan Z, Kasikcioglu E, Cuhadaroglu C, Cam N. Occult cardiac dysfunction in patients with obstructive sleep apnea syndrome revealed by tissue Doppler imaging. Int J Cardiol. 2007;118:203-5. PMID: 16997399.
  • 5. Grunig E, Peacock AJ. Imaging the heart in pulmonary hypertension: an update. Eur Respir Rev. 2015;24:653-64. PMID: 26621979.
  • 6. Vonk Noordegraaf A, Haddad F, Bogaard HJ, Hassoun PM. Noninvasive imaging in the assessment of the cardiopulmonary vascular unit. Circulation. 2015;131:899-913. PMID: 25753343.
  • 7. Lattimore JD, Celermajer DS, Wilcox I. Obstructive sleep apnea and cardiovascular disease. J Am Coll Cardiol. 2003;41:1429-37. PMID: 12742277.
  • 8. Practice parameters for the indications for polysomnography and related procedures. Polysomnography Task Force, American Sleep Disorders Association Standards of Practice Committee. Sleep. 1997;20:406-22. PMID: 9302725.
  • 9. Fleetham J, Ayas N, Bradley D, Ferguson K, Fitzpatrick M, George C, et al. Canadian Thoracic Society guidelines: diagnosis and treatment of sleep disordered breathing in adults. Can Respir J. 2006;13:387-92. PMID: 17036094.
  • 10. Izci B, Ardic S, Firat H, Sahin A, Altinors M, Karacan I. Reliability and validity studies of the Turkish version of the Epworth Sleepiness Scale. Sleep Breath. 2008;12:161-8. PMID: 17922157.
  • 11. de Simone G, Devereux RB, Ganau A, Hahn RT, Saba PS, Mureddu GF, et al. Estimation of left ventricular chamber and stroke volume by limited M-mode echocardiography and validation by two-dimensional and Doppler echocardiography. Am J Cardiol. 1996;78:801-7. PMID: 8857486.
  • 12. Devereux RB, Lutas EM, Casale PN, Kligfield P, Eisenberg RR, Hammond IW, et al. Standardization of M-mode echocardiographic left ventricular anatomic measurements. J Am Coll Cardiol. 1984;4:1222-30. PMID: 6238987.
  • 13. Du Bois D, Du Bois EF. A formula to estimate the approximate surface area if height and weight be known. 1916. Nutrition. 1989;5:303-11; discussion 12-3. PMID: 2520314.
  • 14. Wang AY, Wang M, Lam CW, Chan IH, Zhang Y, Sanderson JE. Left ventricular filling pressure by Doppler echocardiography in patients with end-stage renal disease. Hypertension. 2008;52:107-14. PMID: 18474835.
  • 15. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. 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. J Am Soc Echocardiogr. 2010;23:685-713; quiz 86-8. PMID: 20620859.
  • 16. Anavekar NS, Skali H, Bourgoun M, Ghali JK, Kober L, Maggioni AP, et al. Usefulness of right ventricular fractional area change to predict death, heart failure, and stroke following myocardial infarction (from the VALIANT ECHO Study). Am J Cardiol. 2008;101:607-12. PMID: 18308007.
  • 17. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2012;8:597-619. PMID: 23066376.
  • 18. Altay H, Altın C, Coner A, Muderrisoglu H, Giray S. Parathyroid hormone and ischemic cerebrovascular event. Endoc Metab Immune Drug Targets. 2019; 19: 1134-1140. PMID: 30806331
  • 19. Stewart, S. A., Skomro, R., Reid, J., Penz, E., Fenton, M., Gjevre, J., & Cotton, D. (2015). Improvement in obstructive sleep apnea diagnosis and management wait times: A retrospective analysis of a home management pathway for obstructive sleep apnea. Canadian respiratory journal, 22(3), 167-170. DOI: 10.1155/2015/516580
  • 20. Altintas N, Aslan E, Helvaci A, Malhotra A. Relationship between obstructive sleep apnea severity index and left ventricular function and volume. Ann Saudi Med. 2012;32:384-90. PMID: 22705609.
  • 21. Xie S, Deng Y, Pan YY, Ren J, Jin M, Wang Y, et al. Chronic intermittent hypoxia induces cardiac hypertrophy by impairing autophagy through the adenosine 5'-monophosphate-activated protein kinase pathway. Arch Biochem Biophys. 2016;606:41-52. PMID: 27412517.
  • 22. Yu L, Li H, Liu X, Fan J, Zhu Q, Li J, et al. Left ventricular remodeling and dysfunction in obstructive sleep apnea : Systematic review and meta-analysis. Herz. 2019. DOI: 10.1007/s00059-019-04850-w
  • 23. Hedner J, Ejnell H, Caidahl K. Left ventricular hypertrophy independent of hypertension in patients with obstructive sleep apnoea. J Hypertens. 1990;8:941-6. PMID: 2174947.
  • 24. Kou S, Caballero L, Dulgheru R, Voilliot D, De Sousa C, Kacharava G, et al. Echocardiographic reference ranges for normal cardiac chamber size: results from the NORRE study. Eur Heart J Cardiovasc Imaging. 2014;15:680-90. PMCID: 4402333.
  • 25. Sajkov D, McEvoy RD. Obstructive sleep apnea and pulmonary hypertension. Prog Cardiovasc Dis. 2009;51:363-70. DOI: 10.1016/j.pcad.2008.06.001
  • 26. Dobrowolski P, Florczak E, Klisiewicz A, Prejbisz A, Rybicka J, Sliwinski P, et al. Pulmonary artery dilation indicates severe obstructive sleep apnea in patients with resistant hypertension: the Resist-POL Study. Pol Arch Med Wewn. 2016;126:222-9. PMID: 27129085.
  • 27. Dobrowolski P, Klisiewicz A, Florczak E, Prejbisz A, Bielen P, Sliwinski P, et al. Independent association of obstructive sleep apnea with left ventricular geometry and systolic function in resistant hypertension: the RESIST-POL study. Sleep Med. 2014;15:1302-8. PMID: 25260432.
  • 28. Vitarelli A, Terzano C, Saponara M, Gaudio C, Mangieri E, Capotosto L, et al. Assessment of Right Ventricular Function in Obstructive Sleep Apnea Syndrome and Effects of Continuous Positive Airway Pressure Therapy: A Pilot Study. Can J Cardiol. 2015;31:823-31. PMID: 25980631.
  • 29. Shivalkar B, Van de Heyning C, Kerremans M, Rinkevich D, Verbraecken J, De Backer W, et al. Obstructive sleep apnea syndrome: more insights on structural and functional cardiac alterations, and the effects of treatment with continuous positive airway pressure. J Am Coll Cardiol. 2006;47:1433-9. PMID: 16580533
There are 29 citations in total.

Details

Primary Language English
Subjects ​Internal Diseases
Journal Section Research Article
Authors

Deniz Demırcı 0000-0002-1571-7034

Duygu ersan Demirci 0000-0003-2696-1531

Ömer Tarık Selçuk 0000-0002-7364-7599

Publication Date July 12, 2020
Submission Date December 3, 2019
Acceptance Date January 30, 2020
Published in Issue Year 2020 Volume: 4 Issue: 2

Cite

Vancouver Demırcı D, Demirci D, Selçuk ÖT. Echocardiographic evaluation may provide more accurate patient selection for polysomnography in patients with obstructive sleep apnea: Predicting the severity of disease by echocardiography. Acta Med. Alanya. 2020;4(2):113-21.

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