SAĞLIKLI BİREYLERDE SİMÜLE OBSTRÜKTİF APNEDE ATRİYAL ELEKTROMEKANİK GECİKMENİN DEĞERLENDİRİLMESİ

Öz

Amaç: Çalışmalar, obstrüktif uyku apnesinin, atriyal fibrilasyon gibi artmış disritmi riskine işaret ettiğini ileri sürmektedir. Atriyal elektriksel aktivitenin başlangıcı ile atriyal kontraksiyonun başlangıcı arasındaki zaman aralığı, atriyal elektromekanik gecikme olarak tanımlanmış ve uzamış atriyal elektromekanik gecikme, atriyal fibrilasyonun bir prediktörü olarak önerilmiştir. Bu çalışmanın amacı, solunum manevraları yoluyla obstrüktif uyku apnesini simüle ederek atriyal elektromekanik gecikme üzerindeki akut etkilerini değerlendirmektir.

Gereç ve Yöntemler: Çalışmaya toplam 50 sağlıklı birey dahil edildi ve simüle edilmiş obstrüktif apne (Mueller manevrası), istemli ekspirasyon sonu santral apne ve normal solunum esnasında doku Doppler görüntüleri kaydedildi. Bu kayıtlardan intra-atriyal ve interatriyal elektromekanik gecikme ölçüldü.

Bulgular: Tüm sağlıklı deneklerde Mueller manevrası ve istemli ekspirasyon sonu santral apne sırasında interatriyal elektromekanik gecikme (Mueller Manevrası sırasında + 10.1ms; istemli ekspirasyon sonu santral apne sırasında + 8.7ms; p <0.001) ve sol intra-atriyal elektromekanik gecikme (Mueller Manevrası sırasında +7.3 ms; istemli ekspirasyon sonu santral apne sırasında + 6.7ms; p <0.001) normal solunumla karşılaştırıldığında arttı.

Sonuç: Simüle edilmiş obstrüktif uyku apnesi, sağlıklı deneklerde intra-atriyal ve interatriyal elektromekanik gecikmeyi artırdı. Bu bulgular, obstrüktif uyku apnesindeki akut intratorasik basınç değişikliğinin atriyal fibrilasyonun bağımsız bir tetikleyicisi olabileceğini gösterebilir.

Anahtar Kelimeler

• Atriyal Elektromekanik Gecikme
• Atrial fibrilasyon
• Obstrüktif uyku apnesi

Evaluation of Atrial Electromechanical Delay in Simulated Obstructive Apnea in Healthy Individuals

Öz

Objective: Studies have suggested that obstructive sleep apnea portends an increased risk of dysrhythmia, such as atrial fibrillation. The time interval between the onset of atrial electrical activity and the onset of atrial contraction has been defined as atrial electromechanical delay, and prolonged atrial electromechanical delay has been proposed as a predictor of atrial fibrillation. The aim of this study is to simulate obstructive sleep apnea through respiratory maneuvers to evaluate its acute effects on atrial electromechanical delay.

Material and Methods: A total of 50 healthy individuals were included in the study and tissue Doppler images were recorded during simulated obstructive apnea (Mueller maneuver, voluntary end-expiratory central apnea and normal breathing. From these recordings intra-atrial and interatrial electromechanical delay were measured.

Results: Interatrial electromechanical delay (+10.1ms during Mueller maneuver; +8.7ms during voluntary end-expiratory central apnea; p<0.001) and left intra-atrial electromechanical delay (+7.3 ms during Mueller maneuver; +6.7ms during voluntary end-expiratory central apnea; p<0.001) increased during Mueller maneuver and voluntary end-expiratory central apnea compared to normal breathing in all healthy subjects.

Conclusion: Simulated obstructive sleep apnea increased intra-atrial and interatrial electromechanical delay in healthy subjects. These findings may indicate that acute intrathoracic pressure change in obstructive sleep apnea may be an independent trigger of atrial fibrillation.

Anahtar Kelimeler

• Atrial fibrillation
• Obstructive sleep apnea
• Atrial Electromechanical Delay

Kaynakça

1. 1. Stradling J, Crosby J. Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men. Thorax. 1991;46(2):85-9.
2. 2. Redline S, Yenokyan G, Gottlieb DJ, Shahar E, O'Connor GT, Resnick HE et al. Obstructive sleep apnea–hypopnea and incident stroke: the sleep heart health study. Am J Respir Crit Care Med. 2010;182(2):269-77.
3. 3. Gami AS, Howard DE, Olson EJ, Somers VK. Day–night pattern of sudden death in obstructive sleep apnea. NEJM. 2005;352(12):1206-14.
4. 4. Zamagni M, Sforza E, Boudewijns A, Petiau C, Krieger J. Respiratory effort: A factor contributing to sleep propensity in patients with obstructive sleep apnea. Chest. 1996;109(3):651-8.
5. 5. Somers VK, Dyken ME, Clary MP, Abboud FM. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest. 1995;96(4):1897-904.
6. 6. Yokoe T, Minoguchi K, Matsuo H, Oda N, Minoguchi H, Yoshino G et al. Elevated levels of C-reactive protein and interleukin-6 in patients with obstructive sleep apnea syndrome are decreased by nasal continuous positive airway pressure. Circulation. 2003;107(8):1129-34.
7. 7. Ip MS, Tse HF, Lam B, Tsang KW, Lam WK. Endothelial function in obstructive sleep apnea and response to treatment. Am J Respir Crit Care Med. 2004;169(3):348-53.
8. 8. Alonso-Fernández A, García-Río F, Arias MA, Hernanz Á, de la Peña M, Pierola J et al. Effects of CPAP on oxidative stress and nitrate efficiency in sleep apnoea: a randomised trial. Thorax. 2009;64(7):581-6.

9. 9. Wang K, Xiao HB, Fujimoto S, Gibson DG. Atrial electromechanical sequence in normal subjects and patients with DDD pacemakers. Heart. 1995;74(4):403-7.
10. 10. Özer N, Yavuz B, Can I, Atalar E, Aksöyek S, Övünç K et al. Doppler tissue evaluation of intra-atrial and interatrial electromechanical delay and comparison with P-wave dispersion in patients with mitral stenosis. J Am Soc Echocardiogr. 2005;18(9):945-8.
11. 11. Gami AS, Hodge DO, Herges RM, Olson EJ, Nykodym J, Kara T et al. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J Am Coll Cardiol. 2007;49(5):565-71.
12. 12. Kanagala R, Murali NS, Friedman PA, Ammash NM, Gersh BJ, Ballman KV et al. Obstructive sleep apnea and the recurrence of atrial fibrillation. Circulation. 2003;107(20):2589-94.
13. 13. Acar G, Akcay A, Sokmen A, Ozkaya M, Guler E, Sokmen G et al. Assessment of atrial electromechanical delay, diastolic functions, and left atrial mechanical functions in patients with type 1 diabetes mellitus. J Am Soc Echocardiogr. 2009;22(6):732-8.
14. 14. Roshanali F, Mandegar MH, Yousefnia MA, Alaeddini F, Saidi B. Prevention of atrial fibrillation after coronary artery bypass grafting via atrial electromechanical interval and use of amiodarone prophylaxis. Interact Cardiovasc Thorac Surg. 2009;8(4):421-5.
15. 15. Linz D, Schotten U, Neuberger H-R, Böhm M, Wirth K. Negative tracheal pressure during obstructive respiratory events promotes atrial fibrillation by vagal activation. Heart Rhythm. 2011;8(9):1436-43.
16. 16. Somers VK, Dyken ME, Skinner JL. Autonomic and hemodynamic responses and interactions during the Mueller maneuver in humans. J Auton Nerv Syst. 1993;44(2-3):253-9.
17. 17. Yagmur J, Yetkin O, Cansel M, Acikgoz N, Ermis N, Karakus Y et al. Assessment of atrial electromechanical delay and influential factors in patients with obstructive sleep apnea. Sleep Breath. 2012;16(1):83-8.
18. 18. Schotten U, Verheule S, Kirchhof P, Goette A. Pathophysiological mechanisms of atrial fibrillation: a translational appraisal. Physiol Rev. 2011;91(1):265-325.