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

Yıl 2020, Cilt: 4 Sayı: 2, 113 - 121, 12.07.2020

Deniz Demırcı Duygu ersan Demirci Ömer Tarık Selçuk

https://doi.org/10.30565/medalanya.654444

Öz

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.

Anahtar Kelimeler

Ekokardiyografi,, tıkayıcı uyku apnesi,, polisomnogrefi,

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

Öz

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.

Anahtar Kelimeler

Obstrucitive Sleep Apnea,, Echocardiography,, Polysomnography,

Kaynakça

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