The Function of the Right Ventricle and the Incidence of Pulmonary Hypertension in Patients with Obstructive Sleep Apnoea Syndrome

Česká verzia

Authors: E. Sovová ¹; M. Hobzová ²; J. Zapletalová ³; V. Kolek ²; J. Lukl ¹
Authors place of work: Ústav lékařské biofyziky LF UP Olomouc ¹; I. interní klinika LF UP a FN Olomouc ¹; Klinika plicních nemocí a tuberkulózy LF UP a FN Olomouc ²
Published in the journal: Cesk Slov Neurol N 2008; 71/104(3): 293-297
Category: Original Paper

Summary

The objective of the study was to evaluate the overall function of the right ventricle (RV) and to determine the incidence of pulmonary hypertension (PH) in patients diagnosed with moderate or severe obstructive sleep apnoea (OSA).

Set of patients and methods:
75 patients (of which 65 men) with an average age of 52.3 ± and OSA diagnosis were screened by an GE VIVID 7 echocardiograph (RV size, pulmonary artery acceleration time, pulmonary valve and tricuspidal valve regurgitation, the measurement of RV pressure and of RV systolic and diastolic speed using tissue Doppler echocardiography, and the determination of the TEI index of global RV function). The A group with moderate OSA consisted of 17 patients (of which 15 men) aged 54.6 ± 9.2 years, with body mass index (BMI) 33.6 ± 6.3 and oxygen (O₂) saturation at rest prior to examination (the ASTRUP method) 94.0 ± 2.4 %. The B group of patients with severe OSA consisted of 58 patients (of which 50 men) aged 51.7 ± 10.3 years, with BMI 35.1 ± 5.9 and O₂ saturation at rest prior to examination (the ASTRUP method) 93.0 ± 3.2 %. Other causes of pulmonary hypertension were excluded in the patients.

Results:
The A and B groups did not differ in terms of sex (p = 0.829), age (p = 0.283), arterial hypertension incidence (p = 0.741), BMI (p = 0.387), O₂ saturation at rest prior to examination (the ASTRUP method) (p = 0.158), or average O₂ saturation during sleep monitoring (p = 0.130). Pulmonary hypertension (pulmonary artery pressure over 30 mm Hg) was diagnosed in 5 patients (5 men), i.e. 6.6 %, the average value of systolic pressure being 34.8 mm Hg (32-37). All patients belonged in the B group. The value of the RV global function TEI index was pathological in 31 patients (41.3 %) of which 2 (11.7 %) were of the A and 29 (50 %) of the B group, respectively. There was a statistically significant difference between the groups in terms of the number of patients with a pathological value of the RV global function TEI index (p = 0.016). The average value of the global RV function TEI index was 0.31 ± 0.23 in the set, with 0.19 ± 0.13 in group A and 0.35 ± 0.24 in group B. There was a statistically significant difference in the values of the global RV function TEI index between groups A and B, its value being lower in group A (better right ventricle global function in the group with moderate OSA) (p = 0.011).

Conclusion:
The incidence of PH in patients with OSA is low. Patients with OSA are most often diagnosed with RV diastolic function disorder. Patients with severe OSA have worse results for global RV function determined with the use of the global RV function TEI index.

Key words:
obstructive sleep apnoea – pulmonary hypertension – global RV function TEI index

Zdroje

1. ATS/ACCP/AASM Taskforce Steering Committee. Executive summary on the systematic review and practice parameters for portable monitoring in the investigation of suspected sleep apnea in adults. Am J Respir Crit Care Med 2004; 169(10): 1160–1163.

2. Šonka K et al. Apnoe a další poruchy dýchání ve spánku. Praha: Grada Publishing 2004: 65–97.

3. Tkáčová R. Spánkové apnoe a ochorenia kardiovaskulárneho systému. Praha: Galén 2006: 68.

4. Young TB, Peppard P. Epidemiology of obstructive sleep apnea. In: McNicholas WT, Phillipson EA (Eds). Breathing disorders in sleep. Toronto: W.B. Saunders 2002: 31–43.

5. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep- disordered breathing and hypertension. N Engl J Med 2000; 342(19): 1378–1384.

6. Javaheri S. Sleep disorders in systolic heart failure: a prospective study of 100 male patients. Int J Cardiol 2006; 106(1): 21–28.

7. Nachtmann A, Stang A, Wang YM, Wondzinski E, Thilmann AF. Association of obstructive sleep apnea and stenotic artery disease in ischemic stroke patients. Atherosclerosis 2003; 169(2): 301–307.

8. Mohsenin V. Sleep-disordered breathing: implications in cerebrovascular disease. Prev Cardiol 2003; 6(3): 149–154.

9. Arias MA, Sanchez AM. Obstructive sleep apnea and its relationship to cardiac arrhythmias. J Cardiovascular Electrophysiol 2007; 18(9): 1006–1014.

10. Trefný M, Paleček T, Susa Z, Linhart A, Slavíček J, Trefný Z. Echokardiografické nálezy u syndromu spánkové apnoe. Cesk Slov Neurol N 2004; 67/100(4): 260–264.

11. Tei C. New non invasive index for combined systolic and diastolic ventricular function. J Cardiol 1995; 26(2): 135–136.

12. Paleček T, Linhart A, Dambrauskaite V. Echokardiografie a plicní vaskulární hypertenze. Kardiofórum 2005; 3(1): 11–20.

13. Meluzín J, Špinarová L, Bakala J, Toman J, Krejčí J, Hude P et al. Pulsed Doppler tissue imaging of the velocity of tricuspid annular sytolic motion, a new, rapid, and non invasive method of evaluating righ ventricular systolic function. Eur Heart J 2001; 22(4): 340–348.

14. Arias MA, García-Río F, Alonso- Fernández A, Martínez I, Villamor J. 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.

15. Yamakawa H, Shiomi T, Sasanabe R, Hasegawa R, Oottake K, Banno K et al. Pulmonary hypertension in patients with severe obstructive sleep apnea. Psychiatry Clin Neurosci 2002; 56(3): 311–312.

16. Chaouat A, Weitzenblum E, Krieger J, Oswald M., Kessler R. Pulmonary hemodynamics in the obstructive sleep apnea syndrome. Chest 1996; 109(2): 380–386.

17. 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 continous positive airway pressure. J Am Coll Cardiol 2006; 47(7): 1433–1439.

18. Sanner BM, Konermann M, Sturm A, Muller HJ, Zidek W. Right ventricular dysfunction in patients with obstructive sleep apnoea syndrome. Eur Respir J 1997; 10(9): 2079–2083.

19. Dursunoglu N, Dursunoglu D, Kilic M. Impact of obstructive sleep apnea on right ventricular global function: sleep apnea and myocardial perfromance index. Respiration 2005; 72(3): 278–284.

20. Dursunoglu N, Dursunoglu D, Ozkurt S, Gur S, Ozalp G, Evyapan F. Effects of CPAP on right myocardial performance index in obstructive sleep apnea patients without hypertension. Respir Res 2006; 7(1): 22.

21. Fung JW, Li TS, Choy DK, Yip GW, Ko FW, Sanderson JE et al. Severe obstructive sleep apnea is associated with left ventricular diastolic dysfunction. Chest 2002; 124(2): 422–429.

22. Moráň M, Kadaňka Z, Blatný M. Kvalita spánku u pacientů se syndromem spánkové apnoe a její ovlivnění léčbou trvalým přetlakem, vztah k hypertenzní chorobě. Cesk Slov Neurol N 2000; 63/96(4): 209–214.