Povezanost težine sindroma prestanka disanja u toku spavanja i regionalne i globalne sistolne i dijastolne funkcije srčanih komora
Correlation of the breathing cessation syndrome severity during sleep and regionl and global systolic and diastolic function of heart chambers
Author
Popović-Lisulov, Danica P.Mentor
Krotin, MirjanaCommittee members
Vukčević, MiodragMatić, Mihailo
Dekleva, Milica
Zdravković, Marija
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Uvod: Opstruktivna apneja u spavanju (OSA) pogadja 5-15% odraslog stanovništva u
razvijenim zemljama. Glavne karakteristike su ponavljajuće apneje ili hipopneje izazvane
opstrukcijom gornjih disajnih puteva tokom spavanja. Prema dosadašnjim saznanjima OSA
na jedinstven način pokreće niz patofizioloških promena koje dovode do akutnih i
hroničnih kardiovaskularnih poremećaja. Hipoksija i hiperkapnija, kompenzatorna
aktivacija simpatićkog nervnog sistema i oksidativni stres dovode do ishemije miokarda.
Ciljevi rada: Ciljevi studije su bili da se ispita prevalenca i povezanost stepena težine
sindroma OSA sa pojavom inicijalne dijastolne i sistolne disfunkcije srčanih komora i da se
ispita odnos dijastolne funkcije i stepena endotelne disfunkcije u bolesnika sa sindromom
prestanka disanja u toku spavanja.
Materijal i metode: 161 ispitanika sa normalnom ejekcionom frakcijom kojima je
isključena koronarna bolest i sa novo dijagnostikovanim sindromom prestanka disanja u
toku spavanja (OSAS) su... bili prospektivno uključivani u studiju. Kontrolna grupa se
sastojala od 81 asimptomatičnih zdravih ispitanika. Svim ispitanicima je urađena
polisomnografija i standardni ehokardiografski i Doppler pregled, i pregled pulsnim
tkivnim Dopplerom (TDI). Ispitivanje stepena endotelne disfunkcije metodom
vazodilatacije brahijalne arterije izazvane protokom urađeno je kod svih ispitanika OSAS
grupe, sa i bez dijabetesa, i kontrolne grupe.
Rezultati: Prevalenca poremećaja regionalne sistolne funkcije leve komore je nađena u
65.22%. ispitanika, globalne sistolne funkcije desne komore u 19.87% ispitanika.
Prevalenca inicijalnih poremećaja regionalne sistolne funkcije desne komore je nadjena u
39.13% ispitanika. Prevalenca inicijalnih poremećaja globalne dijastolne funkcije leve
komore je nađena u 44.10% ispitanika, prevalenca poremećaja regionalne dijastolne
funkcije leve komore je nadjena u 66,45% ispitanika. Prevalenca globalne dijastolne
funkcije desne komore je nađena u 17.40% ispitanika. Prevalenca inicijalnih poremećaja
regionalne dijastolne funkcije desne komore 47.82% ispitanika. Dimenzije leve komore
(LVEDD, LVESD, IVS i PW), leve pretkomore i LAVI, dimenzije desne pretkomore i komore (RA, RV) su bile veće u ispitanika OSAS grupe...
Introduction: Opstructive sleep apnea (OSA) affects 5-15% of adult population in
developed countries. Main characteristics of OSA are repeated apneas or hypopneas caused
by the opstruction of upper respiratory tracts during sleep. To our current knowledge, OSA
in a specific manner, triggers a range of pathophysiological changes that lead to acute and
chronic cardiovascular disorders. Hypoxia and hypercapnia, compensatory activation of
sympathic nervous system and oxidative stress lead to myocardial ischemia.
Aims of the Study: The aims of the study were to investigate the prevalence and relation of
OSA syndrome severity degree with the incidence of initial diastolic and systolic
dysfunction of heart chambers and to study the relation of diastolic function and endothelial
dysfunction degree in patients with breathing cessation syndrome during sleep.
Material and Methods: 161 studied individulas with normal ejection fraction without
coronary disease and with the newly diagnosed breathing... cessation syndrome during sleep
(OSAS) were prospectively included in the study. The control group consisted of 81
asymptomatic healthy individuals. All studied individuals have undergone the complete
night polysomnography and complete standard transthoracal echocardiographyc and
Doppler examination, as well as the pulse tissue Doppler (TDI) examination. The
examination of the endothelial dysfunction degree by the method of brachial artery
vasodilatation caused by the flow was conducted in all studied indiviadulas of OSAS
group, with and without diabetes, and in individuals of control group.
Results: The prevalence of regional systolic function of left chamber disturbance was found
in 65.22%. of studied individuals, and of global systolic function of right chamber
disturbance in 19.87% of studied individulas. The prevalence of initial disturbances in
regional systolic function of right chamber was found in 39.13% of studied individuals. The
prevalence of initial disturbances in global diastolic function of left chamber detected by
conventional pulse Doppler was found in 44.10% of studied individuals, the prevalence of
disturbances in regional diastolic function of left chamber detected by Tissue Doppler was
found in 66.45% of studied individuals. The prevalence of global diastolic function of right
chamber disturbances detected by conventional pulse Doppler was found in 17.40% of
studied individuals...