Povezanost težine sindroma prestanka disanja u toku spavanja i regionalne i globalne sistolne i dijastolne funkcije srčanih komora

Abstract

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...