Estrella Fernández-Fabrellas

Analysis of Echocardiographic Alterations Observed in Sleep Apnea-Hypopnea Syndrome and How They Are Influenced by Hypertension

INTRODUCTION AND OBJECTIVES Sleep apnea-hypopnea syndrome (SAHS) is associated with significant effects on the heart, which can be assessed using noninvasive methods such as transthoracic echocardiography. However, it is not clear whether these effects are due to the condition itself or are influenced by associated factors, such as high blood pressure (HBP). The objective of this study was to investigate the echocardiographic alterations observed in SAHS patients and how they are affected by the presence of concomitant HBP. METHODS The study involved 103 consecutive patients (49 with HBP and 54 without) with SAHS and an indication for continuous positive airways pressure treatment and 24 controls matched for age and body mass index. Doppler echocardiography was performed in a blinded manner. Both morphology (i.e., wall thickness, and diameters) and function (i.e., ejection fraction, peak E and A wave velocities, mitral deceleration time, and Tei index) were assessed. Results were compared using ANOVA and Bonferronis test. RESULTS Hypertensive patients had larger morphological changes characteristic of left ventricular hypertrophy (i.e., increased septal and posterior wall thicknesses) than nonhypertensive patients, who in turn had larger changes than controls (septal thickness: HBP-SAHS, 12 [2] mm; non-HBP SAHS, 11 [2] mm, and controls, 9.5 [5] mm; 1 vs. 2, P=.038; 1 vs. 3, P=.0001, 2 vs. 3, P=.034) (posterior wall thickness: HBP-SAHS, 11 [2] mm; non-HBP SAHS, 10 [1] mm, and controls, 9 [1.5] mm; 1 vs. 2, P=.5; 1 vs. 3, P=.0001; 2 vs. 3, P=.001). In addition, there were also greater changes in ventricular filling patterns on the left (HBP-SAHS, 92%; non-HBP SAHS, 72%, controls, 29%; P=.0001) and on the right (HBP-SAHS, 72%; non-HBP SAHS, 58%; controls, 25%; P=.001). There was a trend towards a larger left ventricular Tei index (HBP-SAHS, 0.56 [0.2]; non-HBP SAHS, 0.54 [0.12]; controls, 0.5 [0.1]; 1 vs. 2, P=.8; 1 vs. 3, P=.09; 2 vs. 3, P=.7). CONCLUSIONS From the time of diagnosis, SAHS was associated with left ventricular hypertrophy and impaired biventricular filling, even in the absence of concomitant HBP. The abnormalities observed were more severe when HBP was present.

Hypertension and sleep apnea–hypopnea syndrome: changes in echocardiographic abnormalities depending on the presence of hypertension and treatment with CPAP☆

INTRODUCTION Sleep apnea-hypopnea syndrome (SAHS) is an emerging disease with high prevalence. There is controversy as to whether cardiac abnormalities are due to the disease itself or to the arterial hypertension frequently associated with this disease. OBJECTIVES To analyze echocardiographic abnormalities in a population of SAHS patients depending on the presence or absence of hypertension at the time of diagnosis and after six months of treatment with continuous positive airway pressure (CPAP). METHODS We studied 85 consecutive patients diagnosed with SAHS who required treatment with CPAP (Hypertensive: 43, nonhypertensive: 42). We performed a baseline echocardiogram after six months of treatment. We analyzed morphological (wall thickness, diameters, ejection fraction) and functional (peak E- and A-wave velocities, deceleration time, Tei index) parameters of the left and right ventricles. RESULTS Hypertensive patients were older and had higher blood pressure values, but there were no differences between groups in other clinical parameters. The hypertensive group had greater septal thickness (hypertensive: 12.1+/-2.3; nonhypertensive: 10.8+/-2.1mm; p=0.01). There were also differences in impairment of left (hypertensiveHT: 92.9%, nonhypertensive: 65%, p=0.002) and right (hypertensive: 74.4%, nonhypertensive: 42.1%, p=0.006) ventricular filling. After six months of treatment, an improvement of the myocardial performance index was noted in nonhypertensive patients (baseline Tei: 0.55+/-0.1 vs. 6-month Tei: 0.49+/-0.1; p=0.01), whereas no significant change was observed in hypertensive patients. CONCLUSIONS Cardiac abnormalities in SAHS patients are increased in the presence of associated hypertension. Treatment with CPAP for six months improves cardiac abnormalities in nonhypertensive patients but not in hypertensive patients.

Alteraciones ecocardiográficas asociadas al síndrome de apnea-hipopnea del sueño en función de su gravedad

Introduccion y objetivos El sindrome de apnea-hipopnea del sueno (SAHS) es una enfermedad muy prevalente con repercusiones cardiovasculares conocidas. Sin embargo, son pocos los estudios ecocardiograficos publicados que evaluan estas alteraciones en el momento del diagnostico y su relacion con la gravedad del sindrome. Nuestro objetivo fue analizar parametros morfologicos, funcionales y de rendimiento miocardico en estos pacientes. Metodos Analizamos a 110 pacientes consecutivos diagnosticados, entre junio de 2005 y 2006, de SAHS con indicacion de presion positiva continua en la via aerea (CPAP), divididos en 2 grupos segun la gravedad. Realizamos una ecocardiografia basal y analizamos variables morfologicas y funcionales, comparando los resultados entre grupos mediante analisis univariable y multivariable. Resultados La muestra presentaba una edad media de 54 ± 13 anos, un indice de masa corporal de 32 ± 6, una comorbilidad del 51% y un porcentaje de varones del 74%. Los pacientes con SAHS grave (indice apnea-hipopnea [IAH] ≥ 30) presentaron mayor tabaquismo activo, consumo de alcohol y perimetro de cuello. No encontramos diferencias entre grupos al analizar los parametros morfologicos. En los parametros funcionales, los pacientes graves presentaron menor tiempo de eyeccion aortico (IAH Conclusiones El rendimiento miocardico esta disminuido en pacientes SAHS. Tanto el indice de Tei como los tiempos de eyeccion se asocian con gravedad. El tiempo de eyeccion pulmonar es una variable predictora independiente de gravedad de la enfermedad.

[Silent heart disease in patients with sleep apnea-hypopnea syndrome: usefulness of the myocardial performance index].

OBJECTIVE Sleep apnea-hypopnea syndrome (SAHS) is an emerging disease with considerable cardiovascular impact. The myocardial performance index (MPI) is an echocardiographic parameter that is useful in the assessment of global myocardial function. The purpose of this study was to identify any differences in the MPI between patients with and without SAHS. PATIENTS AND METHODS We studied 120 consecutive patients referred to our department for suspected SAHS. Following the overnight sleep study and after excluding all patients with hypertension, heart disease, or invalid recordings, 54 patients with SAHS and 13 patients without the disease matched for age and body mass were analyzed. A blinded cardiologist performed Doppler echocardiography, measuring parameters related to ventricular hypertrophy, systolic function, diastolic function, and the MPI. The data were compared by chi(2) and analysis of variance. RESULTS Mean (SD) ventricular mass was greater in patients with SAHS (183.17 [40.5] g) than in those without that diagnosis (149 [26] g) (P=.005). No differences were observed in systolic function (78.5% [8.95%] vs 81.6% [7%]) (P=.2), although a higher percentage of patients with SAHS had abnormal diastolic function (71.2% vs 38.5%) (P=.049). The MPI was significantly higher in SAHS patients (0.54 [0.12] vs 0.46 [0.07]) (P=.028). CONCLUSIONS On its own, SAHS leads to left ventricular hypertrophy. Diastolic involvement is common in these patients, although a large number of healthy individuals who are obese also present it. The MPI is higher in SAHS and could be a useful parameter to identify patients with silent heart disease before it progresses.