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Assessment of pulmonary arterial stiffness in obstructive sleep apnea

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Abstract

Pulmonary hypertension (PH) is one of the major complications of obstructive sleep apnea syndrome (OSAS). Pulmonary arterial stiffness (PAS) can be used in determination of PH. The aim of the present study was to evaluate the PAS and cardiac function of patients with OSAS and analyses the relationship between OSAS severity and PAS. Sixty newly diagnosed patients with OSAS (mean age 49.6 ± 11.7 years) and 30 healthy controls (mean age 46.4 ± 14 years) were enrolled. Right ventricle (RV) and left ventricle (LV) echocardiographic parameters and PAS values of study groups were compared. There were no significant differences in terms of LV ejection fraction, LV Tei-index and tricuspid annular plane systolic excursion. PAS, mean pulmonary arterial pressure (PAP) and RV Tei-index were significantly higher but tricuspid annulus early diastolic myocardial velocity was lower in patients with OSAS than control subjects (respectively p < 0.001, p < 0.001, p = 0.001, p = 0.001). Moreover, we found a higher PAS in OSAS patients without PH compared to controls (p < 0.001). When we investigated the relationship between polysomnographic variables and echocardiographic parameters, we found positive correlations between apnea hypopnea index and total oxygen desaturation with PAS and mean PAP (r = 0.384, p < 0.001; r = 0.404, p < 0.001; r = 0.36, p < 0.001; r = 0.349, p = 0.001 respectively). PAS and mean PAP were increased in patients with OSAS. Pulmonary vascular bed may be affected due to the fluctuation of PAP during day and night time. Therefore, assessment of PAS can be more useful than PAP in OSAS patients.

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References

  1. Guilleminault C, Tilkian A, Dement WC (1976) The sleep apnea syndromes. Ann Rev Med 27:465–484

    Article  CAS  PubMed  Google Scholar 

  2. Somers VK, White DP, Amin R et al (2008) Sleep apnea and cardiovascular disease. Circulation 118:1080–1111. doi:10.1161/CIRCULATIONAHA.107.189375

    Article  PubMed  Google Scholar 

  3. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235

    Article  CAS  PubMed  Google Scholar 

  4. Minai OA, Ricaurte B, Kaw R, Hammel J, Mansour M, McCarthy K, Golish JA, Stoller JK (2009) Frequency and impact of pulmonary hypertension in patients with obstructive sleep apnea syndrome. Am J Cardiol 104:1300–1306. doi:10.1016/j.amjcard.2009.06.048

    Article  PubMed  Google Scholar 

  5. Chaouat A, Weitzenblum E, Krieger J, Oswald M, Kessler R (1996) Pulmonary hemodynamics in the obstructive sleep apnea syndrome. Results in 220 consecutive patients. Chest 109:380–386

    Article  CAS  PubMed  Google Scholar 

  6. Atwood CW Jr, McCrory D, Garcia JG, Abman SH, Ahearn GS, American College of Chest Physicians (2004) Pulmonary artery hypertension and sleep-disordered breathing: ACCP evidence-based clinical practice guidelines. Chest 126:72–77

    Article  Google Scholar 

  7. Sajkov D, McEvoy RD (2009) Obstructive sleep apnea and pulmonary hypertension. Prog Cardiovasc Dis 51:363–370. doi:10.1016/j.pcad.2008.06.001

    Article  PubMed  Google Scholar 

  8. Coccagna G, Mantovani M, Brignani F, Parchi C, Lugaresi E (1972) Continuous recording of the pulmonary and systemic arterial pressure during sleep in syndromes of hypersomnia with periodic breathing. Bull Physiopath Resp 8:1159–1172

    CAS  Google Scholar 

  9. Tilkian AG, Guilleminault C, Schroeder JS, Lehrman KL, Simmons FB, Dement WC (1976) Hemodynamics in sleep-induced apneas. Ann Intern Med 85:714–719

    Article  CAS  PubMed  Google Scholar 

  10. Weitzenblum E, Chaouat A (2005) Obstructive sleep apnea syndrome and the pulmonary circulation. Ital Heart J 6:795–798

    PubMed  Google Scholar 

  11. Pasierski TJ, Starling RC, Binkley PF, Pearson AC (1993) Echocardiographic evaluation of pulmonary artery distensibility. Chest 103:1080–1083

    Article  CAS  PubMed  Google Scholar 

  12. Gorgulu S, Eren M, Yildirim A, Ozer O, Uslu N, Celik S, Dağdeviren B, Nurkalem Z, Bağirtan B, Tezel T (2003) A new echocardiographic approach in assessing pulmonary vascular bed in patients with congenital heart disease: pulmonary artery stiffness. Anadolu Kardiyol Derg 3:92–97

    PubMed  Google Scholar 

  13. Berry RB, Budhiraja R, Gottlieb DJ et al (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. J Clin Sleep Med 8:597–619. doi:10.5664/jcsm.2172

    PubMed  PubMed Central  Google Scholar 

  14. Sciller NB, Shah PM, Crawford M et al (1989) Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. The American Society of Echocardiography Committee on Standards. Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr 2:358–367

    Article  Google Scholar 

  15. Isobe M, Yazaki Y, Takaku F, Koizumi K, Hara K, Tsuneyoshi H, Yamaguchi T, Machii K (1986) Prediction of pulmonary arterial pressure in adults by pulsed Doppler echocardiography. Am J Cardiol 57:316–321

    Article  CAS  PubMed  Google Scholar 

  16. Dabestani A, Mahan G, Gardin JM, Takenaka K, Burn C, Allfie A, Henry WL (1987) Evaluation of pulmonary artery pressure and resistance by pulsed Doppler echocardiography. Am J Cardiol 59:662–668

    Article  CAS  PubMed  Google Scholar 

  17. Hetzel M, Kochs M, Marx N, Woehrle H, Mobarak I, Hombach V, Hetzel J (2003) Pulmonary hemodynamics in obstructive sleep apnea: frequency and causes of pulmonary hypertension. Lung 181:157–166

    Article  CAS  PubMed  Google Scholar 

  18. Fisher MR, Forfia PR, Chamera E, Housten-Harris T, Champion HC, Girgis RE, Corretti MC, Hassoun PM (2009) Accuracy of Doppler echocardiography in the hemodynamic assessment of pulmonary hypertension. Am J Respir Crit Care Med 179:615–621

    Article  PubMed  PubMed Central  Google Scholar 

  19. Sajkov D, Wang T, Saunders NA, Bune AJ, Neill AM, McEvoy RD (1999) Daytime pulmonary hemodynamics in patients with obstructive sleep apnea without lung. Am J Respir Crit Care Med 159:1518–1526

    Article  CAS  PubMed  Google Scholar 

  20. Bradley TD, Rutherford R, Grossman RF, Lue F, Zamel N, Moldofsky H, Phillipson EA (1985) Role of daytime hypoxemia in the pathogenesis of right heart failure in the obstructive sleep apnea syndrome. Am Rev Respir Dis 131:835–839

    CAS  PubMed  Google Scholar 

  21. Sanner B, Konermann M, Saturm A, Müller HJ, Zidek W (1997) Right ventricular function in patients with obstructive sleep apnea. Eur Respir J 10:2079–2083

    Article  CAS  PubMed  Google Scholar 

  22. Altekin RE, Karakas MS, Yanikoglu A, Ozel D, Ozbudak O, Demir I, Deger N (2012) Determination of right ventricular dysfunction using the speckle tracking echocardiography method in patients with obstructive sleep apnea. Cardiol J 19:130–139

    Article  PubMed  Google Scholar 

  23. Fung JW, Li TS, Choy DK, Yip GW, Ko FW, Sanderson JE, Hui DS (2002) Severe obstructive sleep apnea is associated with left ventricular diastolic dysfunction. Chest 121:422–429

    Article  PubMed  Google Scholar 

  24. Altekin RE, Yanikoglu A, Baktir AO, Karakas MS, Ozel D, Cilli A, Yildirim AB, Yilmaz H, Yalcinkaya S (2012) Assessment of subclinical left ventricular dysfunction in obstructive sleep apnea patients with speckle tracking echocardiography. Int J Cardiovasc Imaging 28:1917–1930

    Article  PubMed  Google Scholar 

  25. Peng HH, Chung HW, Yu HY, Tseng WY (2006) Estimation of pulse wave velocity in main pulmonary artery with phase contrast MRI: preliminary investigation. J Magn Reson Imaging 24:1303–1310

    Article  PubMed  Google Scholar 

  26. Paz R, Mohiaddin RH, Longmore DB (1993) Magnetic resonance assessment of the pulmonary arterial trunk anatomy, flow, pulsatility and distensibility. Eur Heart J 14:1524–1530

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Gulay Ozkececi.

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Ozkececi, G., Ulasli, S.S., Akci, O. et al. Assessment of pulmonary arterial stiffness in obstructive sleep apnea. Int J Cardiovasc Imaging 32, 799–805 (2016). https://doi.org/10.1007/s10554-016-0841-0

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  • DOI: https://doi.org/10.1007/s10554-016-0841-0

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