Tzu Chi Medical Journal
Volume 21, Issue 3 , Pages 210-217, September 2009

The Impact of Sleep Apnea on Conventional Doppler Indices

  • Ching-Chih Lee

      Affiliations

    • Department of Otolaryngology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
    • College of Medicine, Tzu Chi University, tiualien, Taiwan
    • ,
  • Chih-Wei Chen

      Affiliations

    • College of Medicine, Tzu Chi University, tiualien, Taiwan
    • Division of Cardiology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
    • Corresponding Author InformationCorresponding author. Division of Cardiology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, 2, Min-Sheng Road, Dalin, Chiayi, Taiwan

Received 5 February 2009; received in revised form 18 February 2009; accepted 21 April 2009.

Article Outline

Abstract 

Objective

To prospectively explore the impact of obstructive sleep apnea (OSA) on conventional Doppler indices and to identify possible negative prognostic factors for left ventricular diastolic dysfunction. Materials and Methods: All included subjects had overnight polysomnog-raphy. All subjects underwent a comprehensive echocardiography examination to evaluate systolic and diastolic function of the left ventricle. A multiple logistic regression model was created to identify potential negative prognostic factors for left ventricular dysfunction.

Results

A significant decrease in the ratio of early and atrial mitral flow velocity (E/A ratio) in OSA patients was found. Patients with moderate-to-severe OSA had a significant increase in the odds ratio for development of an abnormal E/A ratio (p=0.014, multivariate logistic regression). There was a significant negative correlation between E/A ratio and apnea-hypopnea index (p = 0.01). Non-obese OSA patients and obese-OSA patients carried significantly increased odds ratios for the development of a reduced E/A ratio (p = 0.02 and 0.038, respectively).

Conclusion

Subjects with OSA had reduced mitral E/A ratios, which implies possible impaired diastolic heart function. Further study to reverse impaired diastolic function via lifestyle modifications and treatment with nasal continuous positive airway pressure or surgery is warranted.

Keywords:  Diastolic function , Echocardiography , Obstructive sleep apnea

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. National Commission on Sleep Disorders Research  . Wake Up America: A National Sleep Alert . Washington, DC: National Commission on Sleep Disorders Research; 1993;
  2. Mooe T , Frankin KA , Wiklund U , Rabben T , Holmstrom K . Cardiac rhythm in patients with sleep-disordered breathing and coronary artery disease . Scand Cardiovasc J . 2000;34:272–276
  3. Dziewas R , Ritter M , Usta N , et al.   Atherosclerosis and obstructive sleep apnea in patients with ischemic stroke . Cerebrovas Dis . 2007;24:122–126
  4. Dahlof P , Norlin-Bagge E , Hedner J , Ejnell H , Hetta J , Hallstrom T . Improvement in neuropsychological performance following surgical treatment for obstructive sleep apnea syndrome . Acta Otolaryngol . 2002;122:86–91
  5. Leung RS , Bradley TD . Sleep apnea and cardiovascular disease . Am J Respir Crit Care Med . 2001;164:2147–2165
  6. Dursunoglu D , Dursunoglu N , Evrengul H , et al.   Impact of obstructive sleep apnea on left ventricular mass and global function . Eur Respir J . 2005;26:283–288
  7. Minoguchi K , Tazaki T , Yokoe T , et al.   Elevated production of tumor necrosis factor-{alpha} by monocytes in patients with obstructive sleep apnea syndrome . Chest . 2004;126:1473–1479
  8. Borbely A , van der Velden J , Papp Z , et al.   Cardiomyocyte stiffness in diastolic heart failure . Circulation . 2005;111:774–781
  9. Heymans S , Schroen B , Vermeersch P , et al.   Increased cardiac expression of tissue inhibitor of metalloproteinase-1 and tissue inhibitor of metalloproteinase-2 is related to cardiac fibrosis and dysfunction in the chronic pressure-overloaded human heart . Circulation . 2005;112:1136–1144
  10. Tazaki T , Minoguchi K , Yokoe T , et al.   Increased levels and activity of matrix metalloproteinase-9 in obstructive sleep apnea syndrome . Am J Respir Crit Care Med . 2004;170:1354–1359
  11. Virolainen J , Ventila M , Turto H , Kupari M . Effect of negative intrathoracic pressure on left ventricular pressure dynamics and relaxation . J Appl Physiol . 1995;79:455–460
  12. Chami HA , Devereux RB , Gottdiener JS , et al.   Left ventricular morphology and systolic function in sleep-disordered breathing: the Sleep Heart Health Study . Circulation . 2008;117:2599–2607
  13. Paulus WJ , Tschope C , Sanderson JE , et al.   How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the heart failure and echocardiography associations of the European Society of Cardiology . Eur Heart J . 2007;28:2539–2550
  14. Niroumand M , Kuperstein R , Sasson Z , Hanly PJ . Impact of obstructive sleep apnea on left ventricular mass and diastolic function . Am J Respir Crit Care Med . 2001;163:1632–1636
  15. Arias MA , Garcia-Rio F , Alonso-Fernandez A , Mediano O , Martinez I , Villamor J . Obstructive sleep apnea syndrome affects left ventricular diastolic function: effects of nasal continuous positive airway pressure in men . Circulation . 2005;112:375–383
  16. Kim SH , Cho GY , Shih C , et al.   Impact of obstructive sleep apnea on left ventricular diastolic function . Am J Cardiol . 2008;101:1663–1668
  17. Cohn JN , Ferrari R , Sharpe N . Cardiac remodeling— concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. Behalf of an International Forum on Cardiac Remodeling . J Am Coll Cardiol . 2000;35:569–582
  18. Brinker JA , Weiss JL , Lappe DL , et al.   Leftward septal displacement during right ventricular loading in man . Circulation . 1980;61:626–633

PII: S1016-3190(09)60041-0

doi:10.1016/S1016-3190(09)60041-0

Tzu Chi Medical Journal
Volume 21, Issue 3 , Pages 210-217, September 2009

Article Tools