Left ventricular diastolic function in patients with obstructive sleep apnoea syndrome and obesity

I. A. Andreieva; O. I. Tokarenko

doi:10.15421/021760

I. A. Andreieva Zaporizhia Medical Academy of Post-Graduate Education Ministry of Health of Ukraine http://orcid.org/0000-0002-7959-992X
O. I. Tokarenko Zaporizhia Medical Academy of Post-Graduate Education Ministry of Health of Ukraine http://orcid.org/0000-0002-3865-7441

Keywords: dystolic dysfunction, echocardiography, overweight, chronic disease

Abstract

Obstructive sleep apnea syndrome (OSAS) is a chronic disease characterized by recurrent episodes of complete or partial obstruction of the upper airways during sleep and results in sleep fragmentation, night hypoxemia, and daytime sleepiness. The aim of this study was to investigate the state of left ventricular diastolic function in patients with first diagnosed COAS and obesity and to define the determinants of diastolic dysfunction in this category of patients. There were 46 patients (33 men and 13 women) with OSAS and obesity and 52 patients with obesity without OSAS enrolled in the study. The control group included 22 practically healthy individuals. Each patient underwent assessment of body mass index (BMI), 24-hour ambulatory blood pressure monitoring, cardiorespiratory monitoring, transthoracic echocardiography. We found that patients with OSAS and obesity had significant impairment of diastolic function in comparison with patients with obesity without OSAS, which manifested itself in decreasing of E/A ratio, increasing deceleration time and increasing isovolumic relaxation time. Increasing body mass index and increasing level of hypoxia lead to impairment of diastolic dysfunction. Diastolic dysfunction was diagnosed in 4 obese patients without OSAS and in 17 patients with OSAS and obesity. All patients with diastolic dysfunction had second or third stage obesity and severe OSAS. Left ventricular hypertrophy was diagnosed in 9 patients with OSAS and obesity. Patients with concentric hypertrophy had significantly lower E/A in comparison with patients without hypertrophy or with concentric remodeling. We found that the deceleration time has positive correlation with body mass index and desaturation index and negative correlation with min SaO2. Isovolumic relaxation time correlated only with desaturation index. According to the results of univariable regression analysis, five variables were allocated: body mass index, age, desaturation index, index apnea-hypopnea and left ventricular mass index. The multivariate analyses, after adjustment for age and sex and stepwise regression, showed that only the desaturation index was an independent predictor of left ventricular diastolic dysfunction in patients with OSAS and obesity. Obstructive sleep apnea syndrome combined with obesity leads to a deterioration of the diastolic function of the left ventricle even in patients without cardio-vascular diseases. The state of the diastolic function of the left ventricule worsens with an increase in the severity of hypoxic disorders in the syndrome of obstructive sleep apnea and with the degree of obesity. In multivariate regression analysis, the desaturation index was a predictor of left ventricular diastolic dysfunction in patients with obstructive sleep apnea syndrome and obesity.

References

Altintas, N., Aslan, E., Helvaci, A., & Malhotra, A. (2012). Relationship between obstructive sleep apnea severity index and left ventricular function and volume. Annals of Saudi Medicine, 32(4), 384–390.

Baguet, J., Barone-Rochette, G., Tamisier, R., Levy, P., & Pépin, J. (2012). Mechanisms of cardiac dysfunction in obstructive sleep apnea. Nature Reviews Cardiology, 9(12), 679–688.

Bibra, H., Paulus, W., & St. John Sutton, M. (2016). Cardiometabolic syndrome and increased risk of heart failure. Current Heart Failure Reports, 13(5), 219–229.

Bodez, D., Damy, T., Soulat-Dufour, L., Meuleman, C., & Cohen, A. (2016). Consequences of obstructive sleep apnoea syndrome on left ventricular geometry and diastolic function. Archives of Cardiovascular Diseases, 109(8–9), 494–503.

Bodez, D., Lang, S., Meuleman, C., Boyer-Châtenet, L., Nguyen, X., Soulat-Dufour, L., Boccara, F., Fleury, B., & Cohen, A. (2015). Left ventricular dia stolic dysfunction in obstructive sleep apnoea syndrome by an echocardio graphic standardized approach: An observational study. Archives of Cardiovascular Diseases, 108(10), 480–490.

Danica, L., Krotin, M., Zdravkovic, M., Soldatovic, I., Zdravkovic, D., Brajkovic, M., Gardijan, V., Saric, J., Pokrajac, R., Lovic, D., Stevanovic, P., Gajic, M., & Vukcevic, M. (2014). Early left ventricular systolic and diastolic dysfunc tion in patients with newly diagnosed obstructive sleep apnoea and normal left ventricular ejection fraction. The Scientific World Journal, 2014, 1–7.

Hamilton, G. S., & Joosten, S. A. (2017) Obstructive sleep apnoea and obesity. Australian Family Physician, 46(7), 460–463.

Heinzer, R., Vat, S., Marques-Vidal, P., Marti-Soler, H., Andries, D., Tobback, N., Mooser, V., Preisig, M., Malhotra, A., Waeber, G., Vollenweider, P., Tafti, M., & Haba-Rubio, J. (2015). Prevalence of sleep-disordered breathing in the general population: The HypnoLaus study. The Lancet Respiratory Medicine, 3(4), 310–318.

Johns, M. (1993). Daytime sleepiness, snoring, and obstructive sleep apnea. Chest, 103(1), 30–36.

Jordan, A., McSharry, D., & Malhotra, A. (2014). Adult obstructive sleep apnoea. The Lancet, 383(9918), 736–747.

Korcarz, C., Peppard, P., Young, T., Chapman, C., Hla, K., Barnet, J., Hagen, E., & Stein, J. (2016). Effects of obstructive sleep apnea and obesity on cardiac remodeling: The Wisconsin sleep cohort study. Sleep, 39(6), 1187–1195.

Leopoldo, A., Sugizaki, M., Lima-Leopoldo, A., do Nascimento, A., Luvizotto, R., de Campos, D., Okoshi, K., Pai-Silva, M., Padovani, C., & Cicogna, A. (2010). Cardiac remodeling in a rat model of diet-induced obesity. Canadian Journal of Cardiology, 26(8), 423–429.

Maeder, M., Schoch, O., & Rickli, H. (2016). A clinical approach to obstructive sleep apnea as a risk factor for cardiovascular disease. Vascular Health and Risk Management, 85–103.

Mansukhani, M. P., Kolla, B. P., & Ramar, K. (2014). International classification of sleep disorders 2 and American Academy of Sleep Medicine practice parameters for central sleep apnea. Sleep Medicine Clinics, 9(1), 1–11.

Nagueh, S. F., Appleton, C. P., & Gillebert, T. C. (2009). CME test for Recom mendations for the evaluation of left ventricular diastolic function in echocardiography. Journal of the American Society of Echocardiography, 22(2), 208–209.

Ong, C., O’Driscoll, D., Truby, H., Naughton, M., & Hamilton, G. (2013). The reciprocal interaction between obesity and obstructive sleep apnoea. Sleep Medicine Reviews, 17(2), 123–131.

Patinkin, Z., Feinn, R., & Santos, M. (2017). Metabolic consequences of obstructive sleep apnea in adolescents with obesity: A systematic literature review and meta-analysis. Childhood Obesity, 13(2), 102–110.

Peppard, P. E., Young, T., Barnet, J. H., Palta, M., Hagen, E. W., & Hla, K. M. (2013). Increased prevalence of sleep-disordered breathing in adults. American Journal of Epidemiology, 177(9), 1006–1014.

Qaseem, A., Dallas, P., Owens, D. K., Starkey, M., Holty, J.-E. C., & Shekelle, P. (2014). Diagnosis of obstructive sleep apnea in adults: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 161(3), 210.

Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging (2014). European Heart Journal – Cardiovascular Imaging, 17(4), 412–412.

Reis, J., Allen, N., Gibbs, B., Gidding, S., Lee, J., Lewis, C., Lima, J., Lloyd-Jones, D., Loria, C., Powell-Wiley, T., Sharma, S., Wei, G., & Liu, K. (2014). Association of the degree of adiposity and duration of obesity with measures of cardiac structure and function: The CARDIA study. Obesity, 22(11), 2434–2440.

Rider, O., Lewis, A., & Neubauer, S. (2014). Structural and metabolic effects of obesity on the myocardium and the aorta. Obesity Facts, 7(5), 329–338.

Senaratna, C., Perret, J., Lodge, C., Lowe, A., Campbell, B., Matheson, M., Ha milton, G., & Dharmage, S. (2017). Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep Medicine Reviews, 34, 70–81.

Sharma, N., Lee, J., Youssef, I., Salifu, M., & McFarlane, S. (2017). Obesity, cardiovascular disease and sleep disorders: Insights into the rising epidemic. Journal of Sleep Disorders and Therapy, 6(1), 260

Sia, C., Hong, Y., Tan, L., van Dam, R., Lee, C., & Tan, A. (2017). Awareness and knowledge of obstructive sleep apnea among the general population. Sleep Medicine, 36, 10–17.

Usui, Y., Takata, Y., Inoue, Y., Tomiyama, H., Kurohane, S., Hashimura, Y., Kato, K., Saruhara, H., Asano, K., Shiina, K., & Yamashina, A. (2013). Severe obstructive sleep apnea impairs left ventricular diastolic function in non-obese men. Sleep Medicine, 14(2), 155–159.

Vrints, H., Shivalkar, B., Heuten, H., Vanderveken, O., Hamans, E., Van de Heyning, P., De Backer, W., & Verbraecken, J. (2013). Cardiovascular mechanisms and consequences of obstructive sleep apnoea. Acta Clinica Belgica, 68(3), 169–178.

Wachter, R., Lüthje, L., Klemmstein, D., Lüers, C., Stahrenberg, R., Edelmann, F., Holzendorf, V., Hasenfuß, G., Andreas, S., & Pieske, B. (2012). Impact of obstructive sleep apnoea on diastolic function. European Respiratory Journal, 41(2), 376–383.

Wang, J., Zhang, H., Wu, C., Han, J., Guo, Z., Jia, C., Yang, L., Hao, Y., Xu, K., Liu, X., & Si, J. (2015). Correlation of left ventricular diastolic function and left ventricular geometry in patients with obstructive sleep Apnoea Syndrome. West Indian Medical Journal, 64(2), 92–98.

Wang, Y., Liang, C., Gopal, D., Ayalon, N., Donohue, C., Santhanakrishnan, R., Sandhu, H., Perez, A., Downing, J., Gokce, N., Colucci, W., & Ho, J. (2015). Preclinical systolic and diastolic dysfunctions in metabolically healthy and unhealthy obese individuals clinical perspective. Circulation: Heart Failure, 8(5), 897–904.