CARDIAC-HYPERTROPHY IN OBSTRUCTIVE SLEEP-APNEA SYNDROME

被引：127

作者：

NODA, A ^{[1
]}

OKADA, T ^{[1
]}

YASUMA, F ^{[1
]}

NAKASHIMA, N ^{[1
]}

YOKOTA, M ^{[1
]}

机构：

[1] NAGOYA UNIV HOSP,COLL MED TECHNOL,DEPT CLIN LAB MED,CARDIOVASC DIS SECT,SHOWA KU,NAGOYA,AICHI 466,JAPAN

来源：

CHEST | 1995年 / 107卷 / 06期

关键词：

HYPERTENSION; HYPOXIA; LEFT VENTRICULAR HYPERTROPHY; RIGHT VENTRICULAR HYPERTROPHY; SLEEP APNEA;

D O I：

10.1378/chest.107.6.1538

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Fifty-one middle-aged male patients with obstructive sleep apnea syndrome (OSAS) were evaluated using two-dimensional echocardiography, 24-h blood pressure measurements, polysomnography, and plasma norepinephrine (NE) measurements. Among these patients,left ventricular hypertrophy (LVH) (left ventricular posterior wall thickness [LVPWT] or interventricular septal thickness [IVST] greater than or equal to 12 mm) and right ventricular hypertrophy (RVH) (right ventricular wall thickness [RVT] greater than or equal to 5 mm) were present in 41.2% (21/51) and 11.8% (6/51). LVH was present in 50.0% of group 2 patients (apnea index greater than or equal to 20) and in 30.5% of group 1 patients (apnea index <20). All patients with LVH had hypertension. RVH was present in 21.4% of group 2 patients and none of the group I patients. IVST, LVPWT, LV mass, LV mass/body surface area (BSA), and obesity index were significantly greater in group 2 than in group 1. Apnea index and the duration in which nocturnal oxygen saturation was decreased under 90% (duration of SaO(2) <90%), were significantly correlated with LV mass/BSA and 24-h mean blood pressure. Apnea index, number of apneas, duration of nocturnal oxygen saturation less than 90%, weight, and obesity index were significantly greater in patients with both LVH and RVH than in patients without LVH and RVH, or those with only LVH. Plasma NE after waking significantly increased compared with that before sleep (p<0.05). The ratio of plasma NE levels after waking to those before sleep was significantly correlated with the duration of SaO(2) <90% (r=0.83, p<0.05), but not with apnea index. These results suggest that frequent episodes of oxygen desaturation and/or arousal responses caused by apnea may contribute to the complication of LVH and RVH in the long term, and apnea-induced cyclical increases in blood pressure and the resulting sustained elevation in blood pressure associated with the increase in afterload and sympathetic activity may play a role in the development of LVH.

引用

页码：1538 / 1544

页数：7

共 45 条

[1]

Feigenbaum H, pp. 538-540, (1994)

[2]

Levy D, Garrison RJ, Savage DD, Et al., Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study, N Engl J Med, 322, pp. 1561-1566, (1990)

[3]

Guilleminault C, Natural history, cardiac impact, and long-term follow-up of sleep apnea syndrome, pp. 107-125, (1983)

[4]

Peter JH, Sleep apnea and cardiovascular diseases, pp. 81-98, (1990)

[5]

Noda A, Okada T, Hayashi H, Et al., 24-hour ambulatory blood pressure variability in obstructive sleep apnea syndrome, Chest, 103,5, pp. 1343-1347, (1993)

[6]

Somers VK, Dyken ME, Mark AL, Et al., Autonomic and hemodynamic responses during sleep in normal and sleep apneic humans, Clin Res, 39, (1991)

[7]

Bernman EJ, DiBenedetto R, Causey DE, Et al., Right ventricular hypertrophy detected by echocardiography in patients with newly diagnosed obstructive sleep apnea, Chest, 100, pp. 347-350, (1991)

[8]

Sajkov D, Cowie RJ, Thornton AT, Et al., Pulmonary hypertension and hypoxemia in obstructive sleep apnea syndrome, Am J Respir Crit Care Med, 149, pp. 416-422, (1994)

[9]

Weitzenblum E, Krieger J, Apprill M, Et al., Daytime pulmonary hypertension in patients with obstructive sleep apnea syndrome, Am Rev Respir Dis, 138, pp. 345-349, (1988)

[10]

Bradley TD, Rutherford R, Grossman RF, Et al., Role of daytime hypoxemia in the pathogenesis of right heart failure in the obstructive sleep apnea syndrome, Am Rev Respir Dis, 131, pp. 835-839, (1985)

← 1 2 3 4 5 →