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Thammaiah SH, Sreenath RH, Kumararadhya GB, Babu N, Archana K. Preoperative STOP-BANG questionnaire to predict difficult airway in undiagnosed obstructive sleep apnea patients undergoing elective gynecological surgeries under general endotracheal anesthesia: A prospective observational study. Ann Afr Med 2023; 22:520-525. [PMID: 38358155 PMCID: PMC10775942 DOI: 10.4103/aam.aam_2_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/05/2023] [Accepted: 05/03/2023] [Indexed: 02/16/2024] Open
Abstract
Background STOP-BANG questionnaire is an established tool for obstructive sleep apnea (OSA) screening. Its utility in predicting difficult airway has not been evaluated. We intend to assess difficulty in airway management and associated perioperative complications in patients with undiagnosed OSA using the STOP-BANG questionnaire. Materials and Methods We performed a prospective observational study on 250 patients with the American Society of Anesthesiologists Physical Status Class I-II, aged 18-65 years STOP-BANG score were recorded. Occurrences of difficult mask ventilation (DMV), laryngoscopy, and intubation were assessed using mask ventilation grade, intubation difficulty score intubation difficult score (IDS), and modified Cormack-Lehane grading during induction of anesthesia. Hypoxic events, hemodynamic disturbances, laryngospasm, and bronchospasm were also recorded. Results Overall, 250 patients completed the study (Group H: n = 102, with STOP-BANG questionnaire ≥3 and Group L: n = 148, with STOP-BANG criteria < 3). A total of 67 (26.8%) cases of DMV and 63 (25.2%) cases of difficult tracheal intubation (DIT) were encountered overall. The proportion of patients with DMV during induction was 59.8% in Group H versus 4.05% in Group L (P < 0.001). A higher incidence of difficult intubation was observed in Group H (56.9% vs. 11.5%, P < 0.001). More patients in Group H had airway complications such as bleeding and injury to the posterior pharyngeal wall or teeth (P < 0.001). Complications such as hypoxia, hypertension, and tachycardia were observed to be higher in Group H (P < 0.001). Conclusion STOP-BANG questionnaire is an effective bedside preoperative tool that helps in identifying unanticipated difficult airway.
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Affiliation(s)
- Srinivas Hebbal Thammaiah
- Department of Anaesthesiology and Critical Care, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Rashmi Hosahalli Sreenath
- Department of OBG, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Girish Bandigowdanahalli Kumararadhya
- Department of Anaesthesiology and Critical Care, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Nivetha Babu
- Department of Anaesthesiology and Critical Care, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - K.N. Archana
- Department of Anaesthesiology and Critical Care, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
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Abd Elghany OSAA, Elessawy AF, Elkhashab KA, Elebiary AM, Ebeid HM. Correlation between obstructive sleep apnea and ventricular function: a cross-sectional hospital-based study. Acta Cardiol 2023; 78:805-812. [PMID: 35695452 DOI: 10.1080/00015385.2022.2087267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/20/2022] [Accepted: 06/03/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is a major cause of cardiovascular morbidity and mortality worldwide. Previous studies showed high prevalence of OSA in heart failure. We aimed to evaluate the association of OSA with cardiac dysfunction and the importance of myocardial performance index (Tei) in identifying cardiac dysfunction. METHODS Participants with OSA and sinus rhythm were included, while participants with arrhythmia, debilitating disease, or significant valvular heart disease were excluded. Thirty participants were enrolled, consecutively allocated in a single group, and underwent nocturnal polysomnography, electrocardiogram, and transthoracic echocardiography. RESULTS The prevalence of hypertension, diabetes, and smoking in the study population was 50%, 30%, and 23.3%, respectively. The mean body mass index and apnoea-hypopnoea index (AHI) of the study population was 40.11 ± 7.5 kg/m2 and22.12 ± 13.54 events/h, respectively. There were statistically significant differences between mild, moderate, and severe OSA regarding the left ventricular end diastolic diameter, left ventricular end systolic diameter, ejection fraction, and fractional shortening (p = 0.006, p = 0.002, p = 0.014 and p = 0.011),respectively. There were statistically significant regular positive correlations between the AHI and the right and left Tei (r = 0.447, p = 0.001 and r = 0.391, p = 0.003),respectively. CONCLUSIONS The prevalence of OSA was more in patients with comorbidities especially hypertension and diabetes. OSA was significantly associated with ventricular remodelling and cardiac dysfunction. A significant regular positive correlation was observed between the severity of OSA and worsening cardiac function as measured by Tei. Echocardiographic evaluation of the right and left ventricles and the right and left Tei could be considered as potentially valid, reproducible, and clinically applicable non-invasive methods for estimation of ventricular global function in patients with OSA.
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Khamsai S, Sanlung T, Limpawattana P, Chindaprasirt J, Boonsawat W, Silaruks S, Sawanyawisuth K. Risk factors of left ventricular hypertrophy in obstructive sleep apnea. Biomed Rep 2022; 18:6. [PMID: 36544855 PMCID: PMC9755921 DOI: 10.3892/br.2022.1588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/24/2022] [Indexed: 11/25/2022] Open
Abstract
Obstructive sleep apnea (OSA) and left ventricular hypertrophy (LVH) are both related to major cardiovascular diseases. Previous studies have indicated that, compared with non-OSA, OSA is related to LVH with an odds ratio (OR) of 1.70 (95% CI: 1.44-2.00), particularly in patients with coronary artery disease. Meta-analysis has revealed that the severity of OSA is significantly associated with left ventricular mass compared with non-OSA controls. There is, however, limited data on the risk factors of LVH in patients with OSA. The present study aimed to assess the prevalence and clinical factors that are predictive of LVH in patients with OSA. A retrospective analysis of adult patients diagnosed with OSA who had undergone echocardiography was performed. LVH defined by echocardiography indicated an enlarged LV mass index. Clinical factors predictive of LVH were assessed using multivariate logistic regression analyses. An unadjusted OR and an adjusted OR with 95% confidence intervals (CI) were determined. During the study period, 130 patients met the study criteria, with an LVH prevalence of 27.69% (36 patients). The final predictive model of LVH comprised six factors: Age, sex, unrefreshed sleep, body mass index, systolic blood pressure and apnea-hypopnea index. Only age was independently associated with LVH, with an adjusted OR of 1.048 (95% CI: 1.002-1.096). The prevalence rate of LVH in patients with OSA was 27.69%. Older age was independently related to LVH in patients with OSA.
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Affiliation(s)
- Sittichai Khamsai
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Thanachai Sanlung
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Panita Limpawattana
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Jarin Chindaprasirt
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Watchara Boonsawat
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Songkwan Silaruks
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand,Correspondence to: Professor Kittisak Sawanyawisuth or Professor Songkwan Silaruks, Department of Medicine, Faculty of Medicine, Khon Kaen University, 123 Mitraparp Road, Khon Kaen 40002, Thailand
| | - Kittisak Sawanyawisuth
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand,Correspondence to: Professor Kittisak Sawanyawisuth or Professor Songkwan Silaruks, Department of Medicine, Faculty of Medicine, Khon Kaen University, 123 Mitraparp Road, Khon Kaen 40002, Thailand
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Wang Q, Fu C, Xia H, Gao Y. Aggravating effect of obstructive sleep apnoea on left ventricular remodelling and function disorder in patients with type 2 diabetes mellitus: a case-control study by 3D speckle tracking echocardiography. Acta Cardiol 2022; 77:734-743. [PMID: 34514948 DOI: 10.1080/00015385.2021.1973772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the early alterations of left ventricular (LV) structure and function in type 2 diabetes mellitus (T2DM) patients with or without obstructive sleep apnoea (OSA) using 3 D speckle tracking echocardiography (3DSTE). METHODS Eighty T2DM patients with preserved LVEF were included, half of whom had OSA as co-morbidity. Forty age- and sex-matched controls were also enrolled. LV structure and function were evaluated by conventional echocardiography and 3DSTE. LV global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS) were all measured by 3DSTE. RESULTS Four geometric patterns (normal geometry, concentric remodelling, concentric and eccentric hypertrophy) occupied significantly different proportions within the three groups (p = .014). LV remodelling made up higher shares in two T2DM groups than in the controls, whereas LV hypertrophy appeared most frequently in the patients with T2DM and OSA. The patients with T2DM alone had significantly lower GLS and GCS than the controls (both p < .01). The patients with T2DM and OSA had significantly lower GLS, GCS, GAS, and GRS than the controls and the patients with T2DM alone (all p < .01). Fasting plasma glucose (FPG), OSA and BMI had negative impacts on all and part of the strain values in T2DM patients. The T2DM patients with moderate-to-severe OSA showed significantly lower GLS, GCS, GAS, and GRS than those with mild OSA (all p < .05). CONCLUSIONS The 3DSTE plus conventional echocardiography could detect the sub-clinical LV alterations in T2DM patients with or without OSA.
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Affiliation(s)
- Qingqing Wang
- Department of Ultrasound, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Chixue Fu
- Department of Ultrasound, the Armed Police Corps Hospital of Chongqing, Chongqing, China
| | - Hongmei Xia
- Department of Ultrasound, Xinqiao Hospital, The Third Military Medical University, Chongqing, China
| | - Yunhua Gao
- Department of Ultrasound, Xinqiao Hospital, The Third Military Medical University, Chongqing, China
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Lu M, Wang Z, Zhan X, Wei Y. Obstructive sleep apnea increases the risk of cardiovascular damage: a systematic review and meta-analysis of imaging studies. Syst Rev 2021; 10:212. [PMID: 34330323 PMCID: PMC8325188 DOI: 10.1186/s13643-021-01759-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/08/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND We aimed to perform a systematic review and meta-analysis of the association between obstructive sleep apnea (OSA) and cardiac as well as coronary impairment evaluated using imaging modalities. Finding of this study will provide more robust evidence regarding OSA-induced cardiovascular damage. METHODS We systematically searched through PubMed, EMBASE, and Cochrane library databases for relevant literatures on the association between OSA and cardiovascular damage evaluated using imaging modalities, and manually searched the references of selected articles for additional relevant articles. For each clinical parameter relevant to the meta-analysis, we first evaluated the methodological heterogeneity of the relevant studies and thereafter pooled the data together using fixed effect or random effect model. The difference in the relevant indices of cardiovascular damage between OSA patients and controls was evaluated using the standardized mean difference. RESULTS Of the 82 articles included in the final systematic analysis, 20 studies explored the association between OSA and coronary atherosclerosis. OSA patients had higher rate of coronary atherosclerosis assessed by coronary artery calcification score and plaque volume. Moreover, the severity of OSA and coronary atherosclerosis displayed a positive correlation. The rest of the studies (n = 62) evaluated cardiac alterations in OSA patients. According to the inclusion and exclusion criteria, 46 studies yielding 3082 OSA patients and 1774 controls were pooled for the meta-analysis. For left cardiac structure and function, OSA patients exhibited significantly wider left atrial diameter; higher left atrium volume index; wider left ventricular end-systolic diameter, left ventricular end-diastolic diameter, and left ventricular mass; higher left ventricular mass index; wider interventricular septum diameter and posterior wall diameter; and higher left ventricular myocardial performance index (all p < 0.05). In addition, compared with controls, left ventricular ejection fraction was significantly decreased in OSA patients (p = 0.001). For right cardiac structure and function, OSA patients displayed a significant increase in right ventricular diameter and right ventricular myocardial performance index (both p < 0.001). Finally, compared with controls, OSA patients displayed significant decrease in tricuspid annular plane systolic excursion and RV fractional area change (p = 0.001). CONCLUSION Overall, this systematic review and meta-analysis provides imaging evidence in support that OSA patients are at a higher risk of developing coronary atherosclerosis and display cardiac remodeling and dysfunction.
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Affiliation(s)
- Mi Lu
- Department of Otolaryngology Head & Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Beijing, 100029, China.,The Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases, Beijing Institute of Heart, Lung and Blood Vessel Diseases, No.2 Anzhen Road, Beijing, 100029, China
| | - Zhenjia Wang
- Department of Radiology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23 Back Road of Art Gallery, Beijing, 100010, China
| | - Xiaojun Zhan
- Department of Otolaryngology Head & Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Beijing, 100029, China.,The Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases, Beijing Institute of Heart, Lung and Blood Vessel Diseases, No.2 Anzhen Road, Beijing, 100029, China
| | - Yongxiang Wei
- Department of Otolaryngology Head & Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Beijing, 100029, China. .,The Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases, Beijing Institute of Heart, Lung and Blood Vessel Diseases, No.2 Anzhen Road, Beijing, 100029, China. .,Department of Otorhinolaryngology Head and Neck Surgery, Capital Institute of Pediatrics, No.2 Yabao Road, Beijing, 100020, China.
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Subclinical Changes in Cardiac Functional Parameters as Determined by Cardiovascular Magnetic Resonance (CMR) Imaging in Sleep Apnea and Snoring: Findings from UK Biobank. ACTA ACUST UNITED AC 2021; 57:medicina57060555. [PMID: 34072775 PMCID: PMC8230102 DOI: 10.3390/medicina57060555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/13/2021] [Accepted: 05/27/2021] [Indexed: 11/18/2022]
Abstract
Background and Objectives: Obstructive sleep apnea (OSA) is a common disorder with an increased risk for left ventricular and right ventricular dysfunction. Most studies to date have examined populations with manifest cardiovascular disease using echocardiography to analyze ventricular dysfunction with little or no reference to ventricular volumes or myocardial mass. Our aim was to explore these parameters with cardiac MRI. We hypothesized that there would be stepwise increase in left ventricular mass and right ventricular volumes from the unaffected, to the snoring and the OSA group. Materials and Methods: We analyzed cardiac MRI data from 4978 UK Biobank participants free from cardiovascular disease. Participants were allocated into three cohorts: with OSA, with self-reported snoring and without OSA or snoring (n = 118, 1886 and 2477). We analyzed cardiac parameters from balanced cine-SSFP sequences and indexed them to body surface area. Results: Patients with OSA were mostly males (47.3% vs. 79.7%; p < 0.001) with higher body mass index (25.7 ± 4.0 vs. 31.3 ± 5.3 kg/m²; p < 0.001) and higher blood pressure (135 ± 18 vs. 140 ± 17 mmHg; p = 0.012) compared to individuals without OSA or snoring. Regression analysis showed a significant effect for OSA in left ventricular end-diastolic index (LVEDVI) (β = −4.9 ± 2.4 mL/m²; p = 0.040) and right ventricular end-diastolic index (RVEDVI) (β = −6.2 ± 2.6 mL/m²; p = 0.016) in females and for right ventricular ejection fraction (RVEF) (β = 1.7 ± 0.8%; p = 0.031) in males. A significant effect was discovered in snoring females for left ventricular mass index (LVMI) (β = 3.5 ± 0.9 g/m²; p < 0.001) and in males for left ventricular ejection fraction (LVEF) (β = 1.0 ± 0.3%; p = 0.001) and RVEF (β = 1.2 ± 0.3%; p < 0.001). Conclusion: Our study suggests that OSA is highly underdiagnosed and that it is an evolving process with gender specific progression. Females with OSA show significantly lower ventricular volumes while males with snoring show increased ejection fractions which may be an early sign of hypertrophy. Separate prospective studies are needed to further explore the direction of causality.
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Evaluation of right ventricular performance and impact of continuous positive airway pressure therapy in patients with obstructive sleep apnea living at high altitude. Sci Rep 2020; 10:20186. [PMID: 33214634 PMCID: PMC7678870 DOI: 10.1038/s41598-020-71584-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 08/10/2020] [Indexed: 02/08/2023] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) can lead to alterations in right ventricular (RV) performance and pulmonary vascular haemodynamics. Additionally, altitude-related hypoxia is associated with pulmonary vasoconstriction, and the effect of high-altitude on the pulmonary circulation in OSAS patients can be further altered. We sought to assess alterations in RV morphology and function in OSAS patients living at high altitude by way of 2-dimensional speckle tracking echocardiography (2D-STE), real-time 3- dimensional echocardiography (RT-3DE) and cardiac biomarkers. We also evaluate the impact of continuous positive airway pressure (CPAP) treatment on RV performance. Seventy-one patients with newly diagnosed OSAS and thirty-one controls were included in this study. All individuals were assessed for cardiac biomarkers as well as underwent 2D-STE and RT-3DE. Forty-five OSAS patients underwent CPAP therapy for at least 24 weeks and were studied before and after CPAP treatment. RT-3DE was used to measure RV volume, and calculate RV 3D ejection fraction (3D RVEF). Peak systolic strain was determined. Cardiac biomarkers, including C-reactive protein (CRP), N-terminal pro-B-type natriuretic peptide, and cardiac troponin T were also measured. Right atrium volume index, RV volume, RV volume index, systolic pulmonary artery pressure (sPAP), pulmonary vascular resistance (PVR) and level of serum CRP were significantly higher in OSAS group, while OSAS patients showed lower 3D RVEF and RV longitudinal strains. Compared to the patients with sPAP < 40 mmHg, RV longitudinal strains in patients with sPAP ≥ 40 mmHg were lower. Both RV global longitudinal strain and sPAP were associated with apnea–hypopnea index. Patients treated with 6 months of CPAP therapy had significant improvement in RV geometry and performance. RV structural abnormalities and RV function impairments were observed in OSAS patients living at moderate high altitude compared to control highlanders. The reversibility of these changes after application of CPAP were further confirmed.
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DEMIRCI D, DEMİRCİ D, SELÇUK ÖT. Echocardiographic evaluation may provide more accurate patient selection for polysomnography in patients with Obstructive Sleep Apnea: Predicting the Severity of Disease by Echocardiography. ACTA MEDICA ALANYA 2020. [DOI: 10.30565/medalanya.654444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Krasińska B, Cofta S, Szczepaniak-Chicheł L, Rzymski P, Trafas T, Paluszkiewicz L, Tykarski A, Krasiński Z. The Effects of Eplerenone on the Circadian Blood Pressure Pattern and Left Ventricular Hypertrophy in Patients with Obstructive Sleep Apnea and Resistant Hypertension-A Randomized, Controlled Trial. J Clin Med 2019; 8:jcm8101671. [PMID: 31614891 PMCID: PMC6832448 DOI: 10.3390/jcm8101671] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/25/2019] [Accepted: 10/03/2019] [Indexed: 12/19/2022] Open
Abstract
The obstructive sleep apnea (OSA) is highly associated with various significant cardiovascular outcomes such as resistant hypertension (RAH). Despite this, as of now the relationship between high night-time blood pressure (BP) and left ventricular hypertrophy (LVH) in patients with OSA and RAH is not fully understood. The aim of this study was to assess the influence of the addition of eplerenone to a standard antihypertensive therapy on parameters of 24-h ambulatory blood pressure measurement (ABPM) as well as on the results of echocardiography and polysomnography in patients with OSA and RAH. The patients were randomly assigned to one of the two study groups: the treatment group, receiving 50 mg/d eplerenone orally for 6 months (n = 51) and the control group, remaining on their standard antihypertensive therapy (n = 51). After that period, a significant reduction in the night-time BP parameters in the treatment group including an increased night blood pressure fall from 4.6 to 8.9% was noted. Additionally, the number of non-dipper patients was reduced by 45.1%. The treatment group also revealed a decrease in left ventricular hypertrophy and in the apnea-hypopnea index (AHI) with a positive correlation being observed between these two parameters. This study is the first to report the improvement of the circadian BP profile and the improvement of the left ventricle geometry in patients with OSA and RAH following the addition of selective mineralocorticoid receptor antagonists to antihypertensive therapy.
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Affiliation(s)
- Beata Krasińska
- Department of Hypertension, Angiology and Internal Disease, Poznan University of Medical Sciences, 61-848 Poznan, Poland.
| | - Szczepan Cofta
- Department of Pulmonology, Allergology and Lung Oncology, Poznan University of Medical Sciences, 61-001 Poznan, Poland.
| | - Ludwina Szczepaniak-Chicheł
- Department of Hypertension, Angiology and Internal Disease, Poznan University of Medical Sciences, 61-848 Poznan, Poland.
| | - Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, 60-806 Poznan, Poland.
| | - Tomasz Trafas
- Department of Pulmonology, Allergology and Lung Oncology, Poznan University of Medical Sciences, 61-001 Poznan, Poland.
| | - Lech Paluszkiewicz
- Bad Oeynhausen, Heart and Diabetes Center NRW, Ruhr-University of Bochum, 32545 Bad Oeynhausen, Germany.
| | - Andrzej Tykarski
- Department of Hypertension, Angiology and Internal Disease, Poznan University of Medical Sciences, 61-848 Poznan, Poland.
| | - Zbigniew Krasiński
- Department of Vascular, Endovascular Surgery, Angiology and Phlebology, Poznan University of Medical Sciences, 61-848 Poznan, Poland.
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Buonauro A, Galderisi M, Santoro C, Canora A, Bocchino ML, Lo Iudice F, Lembo M, Esposito R, Castaldo S, Trimarco B, Sanduzzi A. Obstructive sleep apnoea and right ventricular function: A combined assessment by speckle tracking and three-dimensional echocardiography. Int J Cardiol 2017; 243:544-549. [PMID: 28526545 DOI: 10.1016/j.ijcard.2017.05.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/04/2017] [Accepted: 05/02/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND Little is known on right ventricular (RV) involvement in obstructive sleep apnoea (OSA). This study aimed at evaluating early RV dysfunction by standard and advanced echocardiography in OSA. METHODS Fifty-nine OSA patients without heart failure and 29 age-matched controls underwent standard, speckle tracking and real time 3D echocardiography of right ventricle. OSA patients performed lung function tests and overnight cardio-respiratory monitoring with evaluation of apnea-hypopnea index (AHI). RESULTS OSA had significantly higher body mass index and systolic blood pressure (BP) than controls. RV diameters and systolic pulmonary arterial pressure (sPAP) were significantly higher in OSA, in presence of comparable tricuspid annular plane systolic excursion (TAPSE). OSA showed marginally lower RV global longitudinal strain (GLS) (p<0.05) and RV lateral wall strain (RV LLS) (p=0.04). Three-dimensional RV ejection fraction did not differ between the two groups. By stratifying patients according to sPAP, 18 OSA patients with sPAP≥30mmHg had lower TAPSE (p<0.05), RV GLS and RV LLS (both p<0.001) than 37 patients with normal sPAP. By separate multivariate analyses, RV GLS and RV LLS were independently associated with sPAP (both p<0.0001), AHI (p=0.035 and p=0.015 respectively) and BMI (p<0.05 and p=0.034) but not with age and systolic BP in OSA. CONCLUSIONS A subclinical RV dysfunction is detectable by speckle tracking in OSA. The impairment of RV GLS and RV LLS is more prominent than that of TAPSE and is evident when RVEF is still normal. GLS is independently associated with sPAP and OSA severity.
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Affiliation(s)
- Agostino Buonauro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy.
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Angelo Canora
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Maria Luisa Bocchino
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Francesco Lo Iudice
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Maria Lembo
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Roberta Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Sabrina Castaldo
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Alessandro Sanduzzi
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
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Estrella JM, Aguilar PD, Ayuso RC, Ferrera RC. Obstructive Sleep Apnea Syndrome Implications on Health and Adherence to CPAP Treatment. Health (London) 2015. [DOI: 10.4236/health.2015.75076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Agrawal S, Gupta R, Lahan V, Mustafa G, Kaur U. Prevalence of obstructive sleep apnea in surgical patients presenting to a tertiary care teaching hospital in India: A preliminary study. Saudi J Anaesth 2013; 7:155-9. [PMID: 23956715 PMCID: PMC3737691 DOI: 10.4103/1658-354x.114072] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Obstructive sleep apnea (OSA) is often not diagnosed in patients presenting for surgical procedures thereby increasing the incidence of adverse perioperative course. Early diagnosis of this disease is important in modifying anesthetic management as well as utilizing specific means which may decrease the complications and improve the patient outcome. Methods: Patients greater than eighteen years of age, ASA I-III scheduled for elective surgical procedures under anesthesia were randomly selected. Their demographic data, diagnosis and nature of surgery were noted in a semi-structured performa. They were then screened for the presence of OSA with the help of a STOP BANG questionnaire. Results: This study included two hundred four patients randomly selected. Slight female predominance was seen in this sample (55.4%). Mean age of the subjects was 42.7 years (SD=15.08). 24.5% subjects were at high risk for OSA (STOP-BANG>3) with a male predominance (72% versus 37% in low risk group; X2=18.62; P<0.001). High risk OSA subjects had higher prevalence of cardiovascular risk factors (57% vs. 11.7% in low risk group; X2=33.35; P<0.001). Similarly, this group had a higher prevalence of asthma and chronic obstructive pulmonary disease (COPD) (14% versus 3.8% in low risk group; X2=6.54; P=0.03). Prevalence of diabetes mellitus (22%) and hypothyroidism (6%) was also higher in this group (5.2% and 1.9% in low risk group respectively; X2=15.42; P<0.001). Conclusion: High degree of suspicion and knowledge of association of OSA and medical diseases may help in detection of such cases and decrease the rate of perioperative complications thus improving patients safety.
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Affiliation(s)
- Sanjay Agrawal
- Department of Anaesthesiology, Himalayan Institute of Medical Sciences, Dehradun, Uttrakhand, India
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