Obstructive sleep apnea, hypertension, and their interaction on arterial stiffness and heart remodeling
Obstructive sleep apnea, hypertension, and their interaction on arterial stiffness and heart remodeling
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DOI：
10.1378/chest.06-2703
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发表时间：
2007-05-01
期刊：
影响因子：
9.6
通讯作者：
Lorenzi, Geraldo, Jr.
中科院分区：
文献类型：
--
作者：
Drager, Luciano F.;Bortolotto, Luiz A.;Lorenzi, Geraldo, Jr.
研究目的：阻塞性睡眠呼吸暂停（OSA）和高血压与大动脉僵硬度增加独立相关，可能导致左心室（LV）重塑。我们试图调查的影响，阻塞性睡眠呼吸暂停，高血压，以及他们与动脉僵硬度和心脏structure.Design：我们研究了60名中年受试者分为四组，根据严重阻塞性睡眠呼吸暂停的存在或不存在高血压。所有受试者均无其他合并症。年龄、性别和身体质量指数相匹配的组。测量和结果：所有参与者均进行了完整的多导睡眠图、脉搏波速度（PWV）和经胸超声心动图。与无OSA的正常血压受试者相比，正常血压OSA和高血压无OSA患者的PWV、左房内径、室间隔厚度、左室后壁厚度、左室质量指数和左室肥厚百分比增加相似（所有比较p < 0.05），PWV、LV质量指数、和患有OSA和高血压的受试者中的LV肥大的百分比。多元回归分析显示PWV与收缩压（p < 0.001）和呼吸暂停低通气指数（p = 0.002）相关。与LV质量指数相关的唯一自变量是PWV（p < 0.0001）。结论：重度OSA和高血压与相似程度的动脉僵硬度和心脏结构异常相关，当两种情况共存时，具有累加效应。大动脉僵硬度增加有助于心室后负荷，并可能有助于解释阻塞性睡眠呼吸暂停综合征和高血压的心脏重塑。
Study objectives: Obstructive sleep apnea (OSA) and hypertension are independently associated with increased stiffness of large arteries that may contribute to left ventricular (LV) remodeling. We sought to investigate the impact of OSA, hypertension, and their association with arterial stiffness and heart structure.Design: We studied 60 middle-aged subjects classified into four groups according to the absence or presence of severe OSA with and without hypertension. All participants were free of other comorbidities. The groups were matched for age, sex, and body mass index.Measurements and results: Full polysomnography, pulse-wave velocity (PWV), and transthoracic echocardiography were performed in all participants. Compared with normotensive subjects without OSA, PWV, left atrial diameter, interventricular septal thickness, LV posterior wall thickness, LV mass index, and percentage of LV hypertrophy had similar increases in normotensive OSA and patients with hypertension and no OSA (p < 0.05 for all comparisons), with a significant further increase in PWV, LV mass index, and percentage of LV hypertrophy in subjects with OSA and hypertension. Multivariate regression analysis showed that PWV was associated with systolic BP (p < 0.001) and apnea-hypopnea index (p = 0.002). The only independent variable associated with LV mass index was PWV (p < 0.0001).Conclusions: Severe OSA and hypertension are associated with arterial stiffness and heart structure abnormalities of similar magnitude, with additive effects when both conditions coexist. Increased large arterial stiffness contributes to ventricular afterload and may help to explain heart remodeling in both OSA and hypertension.