The impact of obesity on cardiac dysfunction in patients with sleep-disordered breathing.
The impact of obesity on cardiac dysfunction in patients with sleep-disordered breathing.
复制标题
肥胖对睡眠呼吸障碍患者心功能障碍的影响。
DOI：
10.1007/s11325-013-0861-0
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发表时间：
2014
期刊：
影响因子：
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通讯作者：
Badr,MSafwan
中科院分区：
文献类型：
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作者：
Alkatib,Shatha;Sankri-Tarbichi,AbdulGhani;Badr,MSafwan
简介肥胖和心力衰竭与睡眠呼吸障碍 (SDB) 密切相关。然而，SDB 患者心功能障碍的决定因素尚不清楚。方法我们研究了 90 名疑似患有 SDB 的患者（66% 为女性，67% 为黑人），年龄 50.4±13.4 岁，体重指数 (BMI) 38.6±9.8 kg/m2。呼吸暂停-呼吸不足指数（AHI）和最低脉搏血氧饱和度（SpO2）通过多导睡眠图记录确定。通过超声心动图测定左心房（LA）直径和左心室后壁（LVPW）厚度。 EF < 50%、估计右心室收缩压>45mmHg或瓣膜性心脏病的患者被排除。结果单变量分析显示LA直径与BMI、颈围（NC）和AHI呈正相关（系数分别为0.28、0.34和0.36；p<0.05）。多变量线性回归分析显示BMI是LA扩大的唯一独立预测因子（系数0.02，p< 0.05）。 LVPW 厚度与 BMI、NC 和 AHI 相关（相关系数分别为 0.43、0.47 和 0.33；p< 0.05）。多变量线性回归分析显示，LVPW 厚度与 BMI 和 NC 之间存在显着关系（系数分别为 0.016 和 0.007；p< 0.05），但与 AHI 无关。 BMI 和 LVPW 与最低 SpO2 相关（分别为 r= −0.60,p< 0.01 和 r= −0.21,p= 0.05），并且 BMI 是睡眠期间最低 SpO2 的预测因子（B= −0.59；CI：-0.84， −0.33;p= 0.01)。结论肥胖可以预测心血管发病率和夜间低氧血症，与 SDB 的严重程度无关。我们的研究结果表明，体重过重对 SDB 患者的心功能障碍和缺氧具有独立影响。
IntroductionObesity and heart failure are strongly associated with sleep-disordered breathing (SDB). However, the determinants of cardiac dysfunction in patients with SDB are not known.MethodsWe studied 90 patients suspected of having SDB (66 % women and 67 % black), age 50.4 ± 13.4 years and body mass index (BMI) 38.6 ± 9.8 kg/m2. Apnea–hypopnea index (AHI) and nadir pulse oximetry (SpO2) were determined by polysomnography recordings. Left atrial (LA) diameter and left ventricular posterior wall (LVPW) thickness were determined by echocardiography. Patients who had EF < 50 %, estimated right ventricular systolic pressure >45 mmHg or valvular heart disease were excluded.ResultsUnivariate analysis revealed a positive correlation between LA diameter and each of BMI, neck circumference (NC), and AHI (coefficients, 0.28, 0.34, and 0.36, respectively;p< 0.05). Multivariable linear regression analysis revealed that BMI was the only independent predictor of LA enlargement (coefficient 0.02,p< 0.05). LVPW thickness correlated with BMI, NC, and AHI (correlation coefficients were 0.43, 0.47, and 0.33, respectively;p< 0.05). Multivariable linear regression analysis revealed a significant relationship between LVPW thickness and each of BMI and NC (coefficients 0.016 and 0.007, respectively;p< 0.05) but not AHI. BMI and LVPW associated with nadir SpO2(r= −0.60,p< 0.01 andr= −0.21,p= 0.05; respectively), and BMI was a predictor of nadir SpO2during sleep (B= −0.59; CI: −0.84, −0.33;p= 0.01).ConclusionsObesity can predict cardiovascular morbidity and nocturnal hypoxemia independent of the severity of the SDB. Our findings suggest the independent contribution of excess body weight on cardiac dysfunction and hypoxia in SDB patients.