Morphofunctional features of the myocardium in patients with severe obstructive sleep apnea syndrome and their dynamics during continuous positive airway pressure therapy

Abstract

This paper presents the echocardiographic morphofunctional parameters of the myocardium of patients suffering from severe obstructive sleep apnea syndrome and their dynamics before and after treatment with the help of the “SYNAP” apparatus by creating a constant positive pressure on inspiration during sleep. All patients were divided into two groups: the experimental group suffering from severe obstructive sleep apnea syndrome and the control group without cardiovascular and respiratory diseases. After echocardiography, the experimental group underwent a course of continuous constant positive pressure on inspiration during sleep. The symptoms of severe obstructive sleep apnea syndrome were determined by the presence of daytime drowsiness, loud snoring, witnessed breathing interruptions, or awakenings due to shortness of breath or suffocation, in the presence of at least 30 obstructive respiratory complications (apnea, hypopnea, or excitement associated with respiratory effort) in 1 h of sleep. In the experimental group, remodeling of heart chambers was observed, manifested mainly by an increase in the volume of the left atrium, dilatation of the right ventricle, and development of myocardial hypertrophy of the left and right ventricles. The systolic function of the right ventricle and the diastolic dysfunction of the right and left ventricles decreased, and the systolic pressure in the pulmonary artery increased. A course of continuous constant positive inhalation pressure during sleep in the experimental group led to reverse remodeling of the heart chambers and improvement of the systolic function of the myocardium of both ventricles. A 3-month course of continuous constant positive pressure on inspiration during sleep led to a persistent decrease in systolic pressure in the pulmonary artery. The constant application of continuous, constant positive pressure on inhalation during sleep can prevent the progression of systolic and diastolic abnormalities and reverse these changes in the initial stages before serious structural changes can develop.

Keywords

echocardiography / cardiorespiratory monitoring / obstructive sleep apnea syndrome / myocardial hypertrophy / systolic pressure in the pulmonary artery / diastolic dysfunction / remodeling of the heart chambers / systolic and diastolic anomalies

References

[1] Sviryaev YuV, Korostovceva LS, Medvedeva EA, et al. Sindrom obstruktivnogo apnoe vo vremya sna v klinicheskoi praktike. Saint Petersburg: Almazov National Medical Research Centre; 2019. 53 p. (In Russ.).

[2] Свиряев Ю.В., Коростовцева Л.С., Медведева Е.А., и др. Синдром обструктивного апноэ во время сна в клинической практике. Санкт Петербург: Национальный медицинский исследовательский центр им. В.А. Алмазова, 2019. 53 с.

[3] Kuchmin AN, Ekimov VV, Galaktionov DA, et al. Blood pressure profiles in patients with arterial hypertension and obstructive sleep apnea in different age groups. Arterial Hypertension. 2021;21(5): 530–535. (In Russ.). DOI 10.18705/1607-419X-2021-27-5-530-535

[4] Кучмин А.Н., Екимов В.В., Галактионов Д.А., и др. Суточные профили артериального давления у больных с артериальной гипертензией и синдромом обструктивного апноэ во время сна в различных возрастных группах // Артериальная гипертензия. 2021. Т. 21, № 5. С. 530–535. DOI: 10.18705/1607-419X-2021-27-5-530-535

[5] Yushkevich EK, Petrova EB, Mit'kovskaya NP. Strukturno-funkcional'ny'e osobennosti levy'x otdelov serdcza u licz trudosposobnogo vozrasta s sindromom obstruktivnogo apnoe vo sne. Neotlozhnaya Kardiologiya i Kardiovaskulyarny'e Riski. 2021;5(1):1184–1189. (In Russ.). DOI 10.51922/2616633X.2021.5.2.1184

[6] Юшкевич Е.К., Петрова Е.Б., Митьковская Н.П. Структурно-функциональные особенности левых отделов сердца у лиц трудоспособного возраста с синдромом обструктивного апноэ во сне // Неотложная кардиология и кардиоваскулярные риски. 2021. Т. 5, № 1. С. 1184–1189. DOI 10.51922/2616633X.2021.5.2.1184

[7] Myslinski W, Rekas-Wojcik A, Dybala A, et al. Clinical Characteristics of Hypertensive Patients with Obstructive Sleep Apnoea Syndrome Developing Different Types of Left Ventricular Geometry. Biomed Res Int. 2021;2021:6631500. DOI: 10.1155/2021/6631500

[8] Myslinski W., Rekas-Wojcik A., Dybala A., et al. Clinical Characteristics of Hypertensive Patients with Obstructive Sleep Apnoea Syndrome Developing Different Types of Left Ventricular Geometry // Biomed Res Int. 2021. P. 6631500. DOI: 10.1155/2021/6631500

[9] Thomas AL, Muraru FD, Bap E, et al. Evaluation of left atrial size and function: relevance for clinical practice – Science Direct. J Am Soc Echocardiogr. 2020;33(8):934–952. DOI: 10.1016/j.echo.2020.03.021

[10] Thomas A.L., Muraru F.D., Bap E., et al. Evaluation of left atrial size and function: relevance for clinical practice – Science Direct // J Am Soc Echocardiogr. 2020. Vol. 33, No. 8. P. 934–952. DOI: 10.1016/j.echo.2020.03.021

[11] Kol'czov AV, Yalovecz AA, Koczoeva OT, et al. Combined use of the first representative of arni (sacubitril/valsartan) in combination with empagliflozin in a patient with terminal chronic heart failure. Bulletin of Pirogov National Medical Surgical Center. 2021;16(1): 163–168. DOI: 10.25881/BPNMSC.2021.69.28.031

[12] Кольцов А.В., Яловец А.А., Коцоева О.Т., и др. Комбинированное применение первого представителя АРНИ (сакубитрил/валсартан) в сочетании с эмпаглифлозином у пациента с терминальной хронической сердечной недостаточностью // Вестник Национального медико-хирургического центра им. Н.И. Пирогова. 2021. Т. 16, № 1. С. 163–168. DOI: 10.25881/BPNMSC.2021.69.28.031

[13] Chetan IM, Domokos Gergely B, Albu A, Tomoaia R, et al. Understanding the role of echocardiography in patients with obstructive sleep apnea and right ventricular subclinical myocardial dysfunction – comparison with other conditions affecting RV deformation. Med Ultrason. 2021;23(2):213–219. DOI: 10.11152/mu-2727

[14] Chetan I.M., Domokos Gergely B., Albu A., et al. Understanding the role of echocardiography in patients with obstructive sleep apnea and right ventricular subclinical myocardial dysfunction – comparison with other conditions affecting RV deformation // Med Ultrason. 2021. Vol. 23, No. 2. P. 213–219. DOI: 10.11152/mu-2727

[15] Cuspidi C, Tadic M, Sala C, Gherbesi E, et al. Targeting concentric left ventricular hypertrophy in obstructive sleep apnea syndrome. A meta-analysis of echocardiographic studies. Am J Hypertens. 2020;33(4):310–315. DOI: 10.1093/ajh/hpz198

[16] Cuspidi C., Tadic M., Sala C., et al. Targeting concentric left ventricular hypertrophy in obstructive sleep apnea syndrome. A meta-analysis of echocardiographic studies // Am J оfHypertens. 2020. Vol. 33, No. 4. P. 310–315. DOI: 10.1093/ajh/hpz198

[17] Zhang Y, Shui W, Tian Y, et al. The impact of left ventricular geometry on left atrium phasic function in obstructive sleep apnea syndrome: a multimodal echocardiography investigation. BMC Cardiovasc Disord. 2021;21(1):209. DOI: 10.1186/s12872-021-02018-1

[18] Zhang Y., Shui W., Tian Y., et al. The impact of left ventricular geometry on left atrium phasic function in obstructive sleep apnea syndrome: a multimodal echocardiography investigation // BMC Cardiovasc Disord. 2021. Vol. 21, No. 1. P. 209. DOI: 10.1186/s12872-021-02018-1

[19] Bochkarev MV, Medvedeva EA, Shumejko AA, et al. Cardiovascular effects of non-invasive ventilation in the treatment of breathing-related sleep disorders in bariatric patients. Russian Journal of Cardiology. 2020;25(S3):76–84. (In Russ.). DOI: 10.15829/1560-4071-2020-4025

[20] Бочкарев М.В., Медведева Е.А., Шумейко А.А., и др. Сердечно-сосудистые эффекты неинвазивной вентиляции легких при лечении нарушений дыхания во сне у бариатрических пациентов // Российский кардиологический журнал. 2020. Т. 25, № S3. С. 76–84. DOI: 10.15829/1560-4071-2020-4025

[21] Kuchmin AN, Kazachenko AA, Kulikov AN, et al. Cpap-therapy is a protective cardiovascular factor in patients with severe obstructive sleep apnea syndrome. Arterial Hypertension. 2017;23(4):313–324. (In Russ.). DOI: 10.18705/1607-419X-2017-23-4-313-324

[22] Кучмин А.Н., Казаченко А.А., Куликов А.Н., и др. СРАР-терапия – фактор защиты сердечно-сосудистой системы у пациентов с тяжелой степенью синдрома обструктивного апноэ во сне // Артериальная гипертензия. 2017. Т. 23, № 4. С. 313–324. DOI 10.18705/1607-419X-2017-23-4-313-324

[23] Caples SM, Anderson WM, Calero K, et al. Use of polysomnography and home sleep apnea tests for the longitudinal management of obstructive sleep apnea in adults: an American Academy of Sleep Medicine clinical guidance statement. J Clin Sleep Med. 2021;7(6):1287–1293. DOI: 10.5664/jcsm.9240

[24] Caples S.M., Anderson W.M., Calero K., et al. Use of polysomnography and home sleep apnea tests for the longitudinal management of obstructive sleep apnea in adults: an American Academy of Sleep Medicine clinical guidance statement // J Clin Sleep Med. 2021. Vol. 17, No. 6. P. 1287–1293. DOI: 10.5664/jcsm.9240

[25] Chu AA, Yu HM, Yang H, et al. 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(1):20186. DOI: 10.1038/s41598-020-71584-9

[26] Chu A.A., Yu H.M., Yang H., et al. 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. Vol. 10, No. 1. P. 20186. DOI: 10.1038/s41598-020-71584-9

[27] Panahi L, Udeani G, Ho S, et al. Review of the Management of Obstructive Sleep Apnea and Pharmacological Symptom Management. Medicina (Kaunas). 2021;57(11):1173. DOI: 10.3390/medicina57111173

[28] Panahi L., Udeani G., Ho S., et al. Review of the Management of Obstructive Sleep Apnea and Pharmacological Symptom Management // Medicina (Kaunas). 2021. Vol. 57, No. 11. P. 1173. DOI: 10.3390/medicina57111173

[29] Qi JC, Zhang L, Li H, et al. The effect of constant positive airway pressure on vascular endothelial growth factor in patients with obstructive sleep apnea: a meta-analysis. Sleep and Вreathing. 2019;23(1):5–12. DOI: 10.1007/s11325-018-1660-4

[30] Qi J.C., Zhang L., Li H., et al. The effect of constant positive airway pressure on vascular endothelial growth factor in patients with obstructive sleep apnea: a meta-analysis // Sleep and breathing. 2019. Vol. 23, No. 1. P. 5–12. DOI: 10.1007/s11325-018-1660-4

[31] Zota IM, Sascău RA, Stătescu C, et al. Short-Term CPAP Improves Biventricular Function in Patients with Moderate-Severe OSA and Cardiometabolic Comorbidities. Diagnostics (Basel). 2021;11(5):889. DOI: 10.3390/diagnostics11050889

[32] Zota I.M., Sascău R.A., Stătescu C., et al. Short-Term CPAP Improves Biventricular Function in Patients with Moderate-Severe OSA and Cardiometabolic Comorbidities // Diagnostics (Basel). 2021. Vol. 11, No. 5. P. 889. DOI: 10.3390/diagnostics11050889

[33] Mitchell C, Rahko PS, Blauwet LA, et al. Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2019;32(1):1–64. DOI: 10.1016/j.echo.2018.06.004

[34] Mitchell C., Rahko P.S., Blauwet L.A., et al. Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography // J Am Soc Echocardiogr. 2019. Vol. 32, No. 1. P. 1–64. DOI: 10.1016/j.echo.2018.06.004

[35] Othman F, Abushahba G, Salustri A. Adherence to the American Society of Echocardiography and European Association of Cardiovascular Imaging Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: A Quality Improvement Project. J Am Soc Echocardiogr. 2019;32(12):1619–1621. DOI: 10.1016/j.echo.2019.09.005

[36] Othman F., Abushahba G., Salustri A. Adherence to the American Society of Echocardiography and European Association of Cardiovascular Imaging Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: A Quality Improvement Project // J Am Soc Echocardiogr. 2019. Vol. 32, No. 12. P. 1619–1621. DOI: 10.1016/j.echo.2019.09.005

RIGHTS & PERMISSIONS

Eco-Vector