Analysis of Echocardiographic Alterations Observed in Sleep Apnea–Hypopnea Syndrome and How They Are Influenced by Hypertension

Introduction and objectivesSleep apnea-hypopnea syndrome (SAHS) is associated with significant effects on the heart, which can be assessed using noninvasive methods such as transthoracic echocardiography. However, it is not clear whether these effects are due to the condition itself or are influenced by associated factors, such as high blood pressure (HBP). The objective of this study was to investigate the echocardiographic alterations observed in SAHS patients and how they are affected by the presence of concomitant HBP.MethodsThe study involved 103 consecutive patients (49 with HBP and 54 without) with SAHS and an indication for continuous positive airway pressure treatment and 24 controls matched for age and body mass index. Doppler echocardiography was performed in a blinded manner. Both morphology (ie, wall thickness, and diameters) and function (ie, ejection fraction, peak E and A wave velocities, mitral deceleration time, and Tei index) were assessed. Results were compared using ANOVA and Bonferroni's test.ResultsHypertensive patients had larger morphological changes characteristic of left ventricular hypertrophy (ie, increased septal and posterior wall thicknesses) than nonhypertensive patients, who in turn had larger changes than controls (septal thickness: HBP-SAHS, 12 [2] mm; non-HBP SAHS, 11 [2] mm, and controls, 9.5 [5] mm; 1 vs 2, P=.038; 1 vs 3, P=.0001, 2 vs 3, P=.034) (posterior wall thickness: HBP-SAHS, 11 [2] mm; non-HBP SAHS, 10 [1] mm, and controls, 9 [1.5] mm; 1 vs 2, P=.5; 1 vs 3, P=.0001; 2 vs 3, P=.001). In addition, there were also greater changes in ventricular filling patterns on the left (HBP-SAHS, 92%; non-HBP SAHS, 72%, controls, 29%; P=.0001) and on the right (HBP-SAHS, 72%; non-HBP SAHS, 58%; controls, 25%; P=.001). There was a trend towards a larger left ventricular Tei index (HBP-SAHS, 0.56 [0.2]; non-HBP SAHS, 0.54 [0.12]; controls, 0.5 [0.1]; 1 vs 2, P=.8; 1 vs 3, P=.09; 2 vs 3, P=.7).ConclusionsFrom the time of diagnosis, SAHS was associated with left ventricular hypertrophy and impaired biventricular filling, even in the absence of concomitant HBP. The abnormalities observed were more severe when HBP was present.

Introducción y objetivosEl síndrome de apneas e hi-popneas del sueño (SAHS) conlleva importantes repercu-siones cardiacas que se pueden evaluar mediante méto-dos no invasivos como la ecocardiografía transtorácica; sin embargo, está por dilucidar si se deben a la propia enfermedad o a la influencia de factores concomitantes como la hipertensión arterial (HTA). El objetivo de este estudio es analizar las alteraciones ecocardiográficas en pacientes con SAHS y si se modifican en caso de HTA concomitante.MétodosEstudiamos a 103 pacientes consecutivos diagnosticados de SAHS e indicación de presión positiva continua en la vía aérea (HTA, 49 pacientes; sin HTA, 54) frente a 24 controles ajustados por edad e índice de masa corporal. Realizamos ecocardiograma-Doppler por un observador para el que la asignación estaba enmas-carada. Analizamos variables morfológicas (grosor de pa-redes y diámetros) y funcionales (fracción de eyección, velocidad máxima de ondas E y A, tiempo de decelera-ción mitral e índice Tei). Se compararon los resultados mediante ANOVA y test de Bonferroni.ResultadosLos pacientes hipertensos tuvieron más alteraciones morfológicas tipo hipertrofia ventricular iz-quierda (mayor grosor de septo y pared posterior) que los no hipertensos, y éstos más que los controles. Grosor del septo: SAHS-HTA (1), 12 ± 2; SAHS sin HTA (2), 11 ± 2, y controles (3), 9,5 ± 5 mm (1 frente a 2, p = 0,038; 1 frente a 3, p = 0,0001, y 2 frente a 3, p = 0,034). Pared posterior: SAHS-HTA, 11 ± 2; SAHS sin HTA, 10 ± 1, y controles, 9 ± 1,5 mm (1 frente a 2, p = 0,5; 1 frente a 3, p = 0,0001, y 2 frente a 3, p = 0,001). También hubo más alteraciones en el patrón de llenado ventricular izquierdo (SAHS-HTA, 92%; SAHS sin HTA, 72%, y controles, 29%; p = 0,0001) y derecho (SAHS-HTA, 72%; SAHS sin HTA, 58%, y controles, 25%; p = 0,001). Los valores del índice Tei del VI tuvieron tendencia a incrementarse (SAHS-HTA, 0,56 ± 0,2; SAHS sin HTA, 0,54 ± 0,12, y controles, 0,5 ± 0,1; 1 frente a 2, p = 0,8; 1 frente a 3, p = 0,09; 2 frente a 3, p = 0,7).ConclusionesEl SAHS presenta signos de hipertrofia ventricular izquierda y alteración del llenado biventricular aun en ausencia de HTA concomitante, y desde el mo-mento de su diagnóstico. Las alteraciones detectadas son mayores cuando se asocia HTA.