SESSION TITLE: Aftermath of OSA and Its Treatment
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Tuesday, October 27, 2015 at 08:45 AM - 10:00 AM
PURPOSE: Obstructive sleep apnea (OSA) is an independent risk factor for development and worsening of resistant hypertension (RH) and right ventricle (RV) overloading. Were studied echocardiography parameters (conventional and tissue Doppler) after 1 year of follow up in patients with RH and moderate-severe OSA (polysomnography) adequately treated by CPAP (manual titration).
METHODS: Inclusion criteria: 35-65 years. Exclusion criteria: insomnia, restless leg syndrome, parasomnias, secondary hypertension, uncontrolled cardiovascular, metabolic and respiratory pathologies, lack of adherence/changes in antihypertensive medication. Echocardiography was performed in 10 patients from 265 screened(2010-2013).
RESULTS: Mean values: 6 men (60%), 58.49±1.4 years, Epworth 10±3.85, BMI=35.66±6.4 kg/m2 (unchanged at 1 year), diagnosed with RH for 13.1±11.65 years, AHI=70.66±13.08/h. Blood pressure (BP) ambulatory measured (48h) reduced (systolic: 155.80±20.31 to 135.8±15.0mmHg, p=0.022, diastolic 84.3 to 74.9mmHg, p=NS) Significantly echocardiographic modification: global left ventricle (LV) myocardial performance (Tei index) decreased (tissue Doppler 0.57±0.09 to 0.29±0.16, p=0.003, conventional Doppler 0.53±0.11 to 0.32±0.19, p=0.028); LV diastolic function improved: time closure-to-open (418.28±53.64 to 522.33±61.86, p=0.008), mitral ejection time (271.28±34.41 to 375.33±107.96, p=0.034), e’ medium (0.08±0.01 to 0.11±0.02, p=0.020), e' septal (0.07±0.02 to 0.11±0.03, p=0.027); RV: increased in free wall thickness (4.22±1.64 to 6.02±1.22, p=0.029), systolic area (8.74±1.43 to 11.0±2.32, p=0.049) and decreased in systolic function (fractional area 0.44±0.05 to 0.38±0.04, p=0.034), explained by an increase in filling pressure; aortic and pulmonary preejection time improved (75.8±21.33 to 48.14±14.65, p=0.023, respectively 69.8±14.73 to 46.14±14.79, p=0.021) shown an improvement of interventricular asynchrony; diastolic function and myocardial performance of RV were not modified; there were no concerns regarding pulmonary hypertension.
CONCLUSIONS: Despite of RV remodeling due to increase of filling pressure (explained in absence of hypoxemia by nocturnal rostral fluid shift improvement), the performance of RV remains unchanged. Interventricular asynchrony and LV systolic function were improved (related to improvement of BP).
CLINICAL IMPLICATIONS: Echocardiographic changes shows long term efficacy of CPAP beyond of BP reduction, precise mechanisms requiring a deeper research.
DISCLOSURE: The following authors have nothing to disclose: Oana-Claudia Deleanu, Natalia Patrascu, Miruna Mihaela Micheu, Andra Malaut, Corina Ioana Oprea, Alexandra Roberta Sandu, Ana Maria Nebunoiu, Ligia Puiu, Florin Dumitru Mihaltan
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