OSAS & Heart (1)

11

ASSESSMENT OF AORTIC STIFFNESS WHICH IS A ASSESSMENT OF AORTIC STIFFNESS WHICH IS A NEW CARDIOVASCULAR MORBIDITY AND NEW CARDIOVASCULAR MORBIDITY AND

MORTALITY PREDICTOR IN PATIENTS WITH MORTALITY PREDICTOR IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA SYNDROME AND OBSTRUCTIVE SLEEP APNEA SYNDROME AND RELATION WITH SEVERITY OF THE DISEASERELATION WITH SEVERITY OF THE DISEASE

Yusuf Tavil1 Oğuz Koumlktuumlrk2 Tansu Ulukavak Ccediliftccedili2 Yusuf Tavil1 Oğuz Koumlktuumlrk2 Tansu Ulukavak Ccediliftccedili2 Asiye Kanbay2 Nihat Şen1 MRıdvan Yalccedilın1 Atiye Asiye Kanbay2 Nihat Şen1 MRıdvan Yalccedilın1 Atiye Ccedilengel1Ccedilengel1

Gazi University Faculty of Medicine Departments of Gazi University Faculty of Medicine Departments of Cardiology1 and Pulmonary Medicine2 AnkaraCardiology1 and Pulmonary Medicine2 Ankara

22

OSAS amp Heart (1)OSAS amp Heart (1)

The recurrent sleep arousal in The recurrent sleep arousal in association with intermittent hypoxia association with intermittent hypoxia and hypercapnia has been implicated and hypercapnia has been implicated in the occurrence of adverse in the occurrence of adverse cardiovascular outcomescardiovascular outcomes

33

OSAS amp Heart (2)OSAS amp Heart (2)

10486981048698Hypertension Hypertension 10486981048698Ischemic heart disease Ischemic heart disease 10486981048698Cardiac arrhythmias Cardiac arrhythmias 10486981048698Cerebral infarction 1048698Cerebral infarction 104869810486981048698Pulmonary hypertensionPulmonary hypertension Subclinic Rightampleft heart failureSubclinic Rightampleft heart failure

44

OSAS amp Heart (3)OSAS amp Heart (3)

10486981048698Associations between sleep apnea Associations between sleep apnea hypertension hearthypertension heart

disease and stroke raise the possibility of disease and stroke raise the possibility of common factors andor causal relationships common factors andor causal relationships between sleep apnea and cardiovascular between sleep apnea and cardiovascular disordersdisorders

10486981048698Such links may be related to biochemical factors Such links may be related to biochemical factors such as insulin catecholamine or cortisol that such as insulin catecholamine or cortisol that are increased in stressare increased in stress

10486981048698Alternately obesity sleep apnea and other Alternately obesity sleep apnea and other cardiovascular risk factors may share common cardiovascular risk factors may share common metabolic pathways and therefore may be metabolic pathways and therefore may be genetically determinedgenetically determined

55

66

Arterial amp Aortic Stiffness(1)Arterial amp Aortic Stiffness(1)

Arterial stiffness in large arteries has Arterial stiffness in large arteries has been reported to be the best been reported to be the best predictor of cardiovascular morbidity predictor of cardiovascular morbidity and mortalityand mortality

The measurement of arterial stiffnessThe measurement of arterial stiffness Pressuredistension changesPressuredistension changes Pulse wave velocityPulse wave velocity Pulse wave analysisPulse wave analysis

77

Arterial amp Aortic Stiffness(2)Arterial amp Aortic Stiffness(2)

Pulse pressure was measured by cuffPulse pressure was measured by cuff

sphygmomanometry of the brachial sphygmomanometry of the brachial artery and not invasively in the artery and not invasively in the ascending-Ao However several ascending-Ao However several reports have demonstrated the reports have demonstrated the excellent correlation of the non-excellent correlation of the non-invasively calculated aortic function invasively calculated aortic function indexes with indexes derived from indexes with indexes derived from aortographyaortography

88

PWV and PWA are subject to confoundingfactorsndash Blood pressure ndash increases PWV and AIxndash Heart rate ndash may increase PWV and decreasendash Body height ndash decreases AIx

99

Arterial amp Aortic Stiffness(3)Arterial amp Aortic Stiffness(3)

Aortic distensibility is an important Aortic distensibility is an important determinant of left ventricular (LV) determinant of left ventricular (LV)

function and coronary blood flow function and coronary blood flow Additionally aortic distensibility has Additionally aortic distensibility has been related to increased been related to increased cardiovascular mortality in cardiovascular mortality in different populationsdifferent populations

1010

Study protocolStudy protocol

40 patients with OSAS and 25 age 40 patients with OSAS and 25 age and BMI-matched control without and BMI-matched control without heart and pulmonary diseaseheart and pulmonary disease

Both groups have the same basal Both groups have the same basal characteristicscharacteristics

Corelation analysis have made Corelation analysis have made independent from age and body independent from age and body mass indexmass index

1111

Aortic distensibility was Aortic distensibility was determined non-invasively determined non-invasively based on the relationship based on the relationship between changes in aortic between changes in aortic diameter and pressure diameter and pressure with each cardiac pulsewith each cardiac pulse Ascending aorta was Ascending aorta was recorded at a level 3 cm recorded at a level 3 cm above the aortic valve in above the aortic valve in the M-mode tracing guided the M-mode tracing guided by the two-dimensional by the two-dimensional echocardiogram in the echocardiogram in the parasternal long-axis view parasternal long-axis view

1212

Aortic strain () = (aortic systolic diameter - Aortic strain () = (aortic systolic diameter - diastolicdiastolic

diameter) x100 diastolic diameterdiameter) x100 diastolic diameter

Distensibility Distensibility (10-6 cm2 dynndash1)(10-6 cm2 dynndash1) = (2x Aortic strain) = (2x Aortic strain) (systolic(systolic

pressure - diastolic pressure)pressure - diastolic pressure)

1313

ResultsResults

Strain Strain ()()

DistensibiliDistensibilite (te (1010-6-6 cm cm22

dynndashdynndash11))

Control Control groupgroup

118plusmn21 118plusmn21 58plusmn1758plusmn17

OSAS OSAS groupgroup

72plusmn2472plusmn24 34plusmn16 34plusmn16

plt0005

1414

1515

AHI ile Aortic strain ilişkisi

AHI ile aotic distensibilite ilişkisi

1616

In conclusion decreased aortic In conclusion decreased aortic stiffness parameters in OSAS stiffness parameters in OSAS patients according to severity of patients according to severity of disease is a new markers of disease is a new markers of elevated cardiovascular risk in these elevated cardiovascular risk in these patientspatients