Left Ventricular Remodeling Patterns And Its Risk Factors In Patients With Obstructive Sleep Apnea Syndrome

Objective:To investigate left ventricular remodeling (LVR) patterns and the its relationship with cardiovascular risk factors in patients with obstructive sleep apnea syndrome (OSAS).Methods:198patients with habitual snoring underwent Polysomnography (PSG) monitoring and monitor ambulatory24-h blood pressure. AHI>5per hour were diagnosed OSAS. The nocturnal blood pressure (nSBP, nDBP24:00,2:00,4:00PM), morning blood pressure (mSBP, mDBP6:00PM,8:00) and diurnal blood pressure (dSBP, dDBP22:00,12:00), and general characteristics (gender, age, height, weight, neckline, waistline, hipline, smoke, alcohol, hypertension, diabetes, clinical symptoms and signs, family history and nature of work, etc.), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), hemoglobin (Hb), serum creatinine (SCr), blood urea nitrogen (BUN), fasting glucose (FG) were collected. Finally148patients of AHI>5per hour (age range21to75years, average45;87%men) enrolled the study and underwent complete transthoracic echocardiography. The left ventricular end-diastolic diameter and the left ventricular end-systolic diameter (LVDd and LVSd), interventricular septum thickness and left ventricular posterior wall thickness (IVST and LVPWT) were measured and the relative wall thickness (RWT) and left ventricular mass index (LVMI) were calculated. The left ventricular geometry was categorized as normal geometry (NG), concentric remodeling (CR), eccentric hypertrophy (EH), or concentric hypertrophy (CH) on the basis of RWT>0.42and LVMI>46.7g/m2.7(female) or49.2g/m2.7(male). Multinomial logistic regression were used to analysis the correlation of OSAS risk factors and left ventricular remodeling.Results:1.Of148OSAS patients, there were115(77.7%) with left ventricular remodeling, NG33(22.3%), CR35(23.6%), EH37(25%), CH43(29.1%), concentric geometry (52.7%)(Including CR and CH) higher than the proportion of EH (25%).2.General characteristics:①Compared with NG, BMI and waistline were increased in EH (P<0.05or P<0.01); Age, BMI, waistline, hypertension, diurnal SBP and nocturnal SBP were increased in CH (P<0.05or P<0.01).②Compared with CR, gender, age, BMI and waistline were increased in EH (P<0.05or P<0.01); Age, BMI, waistline, hypertension, nocturnal SBP and TG were increased in CH (P<0.05or P<0.01).③Compared with EH, hypertension was increased in CH (P<0.05).3. Polysomnography characteristics:①Compared with NG, AHI and ODI were increased in CR (P<0.05or P<0.01); AHI, ODI and T90were increased, while Mean SO2and Lowest SO2were decreased in CH (P<0.05or P<0.01).②Compared with CR, AHI was increased in EH (P<0.05). Mean SO2was decreased, but T90was increased in CH (P<0.05or P<0.01).③Compared with EH, Lowest SO2was decreased in CH (P<0.05).4. The characteristics of blood pressure:①Compared with NG,4:00SBP and6:00SBP were increased in CH (P<0.05);②Compared with CR,22:00SBP was increased in CH (P<0.05).5. In multinomial logistic regression analysis, CR was associated with AHI [odds ratio (OR)1.035,P=0.024]. EH was associated with Age (OR1.094,P=0.016), BMI (OR1.397,P=0.011) and4:00SBP (OR1.124,P=0.026).CH was associated with Age (OR1.084,P=0.028).Conclusions:1.OSAS causes LVR, which is associated with high prevalence of CR and CH.2. Age and AHI respectively were significant determinant of CH and CR. Age, BMI and4:00SBP were significant determinant of EH.