СТРУКТУРНО-ФУНКЦИОНАЛЬНЫЕ ОСОБЕННОСТИ ЛЕВЫХ ОТДЕЛОВ СЕРДЦА У ЛИЦ ТРУДОСПОСОБНОГО ВОЗРАСТА С СИНДРОМОМ ОБСТРУКТИВНОГО АПНОЭ ВО СНЕ

Abstract

The aim of the study. To assess the echocardiographic signs of structural and left heart functional changes in the working age individuals with obstructive sleep apnea syndrome. Materials and methods. Cross-sectional prospective observational study of 67 working age individuals was performed. The main group included 45 patients diagnosed with obstructive sleep apnea syndrome. The control group consisted of 22 subjects without any pathology revealed by means of polysomnography. There were no significant differences in gender, age, body mass index, presence of diabetes mellitus, arterial hypertension in patients of both groups. To assess the structural and functional changes in the left heart all subjects underwent echocardiographic heart examination in M and B modes, pulse-wave and tissue Doppler study. Results. According to echocardiographic studies of working age patients with OSAS, the anteroposterior size of the left atrium (LA) and the LA volume index are statistically significantly higher than those in the control group: 38.0 (36.0 - 40.0) mm versus 35.0 (30, 3 - 38.0) mm (p <0.01) and 35.0 (33.0 - 37.0) ml / m2 versus 30 (29.3 - 31.0) ml / m2 (p <0.001), respectively. Mean group values of the end-diastolic volume (115.0 (99.5 - 135.5) ml versus 95.0 (72.5 - 104.8) ml (p <0.01)), the end-systolic volume (47.0 (34.0 - 56.0) ml versus 35.0 (27.3 - 41.5) ml (p <0.01)), the thickness of the posterior wall of the left ventricle (LV) (11.0 (10, 0 - 12.0) mm versus 10.0 (9.00 - 10.8) mm (p <0.05)) in the main group exceeded the required data in the group of healthy individuals. While comparing LV diastolic function in patients with obstructive sleep apnea syndrome with the group of people without intermittent hypoxia, higher indicators of the slowing time of the early left ventricle diastolic filling DT 187.0 (154.0-196.0) ms versus 155.0 (130.0 - 169.0) ms were recorded (p < 0.05) and the velocity of late diastolic movement of the mitral valve lateral wall Am 12.0 (10.0 - 14.0) cm / s versus 9.0 (8.0 - 12.0) cm / s (p <0.05). A direct moderate relationship was established between the presence of intermittent hypoxia and structural and functional changes in the left heart: the LP volume index (r = 0.422, p <0.01), LV end-diastolic volume (r = 0.351, p <0.005), end-systolic LV volume (r = 0.315, p <0.05) and the rate of late diastolic LV filling Am (r = 0.373; p <0.05), and inverse - between the apnea / hypopnea index and the ratio of the rate of early and late diastolic LV filling E \ A (r = -0.371, p <0.05). Conclusion. Echocardiographic examination of working age patients with newly diagnosed obstructive sleep apnea syndrome revealed a significantly more frequent tendency of the left heart region remodeling according to the myocardial hypertrophy type, diastolic left ventricle dysfunction and dilatation of the left atrium associated with the presence of intermittent hypoxia.