Effects Of Obstructive Sleep Apnea On Cardiac Function And Structure In Patients Of Heart Failure With Preserved Ejection Fraction

Objective:To investigate the effect of obstructive sleep apnea on cardiac function and structure in patients with ejection fraction retention force failure.Methods:A total of 184 patients with ejection fraction retention heart failure admitted to the elderly cardiovascular ward of the First Hospital of Lanzhou University from December 2016 to October 2020 were enrolled.According to whether combined with sleep apnea was divided into the control group HFp EF group（n=114）and the experimental group HFp EF+OSA group（n=70）,and further according to apnea-hypopnea index（AHI）will be divided into mild of 18 people,moderate of 23 people,severe of 29 people.Detailed medical history and physical examination were conducted.Blood routine,blood gas analysis,liver function,kidney function,ionic total,thyroid function,N-terminal B-type natriuretic peptide（NT-pro BNP）,cardiac color ultrasound and polysomnography of the experimental group were collected for all subjects.The differences of the above indexes between the control group,the experimental group and the experimental subgroup were compared successively.Statistical methods such as correlation analysis were used to analyze the relationship between sleep breathing monitoring indicators and cardiac structure and function,and to observe the damage of OSA severity on cardiac function in patients with HFp EF.Results:1.Compared with the control group,OSA HFp EF patients were younger in age,larger in body mass index,body surface area,waist-to-hip ratio,and larger in systolic and diastolic blood pressure（P<0.05）.Fatigue and poor sleep were more obvious（P<0.05）,RBC,HGB,NT-pro BNP,TG,TC,LDL-C were increased,GLB,DBIL,folic acid were decreased compared with the control group.2.In the experimental group,LVIDd,LVIDs,IVSTd,IVSTs,PWTd,PWTs,RWT,LVM,LVMi,LV-EDV,LV-ESV,LAD,LADi,E/FPV were significantly increased（P<0.05）,while E/A,s’_L,s’_s,FPV were significantly decreased（P<0.05）;RV-FWd,RV-D1,RV-D2,RV-D3,PA and PASP were significantly increased（P<0.05）.3.With the increase of OSA severity,body mass index,fatigue and poor sleep,UA and TC increased,folate decreased（P<0.05）,IVSTs,PWTd,PWTs,RWT,RVD2,PA and PASP increased,and E/A decreased（P<0.05）.The respiratory disorder index,minimum oxygen saturation,mean oxygen saturation,total apnea time,total hypopnea time,mean suspension time,longest apnea time,total hypopnea time,total obstruction time,total oxygen subtraction time,oxygen subtraction index and fastest pulse rate during the longest respiratory event showed an increasing trend（P<0.05）.4.Correlation analysis showed that the number of blocking types was positively correlated with RWT,DT,RVFWs and PA（P<0.05）.The total number of oxygen reduction was positively correlated with IVSTd,IVSTs,PWTs,RWT and E/FPV（P<0.05）,and negatively correlated with E/A and s/_S’（P<0.05）.Oxygen reduction index was positively correlated with IVSTs,PWTs,RWT,LAD and PA（P<0.05）,but negatively correlated with LVEF,E/A and s’_s（P<0.05）.The total number of hypopnea was positively correlated with IVSTd,LADi,RVFWs and PASP（P<0.05）,and negatively correlated with LVEF and E/A（P<0.05）.The longest apnea time was positively correlated with LVIDd,LVIDs,LVEDVi,LAD,LADi,LAV,E/e’_s,E/FPV,RVFWd,RVFWs,RVD1,RAA and PASP（P<0.05）,and negatively correlated with S’_L and FPV（P<0.05）.The total apnea time was positively correlated with LVIDd,LVIDs,IVSTd,IVSTs,RWT,LVEDVi,LAD,LAV,E/FPV,E/e’s,RVD3,RVOT1,RVOT2,PA,RAD2,RAA and PASP（P<0.05）.It was negatively correlated with E/A and s’_L（P<0.05）.The total hypoventilation time was negatively correlated with LVEF（P<0.05）,but positively correlated with LADi,RVFWd and PASP（P<0.05）.The average pause time was positively correlated with LAV（P<0.05）.The fastest pulse in the longest respiratory event was positively correlated with LVIDs,LAD and LAV（P<0.05）,but negatively correlated with LVEF and s’_L（P<0.05）.The minimum oxygen saturation was positively correlated with E/A（P<0.05）,and negatively correlated with RWT,PA and PASP（P<0.05）.Average blood oxygen saturation was negatively correlated with LVIDs,RWT,RVD2,RVOT2,RAA and PASP（P<0.05）,but positively correlated with LVEF and E/A（P<0.05）.Respiratory disorder index was positively correlated with RWT,LADi and PA（P<0.05）,and negatively correlated with E/A（P<0.05）.Conclusion:OSA exacerbates left ventricular hypertrophy,impels left ventricular diastolic and systolic functions,changes right ventricular structure and left atrium,and increased pulmonary artery pressure in HFp EF patients.The degree of intermittent hypoxia induced by OSA is independently and positively correlated with the degree of cardiac impairment in HFp EF patients,and OSA patients dominated by apnea have more severe cardiac impairment than OSA patients dominated by hypopnea.