Evaluation On Effect Of Obstructive Sleep Apnea Hyponea Syndrome On Ventricular Systolic Function And Carotid Stiffness By New Ultrasound Technology

ObjectiveObstructive sleep apnea-hypopnea syndrome(OSAHS)refers to apnea and hypopnea caused by upper airway obstruction during sleep.It is a common sleep-related respiratory disorder in clinical practice,and the prevalence of OSAHS is increasing worldwide.OSAHS is closely related to cardiovascular disease,which can increase the risk of cardiovascular disease and cardiovascular death.Moreover,the potential negative feedback of OSAHS will worsen cardiovascular disease,which in turn may aggravate OSAHS,eventually forming a vicious circle.Therefore,early identification of cardiovascular injury in OSAHS patients is of great clinical significance for the assessment of patients’ condition and guidance of treatment.Compared with conventional echocardiographic indicators of ventricular systolic function(LVEF,RVFAC,etc.),two-dimensional speckle tracking echocardiography(2D-STE)can detect the damage of ventricular systolic function earlier.Ultrafast pulse wave(uf PWV)ultrasound imaging technology can quickly measure the stiffness of the carotid artery wall,and can detect the elastic damage of the carotid artery wall earlier before the change of IMT.In conclusion,the aim of this study is to determine the effects of OSAHS on ventricular systolic function and carotid stiffness by 2D-STE and uf PWV imaging.Methods1.Research object(1)Case group(OSAHS group of 73 patients): patients over 18 years old diagnosed with obstructive sleep apnea hypopnea syndrome in our hospital.Excluding patients with previous coronary artery disease,cerebrovascular disease,malignant tumor,diabetes,chronic lung disease,severe hepatic and renal insufficiency,cardiac insufficiency,thyroid dysfunction,chronic infectious disease,autoimmune disease,acute and chronic vasculitis,depression,patients who could not cooperate with the examination and patients with poor ultrasound image quality.(2)Control group(50 persons): healthy adults matched in age,sex and body mass index were included during the same period.2.Polysomnography(PSG)All patients underwent PSG examination in our hospital.After overnight sleep monitoring for at least 7h,the severity of patients’ disease was evaluated by the same physician on the next day,and the following PSG parameters were analyzed: apnea hypopnea index(AHI),longest apnea time,and minimum oxygen saturation(LSa O2).Patients were grouped according to AHI: 5≤AHI≤30 times /h for mild to moderate group,AHI>30 times /h for severe group.3.General clinical dataAge,sex,body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),smoking history,alcohol consumption history,Creatinine(Cr),alanine aminotransferase(ALT),triglyceride(TG),total cholesterol(TC),high density lipoprotein(HDLC),low density lipoprotein(LDLC),fasting blood glucose(GLU).4.Echocardiography(1)Left ventricular systolic function ultrasound parametersConventional left ventricular ultrasound parameters: Left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic septal thickness(IVSD),left ventricular end-diastolic posterior wall thickness(LVPWT),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular ejection fraction(LVEF).Left ventricular 2D-STE parameters: Left ventricular global longitudinal strain(LVGLS).(2)Ultrasound parameters of right ventricular systolic functionConventional ultrasound parameters of right ventricle were as follows: right ventricular base transverse diameter(RVBD),right ventricular area change rate(RVFAC),right ventricular wall tricuspid ring systolic displacement(TAPSE),right ventricular wall tricuspid ring systolic peak velocity(TDI-S ’),tricuspid regurgitation velocity(TRV),pulmonary artery systolic pressure(PASP).Parameters of right ventricular 2D-STE: Longitudinal strain of right ventricular free wall(RVFWLS).5.Carotid ultrasound examination(1)Conventional carotid artery parameters: IMT(2)uf PWV parameters: initial carotid wall contraction pulse wave velocity(PWVBS),terminal carotid wall contraction pulse wave velocity(PWV-ES).Result1.Clinical characteristics of patients with OSAHS Seventy-three patients with OSAHS were included in the study.The mean age of OSAHS group was 43.05±10.34 years old,with 60 males(82.19%),40 hypertension(54.79%),42 smokers(57.53%)and 46 drinkers(63.01%).The mean AHI of OSAHS group was 54.15±30.96 times /h.The mean longest apnea time was 48.74±25.94 s,and the mean LSa O2 was 78.22±13.06%.There were 26 patients in the mild to moderate group with an average age of45.08±10.14 years old,including 18 males(69.23%),9 hypertensives(34.62%),12smokers(46.15%)and 14 drinkers(53.85%),with an average AHI of 18.61±7.91times/h.The mean longest apnea time was 26.84±14.78 s,and the mean LSa O2 was86.73±5.02%.A total of 47 patients in the severe OSAHS group,with an average age of 41.94±10.39 years old,including 42 males(89.36%),31 hypertension(65.96%),30smokers(63.83%)and 31 drinkers(65.96%),had an average AHI of 73.81±18.91times/h.The mean longest apnea time was 60.85±22.66 s,and the mean LSa O2 was73.51±13.78%.2.Comparison of general clinical parametersBMI,smoking history,SBP,DBP,ALT,TG and GLU in the OSAHS group were higher than those in the control group(P1<0.05),and BMI and DBP in the severe group were higher than those in the mild-moderate group(P2<0.05).3.Analysis results of right ventricular systolic function parameters(1)Comparison of right ventricular systolic functionCompared with the control group,RVBD in the OSAHS patients group was increased,and RVFAC,TAPSE,TDI-S ’and RVFWLS were decreased(P1<0.05).Compared with the control group,RVFAC and RVFWLS were significantly decreased in the mild to moderate OSAHS group,while RVFAC,TAPSE,TDI-S ’and RVFWLS were decreased in the severe OSAHS group.RVFAC,TAPSE,TDI-S ’and RVFWLS were decreased in severe group compared with mild-moderate group(P2<0.05).(2)Correlation analysis of right ventricular systolic function parametersRVFAC,TAPSE and RVFWLS were negatively correlated with AHI,while RVBD was positively correlated with AHI.Both RVFAC and TAPSE were negatively correlated with the longest apnea time,while RVBD was positively correlated with the longest apnea time.LSa O2 was positively correlated with RVFAC and negatively correlated with RVBD(P<0.05).(3)Influencing factors of decreased RVFWLS in OSAHS patientsSingle-factor Logistics regression results showed that AHI was associated with decreased RVFWLS in OSAHS patients(P<0.05).Multivariate logistic regression results after adjusting for gender,age,BMI and DBP showed that AHI was an independent factor influencing the reduction of RVFWLS in OSAHS patients(OR=1.14;95%CI: 1.05-1.24;P=0.001).ROC analysis of AHI predicting RVFWLS reduction showed that when AHI was greater than 36.5 times/h,the sensitivity to predict RVFWLS reduction in OSAHS patients was 100%.The specificity was 50.98%(AUC=0.729,P<0.001).4.Analysis results of left ventricular systolic function parameters(1)Comparison of left ventricular systolic functionCompared with the control group,LVEDD,LVEDV and LVESV were increased in the OSAHS patient group,while LVEF and LVGLS were decreased(P1<0.05).Compared with the control group,LVEF and LVGLS in the mild to moderate group and the severe group were lower,and LVGLS in the severe group were lower than those in the mild to moderate group(P2<0.05).(2)Correlation analysis of left ventricular systolic function parametersLVEDD,IVSD,LVPWT and LVGLS were all correlated with AHI(P<0.05),and the correlation coefficient between LVGLS and AHI was the highest(r=-0.807,P<0.01).LVGLS was also correlated with longest apnea time,LSa O2 and RVFWLS.(3)Influencing factors of decreased LVGLS in OSAHS patientsSingle-factor Logistics regression results showed that BMI,AHI,longest apnea time,LSa O2,RVFWSL were associated with decreased LVGLS in OSAHS patients(P<0.05).The results of multi-factor Logistics regression after adjusting for sex,age,SBP and GLU showed that AHI was an independent factor of LVGLS reduction(OR=1.10;95%CI: 1.04-1.16;P<0.001).ROC analysis of AHI predicting LVGLS reduction showed that when AHI was greater than 58 times/h,the sensitivity and specificity to predict LVGLS reduction in OSAHS patients were 91.67% and 86.49%(AUC= 0.935,P<0.001).5.Analysis results of carotid stiffness parameters(1)General conditions of carotid artery wall structureCompared with the control group,the proportion of IMT thickening or plaque formation in the OSAHS patient group was significantly higher(P1<0.001),and the mild to moderate group and severe group were higher than the control group(P2<0.001).There was no statistically significant difference in IMT between the control group and the normal IMT group.(2)Comparison of uf PWV parameters in carotid artery wallCompared with the control group,PWV-BS and PWV-ES in severe group were significantly increased(P2<0.05).(3)Correlation analysis of carotid artery wall uf PWV parameters PWV-BS was positively correlated with AHI and negatively correlated with LSa O2,and the correlation coefficient between PWV-BS and AHI was higher(r=0.454,P<0.01).PWV-ES has no correlation with PSG parameters.(4)Influencing factors of PWV-BS elevation in OSAHS patients Single factor Logistics regression showed that gender,smoking history,AHI,longest apnea time and LSa O2 were related to PWV-BS increase in OSAHS patients(P<0.05).Multivariate logistic regression results after adjusting age,BMI,SBP and DBP showed that AHI was an independent factor affecting PWV-BS elevation in OSAHS patients(OR=1.06;95%CI: 1.02-1.10;P=0.002).ROC analysis of AHI to predict PWV-BS increase showed that the sensitivity to predict PWV-BS increase in OSAHS patients with AHI greater than 68.9 times/h was 56.52%.The specificity was 95.45%(AUC=0.838,P<0.001).6.Analysis of early abnormalities in ventricular systolic function and carotid stiffness in patients with OSAHSThere were no significant differences in basic clinical parameters such as age,blood pressure and BMI(P>0.001).There were significant differences in PSG parameters in the group with early abnormalities in ventricular systolic function and carotid stiffness compared with the group with early abnormalities in ventricular systolic function or carotid stiffness and the group without early abnormalities in ventricular systolic function or carotid stiffness group(P < 0.001).Conclusion1.AHI was an independent predictor of decreased RVFWLS and LVGLS in OSAHS patients.2.AHI is an independent predictor of PWV-BS increase in OSAHS patients.3.With the increase of AHI,patients with severe OSAHS may first show early reduced ventricular systolic function,followed by impaired carotid stiffness.4.Early ventricular systolic function damage and carotid stiffness increase in OSAHS patients are closely related to OSAHS severity.