Analysis Of Factors Influencing Structural And Functional Changes Of The Left Heart After Different Treatment Modalities In Men With Hypertension With Moderate To Severe OSAHS

Objective We analyzed and discussed the structural and functional changes of the left heart in male patients with hypertension with moderate to severe obstructive sleep apnea-hypopnea syndrome(OSAHS)after 1 year of treatment with three different treatment modalities: drugs alone,drugs + ontinuous positive airway pressure,and drugs + surgery,to provide a basis for the treatment of these patients in future clinical work and further take effective measures to manage patients with hypertension with OSAHS.Methods A total of 480 male inpatients aged 18 to 70 years with moderate-to-severe OSAHS and hypertension attending Ningxia Medical University General Hospital from January2016 to December 2021 were selected and divided into three groups according to treatment modality,drug-only group(260 cases),drug+CPAP group(120 cases),and drug+surgery group(100 cases),and then age,duration of hypertension disease,and tobacco and alcohol use were used as matching variables,80 study cases were screened out from each group for subsequent comparison;226 male patients with simple hypertension who met the criteria were collected as the control group according to the age,duration of hypertension,and tobacco and alcohol use of the screened out 240 cases of the study population.To compare the pre-treatment hyperemic systolic blood pressure,diastolic blood pressure,hypertension classification,degree of obesity,blood pressure compliance and left heart structural and functional parameters(left atrial internal diameter(LAD),interventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPWT),left ventricular end-diastolic internal diameter(LVEDD),left ventricular mass index(LVMI))between the hypertension-only group and the hypertension-with-OSAHS group.left ventricular ejection fraction(LVEF),mitral flow spectrum early diastolic maximal flow velocity/late diastolic maximal flow velocity(E/A));comparison of left heart structural and functional parameters(as above),systolic blood pressure,diastolic blood pressure,blood pressure compliance,severity of OSAHS,severity of hypoxemia,body weight,and weight in the three screened drug-only,drug+CPAP,and drug+surgery groups before and after 1 year of treatment(as above).hypoxemia severity,body mass index,smoking history,fasting glucose,uric acid,and lipids(total cholesterol,HDL cholesterol,LDL cholesterol,triglycerides);correlation analysis and multiple linear regression were performed on the study data to analyze the factors affecting left ventricular structure and diastolic function.Results1.Clinical characteristics of male hypertensive patients with moderate to severe OSAHS:most patients were overweight,33 cases(13.8%)were overweight and 203 cases(84.5%)were obese,with the majority being obese;the blood pressure level was high and the attainment rate was low,with 163 cases(67.9%)of grade 2 and 3 hypertension,and only 10.0% of patients had attained the blood pressure standard at the time of admission;the hypertensive with OSAHS group The LAD,IVST,LVPWT,LVMI,and LVEDD in the hypertension with OSAHS group were greater than those in the hypertension-only group,and the LVEF and E/A were lower than those in the hypertension-only group(P < 0.05).2.Results of post-treatment analysis in three groups of male hypertensive patients with moderate to severe OSAHS: IVST,LVPWT,and LVMI decreased and E/A increased after 1 year of treatment in all three groups,and LAD shrank after 1 year of treatment in the drug+CPAP and drug+surgery groups,with more significant changes in left ventricular structure and function in the drug+CPAP and drug+surgery groups(P < 0.05).Systolic and diastolic blood pressure were significantly lower and blood pressure compliance was significantly higher in all three groups after 1 year of treatment,with the drug+CPAP and drug+surgery groups outperforming the drug-only group(P < 0.05);OSAHS severity and hypoxemia improved in all three groups after 1year of treatment,with the drug group inferior to the drug+CPAP and drug+surgery groups(P <0.05);the three groups Patients’ weight mass and number of smokers decreased after 1 year of treatment,and body mass index decreased more significantly in the drug+surgery group.Triglycerides decreased and HDL increased in all three groups after 1 year of treatment,and total cholesterol decreased in the drug+CPAP and drug+surgery groups after 1 year of treatment(P <0.05).3.Influencing factors of LV hypertrophy and decreased LV diastolic function: The results of multiple linear regression analysis showed that age,systolic blood pressure,and severity of OSAHS were independent influencing factors of LVMI;age,total cholesterol,and severity of OSAHS were independent influencing factors of E/A.Conclusion1.Hypertension with moderate to severe OSAHS in men can lead to left ventricular hypertrophy and left ventricular diastolic dysfunction.The independent risk factors for left ventricular hypertrophy before treatment were age,systolic blood pressure,and severity of OSAHS,which were positively correlated with left ventricular hypertrophy,and the independent risk factors for reduced left ventricular diastolic function were age,total cholesterol,and severity of OSAHS,which were negatively correlated with left ventricular diastolic function.2.Left ventricular hypertrophy and left ventricular diastolic dysfunction in men with hypertension with moderate to severe OSAHS improved after 1 year of treatment with drugs alone,drugs and CPAP,and drugs and surgery,with more significant results achieved by taking drugs and CPAP and drugs and surgery than drugs alone.