Diastolic dysfunction in controlled hypertensive patients with mild-moderate obstructive sleep apnea

Elisabetta Lisi, Andrea Faini, Grzegorz Bilo, Laura Maria Lonati, Miriam Revera, Sabrina Salerno, Valentina Giuli, Carolina Lombardi, Gianfranco Parati

Research output: Contribution to journalArticle

Abstract

Background: Hypertension and severe obstructive sleep apnea (OSA)may independently contribute to left ventricular diastolic dysfunction. However, scanty data is available on this issue in hypertensives withmild.moderate OSA. Methods and results:Weperformed polysomnography, echocardiography and 24 h ambulatory blood pressure monitoring in 115 treated essential hypertensives with suspicion of OSA. After exclusion of severe/treated OSA and/or cardiovascular disease patients, mild.moderate OSA (5 ≥ apnoea/hypopnoea index b 30 events·h-1) was diagnosed in 47.3% of the remaining 91 patients, while 52.7% were free of OSA. Transmitral early (E) and late (A) peak flow velocities were assessed in 69 patients, and mitral annular velocity (E′) in 53. Compared to non- OSA, mild.moderate OSA heart rate was higher (p =0.031) while E/A was lower (p = 0.001) without differences in 24 h mean systolic and diastolic blood pressures (125.36 ± 12.46/76.46 ± 6.97 vs 128.63 ± 11.50/77.70 ± 7.72 mm Hg, respectively, NS). Patients with E′ > 10 cm/s and E/A > 0.8 showed a lower mean SpO2 than subjects with normal diastolic function (p = 0.004; p > 0.001). In a logistic regression model age, mean SpO2, daytime heart rate and nocturnal diastolic blood pressure fall were associated with altered relaxation pattern, independently from BMI and gender. Conclusions: In controlled hypertensives mild.moderate OSA may be associated with early diastolic dysfunction, independently from age, gender andmean blood pressure and in the absence of concentric left ventricular hypertrophy. Moreover nocturnal hypoxia may be a key factor in determining early diastolic dysfunction, under the synergic effects of hypertension and mild.moderate OSA.

Original languageEnglish
Pages (from-to)686-692
Number of pages7
JournalInternational Journal of Cardiology
Volume187
Issue number1
DOIs
Publication statusPublished - May 6 2015

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Obstructive Sleep Apnea
Blood Pressure
Heart Rate
Logistic Models
Hypertension
Ambulatory Blood Pressure Monitoring
Polysomnography
Left Ventricular Dysfunction
Left Ventricular Hypertrophy
Apnea
Echocardiography
Cardiovascular Diseases

Keywords

  • Hypertension
  • Left ventricular diastolic function
  • Obstructive sleep apnea

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Diastolic dysfunction in controlled hypertensive patients with mild-moderate obstructive sleep apnea. / Lisi, Elisabetta; Faini, Andrea; Bilo, Grzegorz; Lonati, Laura Maria; Revera, Miriam; Salerno, Sabrina; Giuli, Valentina; Lombardi, Carolina; Parati, Gianfranco.

In: International Journal of Cardiology, Vol. 187, No. 1, 06.05.2015, p. 686-692.

Research output: Contribution to journalArticle

Lisi, Elisabetta ; Faini, Andrea ; Bilo, Grzegorz ; Lonati, Laura Maria ; Revera, Miriam ; Salerno, Sabrina ; Giuli, Valentina ; Lombardi, Carolina ; Parati, Gianfranco. / Diastolic dysfunction in controlled hypertensive patients with mild-moderate obstructive sleep apnea. In: International Journal of Cardiology. 2015 ; Vol. 187, No. 1. pp. 686-692.
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T1 - Diastolic dysfunction in controlled hypertensive patients with mild-moderate obstructive sleep apnea

AU - Lisi, Elisabetta

AU - Faini, Andrea

AU - Bilo, Grzegorz

AU - Lonati, Laura Maria

AU - Revera, Miriam

AU - Salerno, Sabrina

AU - Giuli, Valentina

AU - Lombardi, Carolina

AU - Parati, Gianfranco

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N2 - Background: Hypertension and severe obstructive sleep apnea (OSA)may independently contribute to left ventricular diastolic dysfunction. However, scanty data is available on this issue in hypertensives withmild.moderate OSA. Methods and results:Weperformed polysomnography, echocardiography and 24 h ambulatory blood pressure monitoring in 115 treated essential hypertensives with suspicion of OSA. After exclusion of severe/treated OSA and/or cardiovascular disease patients, mild.moderate OSA (5 ≥ apnoea/hypopnoea index b 30 events·h-1) was diagnosed in 47.3% of the remaining 91 patients, while 52.7% were free of OSA. Transmitral early (E) and late (A) peak flow velocities were assessed in 69 patients, and mitral annular velocity (E′) in 53. Compared to non- OSA, mild.moderate OSA heart rate was higher (p =0.031) while E/A was lower (p = 0.001) without differences in 24 h mean systolic and diastolic blood pressures (125.36 ± 12.46/76.46 ± 6.97 vs 128.63 ± 11.50/77.70 ± 7.72 mm Hg, respectively, NS). Patients with E′ > 10 cm/s and E/A > 0.8 showed a lower mean SpO2 than subjects with normal diastolic function (p = 0.004; p > 0.001). In a logistic regression model age, mean SpO2, daytime heart rate and nocturnal diastolic blood pressure fall were associated with altered relaxation pattern, independently from BMI and gender. Conclusions: In controlled hypertensives mild.moderate OSA may be associated with early diastolic dysfunction, independently from age, gender andmean blood pressure and in the absence of concentric left ventricular hypertrophy. Moreover nocturnal hypoxia may be a key factor in determining early diastolic dysfunction, under the synergic effects of hypertension and mild.moderate OSA.

AB - Background: Hypertension and severe obstructive sleep apnea (OSA)may independently contribute to left ventricular diastolic dysfunction. However, scanty data is available on this issue in hypertensives withmild.moderate OSA. Methods and results:Weperformed polysomnography, echocardiography and 24 h ambulatory blood pressure monitoring in 115 treated essential hypertensives with suspicion of OSA. After exclusion of severe/treated OSA and/or cardiovascular disease patients, mild.moderate OSA (5 ≥ apnoea/hypopnoea index b 30 events·h-1) was diagnosed in 47.3% of the remaining 91 patients, while 52.7% were free of OSA. Transmitral early (E) and late (A) peak flow velocities were assessed in 69 patients, and mitral annular velocity (E′) in 53. Compared to non- OSA, mild.moderate OSA heart rate was higher (p =0.031) while E/A was lower (p = 0.001) without differences in 24 h mean systolic and diastolic blood pressures (125.36 ± 12.46/76.46 ± 6.97 vs 128.63 ± 11.50/77.70 ± 7.72 mm Hg, respectively, NS). Patients with E′ > 10 cm/s and E/A > 0.8 showed a lower mean SpO2 than subjects with normal diastolic function (p = 0.004; p > 0.001). In a logistic regression model age, mean SpO2, daytime heart rate and nocturnal diastolic blood pressure fall were associated with altered relaxation pattern, independently from BMI and gender. Conclusions: In controlled hypertensives mild.moderate OSA may be associated with early diastolic dysfunction, independently from age, gender andmean blood pressure and in the absence of concentric left ventricular hypertrophy. Moreover nocturnal hypoxia may be a key factor in determining early diastolic dysfunction, under the synergic effects of hypertension and mild.moderate OSA.

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KW - Obstructive sleep apnea

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