Chest
Volume 122, Issue 4, October 2002, Pages 1133-1138
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Clinical Investigations
Left Ventricular Systolic Dysfunction in Patients with Obstructive Sleep Apnea Syndrome

https://doi.org/10.1378/chest.122.4.1133Get rights and content

Study objectives

Conflicting results have been reported regarding the effects of obstructive sleep apnea syndrome (OSAS) on daytime left ventricular (LV) systolic function. This study aimed to assess the prevalence and causes of LV systolic dysfunction, using radionuclide angiography, in a large group of patients with OSAS.

Design and setting

A prospective study in the pneumology department of a university medical center.

Patients

One hundred sixty-nine consecutive patients with OSAS diagnosed by polysomnography, hospitalized for the administration of nasal continuous positive airway pressure. Patients with a known cardiac disease were excluded.

Measurements

LV ejection fraction (LVEF) was measured in all patients, using radionuclide ventriculography with multiple-gated equilibrium cardiac imaging. Myocardial scintigraphy with a dipyridamole stress test and echocardiography were performed in those patients with LV systolic dysfunction, defined by a LVEF < 50%, to detect silent heart disease, especially coronary artery disease.

Results

LV systolic dysfunction was observed in 7.7% (13 of 169 patients). In these 13 patients, the mean ŷ SD LVEF was 42 ŷ 6%, the lowest value of LVEF was 32%, and no silent cardiac disease was revealed. Age, body mass index, apnea-hypopnea index, parameters of nocturnal oxyhemoglobin desaturation, and prevalence of systemic hypertension did not significantly differ between patients with LVEF < 50% and those with LVEF > 50%. In seven patients with LV dysfunction, LVEF was measured following treatment of OSAS and reached normal values.

Conclusion

OSAS may be a direct cause of daytime LV systolic dysfunction that can resolve following reversal of nocturnal apneas.

Section snippets

Patients

The study population included patients with OSAS diagnosed by polysomnography (apnea-hypopnea index [AHI] > 10 events per hour) consecutively admitted to our Department of Pneumology over a 5-year period for the administration of nasal CPAP. In these patients, LVEF was systematically measured using radionuclide angiography as part of a routine evaluation.

Exclusion Criteria

Exclusion criteria were as follows: (1) central sleep apnea, defined as a central apnea index (AI) > 5/h associated with an obstructive AI <

Results

The main characteristics of the patients are summarized in Table 1. The study population included 169 OSAS patients with a mean AHI of 47/h. The AHI was > 30/h in 71% of the patients, and > 50/h in 41%. Seventy-nine percent of the patients were obese, with massive obesity in 37%.

Radionuclide angiography could be performed in all patients without any technical failure. LV systolic dysfunction was present in 7.7% (13 of 169 patients) of the study population, and these patients had a mean LVEF of

Discussion

This study showed that left ventricular systolic dysfunction, diagnosed by radionuclide angiography, was observed in 7.7% (13 of 169 patients) with OSAS requiring nasal CPAP, and with no associated cardiac disease. LV function impairment was moderate, as the lowest value of LVEF was 32%. In the seven patients with LV dysfunction in whom a second measurement of LVEF could be obtained following efficient treatment of OSAS, LVEF improved significantly and reached normal values in all of them.

This

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