Background: Risk assessment of sudden cardiac death (SCD) is multifactorial and complex, especially among individuals without established cardiovascular disease. There are insufficiently investigated conditions that can affect arrhythmogenesis. One such condition is obstructive sleep apnea (OSA) syndrome, which is not on the list of risk factors of the Russian National Society of Arrhythmology. Objective: The aim of this review article is to discuss clues to the pathophysiology of SCD in OSA subjects. Methods: We searched the literature for data reporting the impact of apnea on arrhythmogenesis. The preferred languages were English and Russian. The most important clinical reports, as well as biochemistry and pathophysiology guides, were selected for inclusion in the review. Results: It was clearly observed in the searched literature that OSA is the crucial aspect of arrhythmogenesis. Among the clues are intermittent nocturnal hypoxia, reactive oxygen species, cardiomyocyte metabolism disturbances, myocardial electric heterogeneity, and intrathoracic pressure changes. Conclusion: This review emphasizes the importance of the inclusion of OSA in the list of risk factors of the Russian National Society of Arrhythmology.
Aim. To analyze heart remodeling features in with obstructive sleep apnea syndrome and its association with obesity in the context of early cardiac aging.Material and methods. The study included 101 men, 41 patients with obstructive sleep apnea (OSA), 30 comorbid patients with OSA and obesity, the control group consisted of 30 healthy people. The average passport age of the patients was 40,4±6,7 years. Evaluation of OSA was carried out by cardiorespiratory monitoring, structural and functional features of the heart condition were studied using the echocardiography method, the average biological age was calculated.Results. Patients of both studied groups were characterized by structural and geometric rearrangement of the left heart chambers, transformation of physiological ellipsoid model into a spherical (left ventricle (LV) sphericity index 0,64±0,07 in the control group, 1,09±0,03 in the OSA group, 1,01±0,03 in the OSA + obesity group, p<0,05), LV hypertrophy (LV myocardial mass index was 78,1±23,9 in the group of healthy individuals, 98,1±11,4 in the OSA group and 116,0±29,4 in the OSA + obesity group, p<0,01). Systolic function in both study groups was preserved however, a tendency to stress of adaptive remodeling mechanisms was revealed. In addition, diastolic dysfunction was detected in both groups, in OSA group was associated with elasticity of the LV wall decrease, and in the OSA + obesity group, both with a violation of elasticity and an increase in the LV wall stiffness. The biological age of patients with OSA is 14% higher than the passport age, and with the association of OSA and obesity, by 39%.Conclusion. The obtained data prove impact of respiratory sleep disorders at heart remodeling as well as increased biological age. At the same time, the association of OSA with obesity has an additive adverse effect on the remodeling processes and the biological age of patients.
BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is epidemiologically related to adverse cardiovascular outcomes. The pathophysiology clues are metabolic changes and obesity. The most studied anthropometric predictors of obesity, such as body mass index (BMI), waist circumference (WC), are influenced by various factors such as sex, type of constitution, hydration balance. The normal range of BMI and WC limits the diagnostic search for metabolic disturbances and visceral obesity in patients with respiratory sleep distress and can lead to increased cardiovascular risks. AIMS: to investigate the visceral obesity predictors in normal weight patients with obstructive sleep apnea syndrome. MATERIALS AND METHODS: We had performed а cross-sectional study, 68 patients were examined with mean age of 38.24 7.4 years. The main group (38 individuals) was represented by patients with OSAS. The control group consisted of healthy individuals without OSAS. Alternative markers of visceral obesity, such as lipid accumulation products, visceral obesity index, conicity index have been studied. RESULTS: In the main group we found different disorders of lipid metabolism such as the increase in triglyceride levels by 94%, low-density lipids by 32%, total cholesterol by 10% compared with the control group. Anthropometric evidence was obtained for excessive fat accumulation in patients with normal body weight and OSAS: WC was 89.6 5.7 cm in the main group and was higher than in the control group 83.7 6.3 cm (p = 0.024) due to an increase in the visceral fat compartment, as evidenced by the conicity index (67.2 7.0 and 59.3 6.2 respectively, p = 0.032) and waist to height ratio (0.58 0.05 and 0.53 0.04 in the main and control groups, respectively, p = 0.041). Correlation relationships between the severity of sleep apnea syndrome and visceral obesity indicators were revealed. CONCLUSIONS: Normal weight patients with breathing disorders are at risk of visceral fat obesity and, thereby, increased cardiovascular risk. Assessment of additional markers of visceral obesity in patients with normal body weight and sleep apnea is recommended to include in the dynamic observation programms.
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