Cardiopulmonary pathology in patients with sleep apnea/obesity hypoventilation syndrome

Ahmed, Qasim; Chung-Park, Moonja; Tomashefski, Joseph F.

doi:10.1016/s0046-8177(97)90122-2

Cited by 74 publications

(34 citation statements)

References 26 publications

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“…The highly significant relationship between myocardial strain abnormality and insulin resistance, BMI, SBP values, LVM h and VO 2max in severely obese patients could have an important physiopathological significance from a global cardiovascular and cardiopulmonary point of view. 25 In particular, the relationship between insulin resistance and myocardial strain could clarify that the described association between obesity and subsequent cardiac heart failure may be largely mediated by insulin resistance.…”

Section: Discussionmentioning

confidence: 99%

Relationship between preclinical abnormalities of global and regional left ventricular function and insulin resistance in severe obesity: a Color Doppler Imaging Study

et al. 2006

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Background: The aim of this study was to evaluate the relationship between insulin resistance and preclinical abnormalities of the left ventricular structure and function detected in severe obesity by Color Doppler Myocardial Imaging (CDMI). Forty-eight consecutive severely obese patients (Group O) (11 males, 37 females, mean age 32.877 years) were enrolled. Forty-eight sexand age-matched non-obese healthy subjects were also recruited as controls (Group C). All subjects underwent conventional 2D-Color Doppler echocardiography and CDMI. The homeostasis model assessment insulin resistance index (HOMA-IR) was used to assess insulin resistance results. Obese subjects had a greater left ventricular mass index (by height) (58.8714 g/m 2.7 ) than controls (3778 g/m 2.7 ) (Po0.0001), owing to compensation response to volume overload caused by a greater cardiac output (Po0.02). Preload reserve was increased in obese subjects, as demonstrated by a significant increase in left atrial dimension (Po0.0001). Obese patients had a slightly reduced LV diastolic function (transmitral E/A ratio: Group O, 1.170.8 vs Group C, 1.5 70.5; Po0.002). Cardiac deformation assessed by regional myocardial systolic strain and strain rate (SR) values was significantly lower (abnormal) in obese patients than in controls, both at the septum and lateral wall level. These strain and SR abnormalities were significantly related to body mass index. In addition, the early phase of diastolic function, evaluated using SR, was compromised in obese patients (Po0.001). The HOMA-IR values in obese patients were significantly higher (3.0971.6) than those determined in the control group (0.9270.5) (Po0.0001). The HOMA-IR values, in the obese group, were significantly related to systolic strain and SR values sampled at the septum level (Po0.0001). Conclusion: In conclusion, this study has demonstrated that obese patients pointed out systolic structural and functional abnormalities at a preclinical stage, in particular through strain and SR analysis; on the other hand, those altered CDMI parameters well distinguish obese subjects as compared with the control group. Furthermore, another main finding of the study was that myocardial deformation (systolic strain) could have a correlation with insulin resistance level.

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Section: Discussionmentioning

confidence: 99%

Relationship between preclinical abnormalities of global and regional left ventricular function and insulin resistance in severe obesity: a Color Doppler Imaging Study

et al. 2006

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“…Severe obesity has long been recognized as the cause of a form of cardiomyopathy characterized by increased rates of hypertension, chronic volume overload, left ventricular hypertrophy, and the development of heart failure (4,11,12,26). Left ventricular dysfunction or biventricular failure was found in morbidly obese patients with respiratory deficiency, severe sleep apnea, or hypoventilation syndrome (2,8). Nocturnal desaturation or nocturnal sustained hypoxia has often been reported in severely obese patients affected by various respiratory deficiencies such as restrictive lung, increased chest wall loading, ventilation-perfusion mismatch, blunted hypoxic response, nocturnal hypoventilation, sleep hypopnea, and/or sleep apnea during sleep (5,17,18,33).…”

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confidence: 99%

The coexistence of nocturnal sustained hypoxia and obesity additively increases cardiac apoptosis

Lee

Kuo

Bau

et al. 2008

Journal of Applied Physiology

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. The coexistence of nocturnal sustained hypoxia and obesity additively increases cardiac apoptosis. J Appl Physiol 104: 1144-1153, 2008. First published January 17, 2008 doi:10.1152 doi:10. /japplphysiol.00152.2007 nocturnal sustained hypoxia during sleeping time has been reported in severe obesity, but no information regarding the cardiac molecular mechanism in the coexistence of nocturnal sustained hypoxia and obesity is available. This study evaluates whether the coexistence of nocturnal sustained hypoxia and obesity will increase cardiac Fas death receptor and mitochondrial-dependent apoptotic pathway. Methods: 32 lean and 32 obese 5-to 6-mo-old rats with or without nocturnal sustained hypoxia were studied and assigned to one of four subgroups: normoxia lean (NL), normoxia obese (NO), hypoxia lean (HL, 12% O2 for 8 h and 21% O2 16 h/day, 1 wk), and hypoxia obese (HO). The heart weight index, tail cuff plethysmography, echocardiography, hematoxylin-eosin staining, TUNEL assays, Western blotting, and RT-PCR were performed. Results: systolic and diastolic blood pressures in HO were higher than those in NL, and fractional shortening in HO was reduced compared with others. The whole heart weight, the left ventricular weight, the abnormal myocardial architecture, and TUNEL-positive apoptotic cells, as well as the activity of cardiac Fas-dependent and mitochondrial-dependent apoptotic pathway, were significantly increased in obese group or nocturnal sustained hypoxia group and were further increased when obesity and nocturnal sustained hypoxia coexisted, the evidence for which is based on decreases in an anti-apoptotic protein Bcl2 level and Bid and increases in Fas, FADD, pro-apoptotic Bad, BNIP3, cytosolic cytochrome c, activated caspase-8, activated caspase-9, and activated caspase-3. Conclusions: The cardiac Fas receptor-and mitochondrial-dependent apoptotic pathways were more activated in obesity with coexistent nocturnal sustained hypoxia, which may represent one possible apoptotic mechanism for the development of heart failure in obesity with nocturnal sustained hypoxia.

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“…Venöz dönüş artışı ve kapiller oklüzyon basıncında artış sonucunda da pulmoner interstisyuma sıvı geçişi olur ve akciğer ödemi gelişir (12). NBPÖ sıklıkla genç erişkinlerde, obez, üst hava yolu darlığı olan, üst hava yolları ile ilişkili operasyon uygulanan, uyku apne sendromu ve mediastinal kitlesi bulunanlarda gözlenmektedir (13,14). Olgularımızın ikisinin de genç erişkin olması dışında risk faktörleri yoktu.…”

Section: Discussionunclassified

A Rare Cause of Non-cardiogenic Pulmonary Edema Negative Pressure Pulmonary Edema: Two Case Reports

Özdemır¹,

Özdemir²,

Karabay³

et al. 2015

Respir Case Rep

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Negatif basınçlı pulmoner ödem (NBPÖ) genel anestezi sonrasında erken postoperatif dönemde laringospazma bağlı olarak gelişebilen, hayatı tehdit eden ve nadir gözlenen nonkardiyojenik bir pulmoner ödem sebebidir. Otuz üç yaşında erkek ve kırk üç yaşında kadın hastaya genel anestezi altında apendektomi ve kolesistektomi operasyonu uygulandı. Entübasyon ve operasyon süresince hemodinamik ve solunumsal sıkıntı yaşanmadı. Birinci olguda ekstubasyon sonrasında birkaç dakika içerisinde ciddi laringospazm ve şiddetli inspiratuvar efor sonrası satürasyonunda düşme saptandı. İkinci olguda ise operasyondan 45dk sonra nefes darlığı ve satürasyonda düşme saptandı. Her iki olgunun da fiziki muayenesinde bilateral orta ve alt zonda ralleri mevcuttu. Postoperatif çekilen akciğer ve toraks tomografilerinde akciğer ödemi ile uyumlu bulgular saptandı. Postoperatif ekokardiyografik bulguları normaldi. Her iki olguya da beta-2 agonist, inhale steroid, oksijen ve diüretik tedavisi verildi. Postoperatif erken dönemde satüras-yon düşüklüğü olan hastalarda ayırıcı tanıda negatif basınçlı pulmoner ödem de akılda tutulmalıdır. Anahtar Sözcükler: Negatif basınçlı pulmoner ödem, anestezi, nonkardiyojenik ödem.Negative pressure pulmonary edema (NPPE) is a life threatening rare cause of non-cardiogenic pulmonary edema that can occur due to laryngospasm in the early postoperative period after general anesthesia. A 33-year-old male and a 43-year-old female appendectomy and cholecystectomy were performed under general anesthesia. Hemodynamic and respiratory distress were not experienced during intubation and operation. Serious laryngospasm and a reduction in saturation after severe inspiratory effort were detected in the first patient within a few minutes after extubation. Dyspnea and a reduction in saturation were established after 45 minutes of the operation in the second patient. Patients had bilateral middle and lower zone crackles upon physical the examination. Postoperative chest and thorax tomography revealed findings consistent with pulmonary edema. Postoperative echocardiographic findings were normal. Beta-2 agonists, inhaled steroids, oxygen, and diuretic therapy were administered to patients. NPPE should also be kept in mind in the differential diagnosis in patients with low saturation in the early postoperative period.

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Cardiopulmonary pathology in patients with sleep apnea/obesity hypoventilation syndrome

Cited by 74 publications

References 26 publications

Relationship between preclinical abnormalities of global and regional left ventricular function and insulin resistance in severe obesity: a Color Doppler Imaging Study

Relationship between preclinical abnormalities of global and regional left ventricular function and insulin resistance in severe obesity: a Color Doppler Imaging Study

The coexistence of nocturnal sustained hypoxia and obesity additively increases cardiac apoptosis

A Rare Cause of Non-cardiogenic Pulmonary Edema Negative Pressure Pulmonary Edema: Two Case Reports

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