Pericardial Effusion in Obstructive Sleep Apnea without Pulmonary Arterial Hypertension and Daily Hypoxemia - is it Unusual?

Abstract

Background:Pericardial effusion in chronic hypoxemic lung diseases, such as Obstructive Sleep Apnea syndrome, usually occurs after the development of severe pulmonary arterial hypertension. However, data about the frequency of pericardial effusions in Obstructive Sleep Apnea syndrome without pulmonary arterial hypertension and/or daytime hypoxemia are still scarce, and their pathogenesis is unclear.Aims:To assess the prevalence of pericardial effusions and their volume and location in patients with obesity and Obstructive Sleep Apnea syndrome without pulmonary arterial hypertension and/or hypoxemia.Study Design:Cross-sectional study.Methods:We included 279 consecutive patients (162 males) with newly diagnosed Obstructive Sleep Apnea syndrome having a mean age of 42.8±12.4 years and a mean body mass index of 37.3±7.8 kg/m2. Obstructive Sleep Apnea syndrome was confirmed by polysomnography. Main exclusion criteria were concomitant inflammatory diseases, thyroid dysfunction, daytime hypoxemia, nephrotic syndrome, left ventricular systolic dysfunction and pulmonary arterial hypertension.Results:Pericardial effusion was found in 102 (36.56%) -all of them with moderate to severe obstructive Sleep Apnea syndrome. The mean effusion volume was mild to moderate (up to 250 mL). In 36 patients (35.3%) the pericardial effusion was diffuse, in 42 (41.2%), the pericardial effusion was located in front of the right atrium and the right ventricle, and in 24 (23.5%) the pericardial effusion was situated in front of the right cardiac cavities and the left atrium. We found a significant positive correlation between the presence of pericardial effusion and apnea-hypopnea index (r=0.374, p<0.001), body mass index (r=0.473, p<0.001), and desaturation time during sleep (r=0.289, p<0.001).Conclusion:Pericardial effusion in patients with obesity and moderate to severe Obstructive Sleep Apnea syndrome without daily hypoxemia and/or pulmonary hypertension is a relatively common finding. The occurrence of pericardial effusions is dependent mostly on the grade of Obstructive Sleep Apnea syndrome, degree of obesity, and duration of sleep desaturation.

Association and Risk Factors for Obstructive Sleep Apnea and Cardiovascular Diseases: A Systematic Review

“…In a prospective longitudinal study in Lebabon [ 26 ], out of 663 patients, the comorbidities of OSA included: coronary artery disease ( n = 65); myocardial infarction ( n = 6); arrhythmias ( n = 66); chronic heart failure ( n = 34); asthma ( n = 52); COPD ( n = 69); kidney disease ( n = 36); and depression ( n = 69) [ 26 ]. Patients with sleep apnea were also associated with pericardial effusion (36.6%) in a cross-sectional study in Bulgaria [ 41 ]. A significant positive correlation was found between the presence of pericardial effusion and AHI ( r = 0.374, p < 0.001), BMI ( r = 0.473, p < 0.001), and desaturation time during sleep ( r = 0.289, p < 0.001) [ 41 ].…”

“…Patients with sleep apnea were also associated with pericardial effusion (36.6%) in a cross-sectional study in Bulgaria [ 41 ]. A significant positive correlation was found between the presence of pericardial effusion and AHI ( r = 0.374, p < 0.001), BMI ( r = 0.473, p < 0.001), and desaturation time during sleep ( r = 0.289, p < 0.001) [ 41 ]. In a prospective follow-up study of patients with OSA in the US [ 25 ], there was increased association of narcolepsy with peripheral neuropathy, glucose intolerance, and automobile-related trauma.…”

“… Score = 4; high; study design, sample size, sample selection and data analyses, each scored 1. Manov et al, 2018 [ 41 ] Bulgaria Cross-sectional study 279; 162 (58%) men; mean age 42.8 ± 12.4 years Pericardial effusion in patients without PH; obesity (mean BMI of 37.3 ± 7.8 kg/m 2 ). Severity of OSA was graded as follows: mild (AHI 5–15), moderate (AHI 15–30), and severe (AHI > 30).…”