Obstructive Sleep Apnea and Cardiovascular Disease: Where Do We Stand?

Obstructive sleep apnea is common in adults with cardiovascular disease. Accumulating evidence suggests an association between obstructive sleep apnea and cardiovascular disease independent of the traditionally recognized cardiovascular disease risk factors. Observational studies indicate that obstructive sleep apnea is a risk factor for development of cardiovascular disease and that alleviation of obstructive events with positive airway pressure may improve cardiovascular disease outcomes. However, recent randomized controlled trials have not supported the beneficial effect of positive airway pressure in cardiac populations with concomitant obstructive sleep apnea. Some evidence suggests that the relationship between obstructive sleep apnea and traditionally recognized cardiovascular disease risk factors is bidirectional, suggesting that patients with cardiovascular disease may also develop obstructive sleep apnea and that efficient treatment of cardiovascular disease may improve obstructive sleep apnea. Recent data also indicate that the apnea-hypopnea index, which is commonly used as a diagnostic measure of obstructive sleep apnea severity, has limited value as a prognostic measure for cardiovascular disease outcomes. Novel markers of obstructive sleep apnea-associated hypoxic burden and cardiac autonomic response seem to be strong predictors of adverse cardiovascular disease outcomes and response to treatment of obstructive sleep apnea. This narrative review and position paper from the Turkish Collaboration of Sleep Apnea Cardiovascular Trialists aims to update the current evidence about the relationship between obstructive sleep apnea and cardiovascular disease and, consequently, raise awareness for health professionals who deal with cardiovascular and respiratory diseases to improve the ability to direct resources at patients most likely to benefit from treatment of obstructive sleep apnea and optimize treatment of the coexisting cardiovascular diseases. Moreover, the Turkish Collaboration of Sleep Apnea Cardiovascular Trialists aims to contribute to strengthening the efforts of the International Collaboration of Sleep Apnea Cardiovascular Trialists in this context.

Aortic stiffness and flow-mediated dilatation in normotensive offspring of parents with hypertension.

OBJECTIVES: Although hypertension has been shown to be one of the most important risk factors for atherosclerosis, data about the presence of subclinical atherosclerosis in normotensive offspring with parental history of hypertension are scarce. Accordingly, the current study was designated to evaluate flow-mediated dilatation and aortic stiffness, which are early signs of atherosclerosis in young subjects with parental history of hypertension. METHODS: A total of 140 [corrected] healthy, non-obese subjects in the age group of 18-22 years were included in this study and divided into two groups. The first group included 70 offspring of hypertensive parents and the second group included 70 offspring of normotensive parents as controls. In all subjects, endothelium-dependent and endothelium-independent vasodilatation of the brachial artery and aortic elastic parameters were investigated using high-resolution Doppler echocardiography. RESULTS: Offspring of hypertensive parents demonstrated higher values of aortic stiffness (7.1 plus or minus 1.88 and 6.42 plus or minus 1.56, respectively) but lower distensibility (9.47 plus or minus 1.33 and 11.8 plus or minus 3.36 square centimetres per dyne per 106) and flow-mediated dilatation (4.57 plus or minus 1.3 versus 6.34 plus or minus 0.83 percent, p equals 0.0001, respectively) than offspring of hypertensive parents. CONCLUSION: We observed blunted endothelium-dependent dilatation and aortic stiffness in offspring of hypertensive parents compared with offspring of normotensive [corrected] parents. This is evident in the absence of overt hypertension and other diseases, suggesting that parental history of hypertension is a risk for subclinical atherosclerosis and it may contribute to the progression to hypertension and overt atherosclerosis in later life.

[Evaluation of serum adiponectin levels in patients with obstructive sleep apnea syndrome]. / Tikayici uyku apnesi sendromlu hastalarin serum adiponektin düzeylerinin degerlendirilmesi.

OBJECTIVES: Serum adiponectin levels have been found to be lower in patients with obesity, hypertension, and coronary artery diseases. In this study, we aimed to evaluate serum adiponectin levels in patients with obstructive sleep apnea syndrome (OSAS) and to correlate these levels with the severity of OSAS. STUDY DESIGN: In 62 OSAS patients (39 males, 23 females) and 32 controls (23 males, 9 females) determined by polisomnography, serum adiponectin levels were analyzed by the ELISA method. Patients were classified as having either mild (apnea hypopnea index, AHI: 5-14), moderate (AHI: 15-29) or severe (AHI ≥30) OSAS, and controls were defined as AHI <5. Plasma fasting glucose, total cholesterol (TC), triglyceride (TG), and high (HDL-C) and low (LDL-C) density lipoprotein cholesterols were analyzed, and the results were compared between the groups. RESULTS: There was no significant difference in mean age (51.6±10.7 years for patients, 48.3±10.8 years for controls) or body mass index (32.9±6.0 kg/m2 for patients, 31.3±5.6 kg/m2 for controls, p>0.05) in our study population. There was no significant difference in the number of hypertensive, diabetics, or smokers between the patients and controls. While serum TC, TG, and HDL cholesterol levels were not significantly different between two groups, the serum adiponectin levels of patients (3.0±3.4 µg/dl) were significantly lower than those of the controls (5.2±5.2 µg/dl, p=0.01). While serum adiponectin levels showed a significantly negative correlation with AHI (r=-0.221, p=0.03), there was a significantly positive correlation with minimum and mean oxygen saturations (r=0.213, p=0.04 and r=0.205, p=0.05). CONCLUSION: Serum adiponectin levels were significantly lower in patients with OSAS, especially for those in the severe OSAS group. Serum adiponectin levels are related to the severity of OSAS and arterial oxygen saturation.

The Relationship Between Mitral Annular Calcification and Controlling Nutritional Status Score.

INTRODUCTION: The relationship between mitral annular calcification (MAC) and the controlling nutritional status (CONUT) score has not been previously studied. In this study, we investigated the relationship between MAC and CONUT score to evaluate the nutritional status of patients with MAC. METHODS: A total of 275 patients, including 150 patients with MAC and 125 patients without MAC, who presented to a cardiology outpatient clinic were enrolled in the study. RESULTS: There was no difference in the CONUT score between the two groups. Correlation analysis indicated that CONUT score was positively correlated with left atrial (LA) diameter (r=0.190, P=0.020) and interventricular septum thickness (r=0.179, P=0.028) in the MAC+ group. In multivariate regression analysis, only LA diameter (odds ratio 95% confidence interval = 1,054-1,189, P=0.0001) was independently associated with MAC. CONCLUSION: The present study investigated the relationship between CONUT score and MAC for the first time in the literature. We demonstrated that CONUT score was not significantly higher in patients with MAC without chronic diseases. However, CONUT score was correlated with LA diameter in patients with MAC. We therefore conclude that, for patients admitted with MAC and high LA diameter, CONUT is a valuable nutritional and inflammatory status index.

[Cardiovascular biomarkers in clinical practice of sleep apnea]. / Uyku apnesinin klinik uygulamasinda kardiyovasküler biyobelirteçler.

Obstructive sleep apnea syndrome (OSAS) leads to cardiovascular complications such as coronary artery disease, left/right ventricular hypertrophy and dysfunction, heart failure, systemic and pulmonary hypertension, arrhythmias and stroke; and these all cardiovascular complications increase morbidity and mortality of OSAS. However, Cheyne-Stokes respiration, central and obstructive apneas may occur in the patient with heart failure. Increased sympathetic activity by hypoxemia and endothelial dysfunction play a role in cardiovascular complications. Some cardiovascular biomarkers have a role in early diagnosis, treatment and prognosis. In the present review, some cardiovascular biomarkers such as serum C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukins, adiponectin, heart-type fatty acid binding protein (hFABP) and brain (B-type) natriuretic peptide (BNP), and their clinical importance were reviewed.

Incidence and predictors of complete atrioventricular conduction recovery among patients with heart block.

Aim: In this study, our aim was to determine clinical factors related to the recovery of the conduction system in patients presenting with atrioventricular (AV) block. Materials & methods: A total of 178 patients who were hospitalized at a tertiary center due to second- or third-degree AV block were retrospectively analyzed. Results: During hospital follow-up, 19.1% of patients had fully recovered from AV block. According to a logistic regression analysis; younger age (odds ratio [OR]: 0.950; 95% CI: 0.932-0.967; p < 0.001), presenting with acute coronary syndrome (OR: 18.863; 95% CI: 3.776-94.222; p < 0.001), ß-blocker usage (OR: 12.081; 95% CI: 3.498-41.726; p < 0.001), high serum creatinine levels (OR: 4.338; 95% CI: 2.110-8.918; p < 0.001) and no calcification at the aortic valve (OR: 0.189; 95% CI: 0.050-0.679; p = 0.011) were found to be related to resolution of AV block. Conclusion: It is crucial to know the reversible causes of AV block to prevent unnecessary permanent pacemaker implantation.

Relationship between hemorheology and Glu(298)Asp polymorphism of endothelial nitric oxide synthase gene in patients with coronary artery disease.

This study aimed to investigate the relationship between endothelial nitric oxide synthase Glu(298)Asp gene polymorphism and hemorheological parameters. Red blood cell (RBC) deformability, aggregation were measured using an ectacytometry, whole blood, plasma viscosities were determined by a viscometer. Restriction fragment length polymorphism was used to detect polymorphism. Plasma nitrite, nitrate concentrations were determined by Griess method. The genotype distribution of the control group was as follows: 50 (67.5%) GG, 21 (28.4%) GT, 3 (4.1%) TT. A 48 (57.8%) of the patients with CAD had GG, 28 (33.7%) GT, 7 (8.5%) of them TT genotype. RBC aggregation index of CAD patients with G allele was higher and t(1/2) lower compared to controls carrying the same allele. The amplitude of RBC aggregation of healthy subjects with T allele, who are under increased cardiovascular risk was lower compared to control subjects with G allele. The results of this study indicate that, alterations in RBC aggregation seem to be a consequence of CAD, more than being a preexisting cause. Additionally, some compensatory mechanisms by causing decrements in RBC aggregation, may help regulation of circulation in healthy individuals with high cardiovascular risk.

Decreased plasma adiponectin concentrations in patients with syndrome X.

OBJECTIVE: The levels of adiponectin, an anti-atherogenic protein, are decreased in patients with coronary artery disease. Syndrome X is associated with endothelial dysfunction, which is a key feature in the evolution of atherosclerosis. We sought to determine whether serum adiponectin levels are decreased in patients with syndrome X. METHODS: Twenty-three syndrome X patients (14 men, 9 women) who presented with stable angina pectoris, had a positive non-invasive stress test or an abnormal myocardial perfusion scintigraphy single photon emission computed tomography (MPS SPECT) and a normal coronary angiogram, were included in our study, as were 17 asymptomatic healthy subjects (13 men, 4 women) with normal results from non-invasive stress testing. The serum adiponectin levels and lipid profiles of the patients and control subjects were determined with venous samples collected after a 12-hour fast. The results were analysed by a Mann Whitney U test. RESULTS: Mean age (54.1 +/- 11.8 y in patients and 59.8 +/- 9.6 y in control subjects, P > 0.05) and body mass index (28.0 +/- 3.3 in patients and 27.1 +/- 4.2 in control subjects, P > 0.05) did not differ between the two groups. Adiponectin levels in patients with syndrome X (1.5 +/- 1.1 microg/dl) were significantly lower than those in the control group (5.3 +/- 2.9 microg/dl, P < 0.0001). Serum total cholesterol (TCHOL), triglyceride (TG), LDL, and HDL-cholesterol levels did not differ between the two groups (P > 0.05). CONCLUSION: Serum adiponectin levels were lower in patients with syndrome X, and these low adiponectin concentrations may cause endothelial dysfunction. Thus, patients with a marked drop in adiponectin levels may be considered at high risk for future coronary events and may therefore benefit from additional pharmacological treatment.

Acute improvement of pulmonary artery pressure by non-invasive positive pressure ventilation in the patients with hypercapnic respiratory failure.

It is very important to decrease pulmonary artery pressure (PAP) in patients with chronic obstructive pulmonary disease (COPD) in order to prevent progression to right heart failure. We showed an acute improvement of PAP by non-invasive positive pressure ventilation (NPPV) treatment in patients with hypercapnic respiratory failure. In 26 patients with COPD (18 males and 8 females), physical examination, Doppler echocardiographic evaluation and arterial blood gases analysis were performed on admission and at discharge. PAP was measured by Doppler echocardiography. NPPV was used when 2 of the following were present without contraindications: 1. Respiratory distress with moderate to severe dyspnea, 2. Arterial pH less than 7.35 with PaCO(2) above 45 mmHg, 3. Respiratory rate of 25/minute or greater. Mean age of the patients was 62.6 ± 10.8 year, and mean usage of the NPPV was 12.6 ± 5.5 day. Mean and systolic PAPs of the patients (43.8 ± 16.9 mmHg and 66.7 ± 23.3 mmHg) were significantly decreased with NPPV treatment (26.6 ± 8.4 mmHg, p< 0.0001 and 41.8 ± 14.6 mmHg, p< 0.0001). Also, each parameter of the arterial blood gases was improved significantly with NPPV usage. An echocardiographic assessment in the COPD patients having NPPV treatment due to acute respiratory failure, might be a useful and easy method to show an improvement of PAP as a supportive measure in the management of those patients, in addition to beneficial effects of that treatment on respiratory acidosis, hypercapnia and hypoxemia.

[Heart failure and sleep apnea]. / Kalp yetersizligi ve uyku apnesi.

Sleep-disordered breathing is one of the important factors contributing to the development and/or progression of heart failure (HF). This condition is related to recurring attacks of apnea, hypopnea, and hyperpnea, sleep disruptions, arousals, intermittent hypoxemia, hypocapnia, and hypercapnia, and intrathoracic pressure changes. Obstructive sleep apnea (OSA) is characterized by recurrent upper airway obstruction (apnea and hypopnea), increased breathing effort against totally or partially occluded upper airway, and sleep disruptions. Cardiovascular consequences are the most serious complications of OSA and include acute myocardial infarction, heart failure, left/right ventricular dysfunction, arrhythmias, stroke, and systemic and pulmonary hypertension. Cheyne-Stokes respiration and central apneas may also occur in patients with HF. This article reviews the most recent information on the physiopathology, diagnosis, and treatment modalities of obstructive and central apneas in patients with HF.

[The association between serum adiponectin levels and the severity of coronary artery lesions on the angiogram]. / Serum adiponektin düzeyleri ile anjiyogramda koroner lezyon ciddiyeti arasindaki iliski.

OBJECTIVES: Decreased serum adiponectin levels have been shown in patients with coronary artery disease (CAD). We evaluated the association between serum adiponectin levels and CAD severity on the angiogram. STUDY DESIGN: The study included 86 patients (70 males, 16 females; mean age 60 years) with angiographically documented CAD (=/>50% stenosis). The patients were divided into three groups according to the number of vessels affected; thus, 18 had single-vessel, 16 had two-vessel, and 52 had multiple-vessel disease. The severity of coronary lesions was assessed using the modified Gensini score. Serum adiponectin levels were measured in the CAD group and in a control group of 33 subjects (16 males, 17 females; mean age 54.8 years) who were found to have normal coronary arteries on angiography. RESULTS: The mean age, the number of male patients, and the number of smokers were significantly higher in the CAD group (p=0.01). Patients with CAD exhibited significantly lower serum levels of adiponectin compared to the control group (2.0+/-2.0 micromg/dl vs. 3.2+/-2.7 micromg/dl; p=0.01). There were no significant differences in adiponectin levels between patients with single-, two, and multiple-vessel disease. Compared to the controls, patients with two- and multiple-vessel disease had significantly lower adiponectin levels (1.5+/-0.9 microg/dl and 2.0+/-2.0 microg/dl, respectively), whereas those with single-vessel disease (2.6+/-2.5 microg/dl) did not differ from the controls in this respect. The mean Gensini score was 3.8+/-1.7 in the CAD group. There was a weak inverse correlation between serum adiponectin levels and the Gensini score (r=-0.209; p=0.02). CONCLUSION: Serum adiponectin levels are decreased in CAD patients compared to controls. This decrease is more prominent with increasing levels of CAD severity, which may be a helpful clue of multivessel disease.

[Evaluation of serum adiponectin levels in patients with heart failure and relationship with functional capacity]. / Kalp yetersizligi olan hastalarda serum adiponektin düzeylerinin degerlendirilmesi ve fonksiyonel kapasite ile iliskisi.

OBJECTIVES: We aimed to evaluate serum adiponectin levels in relation to the NYHA functional capacity class in patients with heart failure (HF). STUDY DESIGN: The study included 49 patients (40 males, 9 females; mean age 63 years) with HF, whose functional capacity was NYHA class II to IV. Echocardiographic examination was performed and serum adiponectin levels were measured. The results were compared in relation to the NYHA classes and with those of 41 control subjects (24 males, 17 females; mean age 54.2 years) without HF. RESULTS: Functional capacity was NYHA class II in 13 patients (26.5%), class III in 23 patients (46.9%), and class IV in 13 patients (26.5%). Compared to the control group, the HF group exhibited a significantly higher mean age (p=0.001), lower body mass index (p=0.004), decreased left ventricular ejection fraction (EF) (33.2+/-7.7% vs. 64.9+/-4.3%; p=0.0001), and increased serum adiponectin level (4.0+/-3.2 micromg/dl vs. 2.4+/-2.3 micromg/dl; p=0.009). Both EF (p=0.001) and adiponectin level (p=0.004) showed significant differences between the NYHA groups, with the latter showing a sharp increase from 2.6+/-2.6 micromg/dl in class II to 6.8+/-3.7 micromg/dl in class IV. In all paired comparisons between the three NYHA groups, EF and serum adiponectin level exhibited significant differences except for the serum adiponectin level for NYHA class II and III (for NYHA class II and IV, p=0.003; for class III and IV, p=0.008). In correlation analysis, serum adiponectin level was in a significantly inverse correlation with EF (r=-0.380, p=0.0001), and a positive correlation with the NYHA class (r=0.423, p=0.0001). CONCLUSION: Serum adiponectin levels significantly increase in patients with HF, in parallel with deterioration in functional capacity and with significant decreases in EF.

Predictors of in-hospital mortality in very eldery patients presenting with acute coronary syndrome: A single-center study.

OBJECTIVE: Acute coronary syndrome (ACS) has become more frequent in the elderly population due to increased life expectancy. The aim of this trial was to determine clinical and laboratory factors related to in-hospital mortality in patients over 80 years of age who presented with ACS. METHODS: A total 171 patients (86 men, median age 83 years) who were over 80 years of age and were hospitalized due to a diagnosis of ACS were enrolled in this study. The patients' demographic data, clinical features, and laboratory values were screened retrospectively from hospital records. RESULTS: During the follow-up period, 19 of 171 patients (11.1%) died. The causes of death were cardiogenic shock (n=6, 31.5%), acute renal failure (n=6, 31.5%), arrhythmia (n=4, 21%), and septic shock (n=3, 15.7%). ST-segment elevation myocardial infarction presentation was more common among those who died [14 (73.7%) vs. 31 (20.5%); p<0.001]. Patients who died during in-hospital follow-up also had higher peak troponin [3.1 ng/mL (7.2) vs. 0.3 ng/mL (1.6); p<0.001] and creatine kinase-MB levels [96.7 ng/mL (194) vs. 10.9 ng/mL (36.2); p<0.001]. The results indicated that a high Global Registry of Acute Coronary Events (GRACE) risk score [odds risk (OR): 1.074, 95% confidence interval (CI): 1.039-1.110; p<0.001], ejection fraction (EF) ≤40% (OR: 8.113, 95% CI: 1.101-59.773; p=0.040), or no use of an angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) (OR: 0.075, 95% CI: 0.006-0.995; p=0.049) was significantly associated with in-hospital mortality. CONCLUSION: Presentation with a high GRACE risk score, no use of an ACEI/ARB, and a low EF at admission were associated with in-hospital mortality in ACS patients more than 80 years old.

[Incidence, prevalence, and mortality estimates for chronic atrial fibrillation in Turkish adults]. / Türk halkinda kronik atriyal fibrilasyon insidansi, prevalansi ve mortalitesine iliskin tahminler.

OBJECTIVES: We investigated the incidence, prevalence, and mortality of chronic atrial fibrillation (AF) in Turkish adults. STUDY DESIGN: In a prospective and cross-sectional design, we analyzed 3,450 eligible participants (1707 men, 1743 women; mean age 52+/-13 years) of the Turkish Adult Risk Factor Study, who had been surveyed until 2006/07. Those who were dead and were found to have AF at baseline were excluded in the estimation of AF prevalence and incidence, respectively. RESULTS: Atrial fibrillation was determined in 67 participants. The total follow-up was 34,100 person-years (mean 9.9 years). There were 43 prevalent and 46 incident cases, which corresponded to 1.25% and 1.35 per 1000 person-years, respectively. For age brackets of 32-59, 60-69, and > or =70 years, the prevalence rates were 0.46%, 2.09%, and 2.49%, and the incidence rates were 0.31, 1.98, and 3.50 per 1000 person-years, respectively. Both were higher in women of all age groups, with female-to-male ratios for overall prevalence and incidence being 1.69 and 1.19, respectively. Survival after onset of AF was 5 to 9 years and overall mortality was 6.8 per 100 person-years. Hypertension was the most common cause of AF, followed by advanced age. Contrary to expectations, waist circumference of men with AF was smaller by 1.9 cm than that of women. Serum C-reactive protein levels in men with AF (mean 1.21 mg/l) were significantly lower than women with AF (mean 2.62 mg/l) and than males without AF (mean 1.78 mg/l). CONCLUSION: In Turkish adults, the current incidence and prevalence of chronic AF can be extrapolated to be 35,000 per year (22,000 in women) and 310,000 (200,000 in women), respectively. Considering the low incidence in males, it seems that inflammatory processes may play a minor role in the development of AF in Turkish men.

[Turkish Adult Risk Factor Survey 2007: decline in all-cause and coronary mortality continues]. / TEKHARF çalismasi 2007 taramasi: mortalite ve koroner mortalitede azalma egilimi sürüyor.

OBJECTIVES: We analyzed all-cause and coronary mortality as well as incident coronary heart disease (CHD) among the participants of the Turkish Adult Risk Factor Study, who resided essentially in the Marmara and Central Anatolia regions and were surveyed in the summer of 2007. STUDY DESIGN: Information on the mode of death was obtained from first-degree relatives and/or health personnel of the local health office. Most of the participants who were alive underwent physical examination and 12-lead electrocardiography. Incident CHD was defined as fatal or nonfatal myocardial infarction that occurred after the previous survey or incident stable angina and/or myocardial ischemia. RESULTS: Of 1,618 participants to be surveyed, 961 were examined, 501 subjects were assessed based on information obtained, 18 men and 12 women were dead, and 52 subjects were lost to follow-up. The number of newly recruited subjects was 138. Addition of 3,010 person-years of follow-up raised the total follow-up of the survey to 48,500 person-years. Eight deaths were attributed to CHD; new coronary events were identified in 16 subjects. Annual mortality was estimated as 10.0 and coronary mortality as 2.7 per 1,000 adults. Overall mortality which was 11.2 per 1,000 person-years in the original cohort declined to 9.1 and 5.9 in more recently recruited 1997/98 and 2002/03 cohorts, respectively. In the age bracket of 45 to 74 years, all-cause mortality which was 15.2 in 2004 decreased to 10.2 per 1,000 person-years in the past three years (p=0.003), with a corresponding decrease in coronary mortality from 6.0 to 5.1 (p<0.18), indicating that the decreasing trend in overall mortality and coronary deaths observed in this age group in the previous years did not level off. CONCLUSION: Our data show that the incidences of overall and coronary mortality continue to decline.

Effect of CPAP on QT interval dispersion in obstructive sleep apnea patients without hypertension.

OBJECTIVES: Delayed cardiac repolarization leading to prolongation of the QT interval is a well-characterised precursor of arrhythmias. Obstructive sleep apnea (OSA) might cause arrhythmias, since QT corrected interval dispersion (QTcd) is increased in these patients. We aimed to determine the effect of nasal continuous positive airway pressure (CPAP) therapy on QTcd in OSA patients without hypertension. METHODS: An overnight polysomnography (PSG) and a standard 12-lead electrocardiogram (ECG) were performed on 49 subjects without hypertension, diabetes mellitus, cardiac or pulmonary disease or any hormonal, hepatic, renal or electrolyte disorders. In 29 moderate-severe OSA (apnea-hypopnea index: AHI15) patients, QTd (defined as the difference between the maximum and minimum QT interval) and QTcd were calculated using the Bazzet formula at baseline and after six months of CPAP therapy. RESULTS: Eighteen patients were compliant with nasal CPAP, and mean age was 46.5+/-4.9 years. Patients had high body mass index (BMI: 30.6+/-4.0 kg/m(2)), but there was no change in either BMI or blood pressure after six months. A strong positive correlation was shown between QTcd and AHI (p<0.001, r=0.913). The QTcd at baseline (54.5+/-8.7 ms) significantly decreased after CPAP therapy (35.5+/-4.2 ms, p<0.001), although it did not significantly change in 11 non-compliant patients. CONCLUSION: In OSA patients without hypertension, CPAP therapy improves the inhomogeneity of repolarization via a significant decrease in QTcd.

Effects of CPAP on left ventricular structure and myocardial performance index in male patients with obstructive sleep apnoea.

BACKGROUND: Obstructive sleep apnoea (OSA) has the potential to cause heart failure. We aimed to determine the effects of nasal continuous positive airway pressure (CPAP) therapy on left ventricular structure and myocardial performance index (MPI) in severe OSA patients. METHODS: Sixty-seven subjects without any cardiac or pulmonary disease had overnight polysomnography and echocardiography. In 33 males with severe OSA, thickness of interventricular septum (IVS) and posterior wall (LVPW) were measured by M-mode. Left ventricular MPI was calculated as (isovolumic contraction time+isovolumic relaxation time)/aortic ejection time by Doppler. RESULTS: Eight males were non-compliant with CPAP. Mean age was 47.9+/-8.2 years, and 20 of 25 patients (80.0%) were hypertensive. Patients had high body mass index (BMI: 31.0+/-3.9 kg/m(2)), but there was no change in BMI from baseline after 6 months. Thickness of IVS (11.0+/-1.1mm) and LVPW (11.0+/-1.0mm) at baseline were significantly decreased after 6 months of CPAP therapy (10.5+/-0.9 mm, P<0.001 and 10.4+/-0.7 mm, P<0.0001, respectively). Left ventricular MPI (60.1+/-13.8%) significantly decreased (53.0+/-10.7%, P<0.0001) after CPAP usage. CONCLUSIONS: In male patients with severe OSA, CPAP therapy significantly decreases left ventricular wall thickness and improves global function even with 6 months of usage.

Do we neglect women with sleep apnea?

Obstructive sleep apnea (OSA) affects approximately 5% of women and 15% of men in the middle-aged adults, and associated with adverse health outcomes. The prevalence and severity of OSA in women increase across the menopause, as the cardiovascular death and events do. Unfortunately, women with OSA might be under-diagnosed due to circumstances related to the family lifestyle and socio-cultural factors in addition to the different OSA clinical expression. Evaluation of cardiovascular global risk assessment in women with OSA is very important to prevent the high potential cardiovascular morbidity and mortality, since they are poorly informed about cardiovascular disease (CVD). So, we should be aware of the clues suspecting OSA and cardiovascular risk in women admitting to sleep clinics.

Anomalous origin of the left circumflex coronary artery: A case report.

The anomalous origin of the left circumflex coronary artery from the right sinus of Valsalva is a relatively common anatomical variation. Difficulties may occur in the diagnostic procedure, but recognition and adequate visualization of the anomaly is essential for proper patient management, especially in patients undergoing evaluation for percutaneous coronary intervention, coronary artery surgery or prosthetic valve replacement. In the present report, a patient who had undergone percutaneous coronary intervention for a right coronary artery lesion after inferior myocardial infarction is described. The anomalous origin of the left circumflex coronary artery arising independently from the right sinus of Valsalva was previously undetected.

[Differences between men and women in the clinical and laboratory findings of patients diagnosed with pulmonary embolism]. / Pulmoner emboli tanili olgularin klinik ve laboratuvar bulgularinda erkek-kadin farklari.

Pulmonary embolism (PE) could not be diagnosed correctly in 2/3 of patients saving of that pathology, and unfortunately mortality in them could be as high as 30%. In the present study, we aimed to investigate the gender differences in clinical, electrocardiography (ECG) and laboratory findings of PE patients diagnosed with contrast-enhanced helical computerized tomography of thorax. 31 patients (18 females, 58% and 13 males, 42%) were included into the study. Symptoms, risk factors, ECG and arterial blood gases were evaluated, and then Wells, Geneva and ECG scores were obtained in each subject. Alveolo-arterial (A-a) oxygen gradient was calculated as P(A-a)O2= 150-(PCO2/0.8)-PO2. Mean pulmonary artery pressure (PAP) was measured by echocardiography. In female and male patients, Wells score (4.8 +/- 1.9 and 3.2 +/- 2.2, p= 0.017); ECG score (5.9 +/- 3.6 and 3.1 +/- 1.8, p= 0.036) and mean PAP (33.5 +/- 12.3 mmHg and 23.2 +/- 10.0 mmHg, p= 0.017) were significantly different. However, between female and male patients Geneva score (4.8 +/- 1.7 and 5.0 +/- 1.6), A-a gradient (35.2 +/- 17.3 and 42.9 +/- 12.3) and PaCO2 (33.5 +/- 15.1 and 29.8 +/- 5.4) did not differ significantly (p> 0.05). Immobilization and surgical interventions as risk factors for PE were established significantly higher in females than males (50%-30.8%, p= 0.02 and 50%-23.1%, p= 0.01). In female patients with PE, Wells and ECG scores, immobilization, surgical interventions and mean PAP are significantly higher than male patients. So, in the clinical practice, these parameters may help to diagnose acute PE especially in females.