Left ventricular diastolic dysfunction in patients with obesity hypoventilation syndrome

Abstract

Background: Obesity hypoventilation syndrome (OHS) can be complicated by several cardiovascular conditions. We assessed the prevalence and factors associated with left ventricular diastolic dysfunction (LVDD) in patients with OHS. Methods: In this prospective observational study, all consecutive OHS patients referred to the sleep disorders clinic between January 2002 to December 2016 were included (n=113). Demographic data, echocardiography, sleep parameters, arterial blood gases (ABGs), and lung functions were recorded. Results: Of 113 patients with OHS who participated, 76 patients (67%) had LVDD. More than twothirds had grade 1 LVDD. Median body mass index (BMI) was 42.8 kg/m 2 . Median PaCO 2 was 55.8 mmHg. Median apnea hypopnea index (AHI) was 52 (25-38.5). Eighty-four (75.7%) patients were hypertensive,and 60 (54.1%) were diabetic. To minimize the effect of fluctuations in intrathoracic pressure during the obstructive respiratory events on the cardiac function, 38 OHS patients with mild to moderate OSA (AHI <30) were identified. Twenty-seven (71%) had LVDD. When compared to OHS patients without LVDD, patients with LVDD had higher BMI (47.4±6.5 versus 41.5±4.5, P=0.009). Hypertension was more common in OHS patients with LVDD than without LVDD (89.3% versus 54.5%, P=0.03). Correlation analysis revealed that hypertension (r=−0.37, P=0.016) had significant correlations with LVDD.Conclusions: Diastolic left ventricular dysfunction is prevalent among OHS patients even in the absence of severe OSA. Hypertension and obesity were significantly more common in patients with LVDD.Assessment of diastolic dysfunction should be included in the initial evaluation of OHS patients to encourage the early institution of therapy.

Comparison of Percutaneous Coronary Intervention Outcomes Among Patients With Obstructive Sleep Apnea, Chronic Obstructive Pulmonary Disease Overlap, and Pickwickian Syndrome (Obesity Hypoventilation Syndrome)

“…OHS patients are at an increased risk of developing heart failure, ventricular dysfunction, cor pulmonale, pulmonary hypertension, and angina pectoris than obese eucapnic individuals [ 18 ]. A study found that the prevalence of left ventricular dysfunction was high in OHS patients even with mild to moderate OSA [ 19 ]. Prior studies reveal that OHS patients have a high prevalence of right ventricular dysfunction, left ventricular hypertrophy, arrhythmias, and pulmonary hypertension due to a reflex elevation of arterial blood pressure and increased heart workload following chronic hypoxia [ 20 ].…”

Impact of nocturnal hypoxia and hypercapnea on global myocardial performance in patients with sleep related breathing disorders

“…Al Otair and his colleagues found positive correlation between PaCO2 and LVDD and negative correlation between PaO2 and LVDD in OSA patients but without significant difference (Al Otair et al, 2018). These data may partly depend on the patient selection and use of only conventional Doppler, which is not accurate for detecting early diastolic dysfunction in patients with a normal ejection fraction (EF) (Ommen et al, 2000).…”