Morphofunctional features of the myocardium in patients with severe obstructive sleep apnea syndrome and their dynamics during continuous positive airway pressure therapy

Abstract

This paper presents the echocardiographic morphofunctional parameters of the myocardium of patients suffering from severe obstructive sleep apnea syndrome and their dynamics before and after treatment with the help of the SYNAP apparatus by creating a constant positive pressure on inspiration during sleep. All patients were divided into two groups: the experimental group suffering from severe obstructive sleep apnea syndrome and the control group without cardiovascular and respiratory diseases. After echocardiography, the experimental group underwent a course of continuous constant positive pressure on inspiration during sleep. The symptoms of severe obstructive sleep apnea syndrome were determined by the presence of daytime drowsiness, loud snoring, witnessed breathing interruptions, or awakenings due to shortness of breath or suffocation, in the presence of at least 30 obstructive respiratory complications (apnea, hypopnea, or excitement associated with respiratory effort) in 1 h of sleep. In the experimental group, remodeling of heart chambers was observed, manifested mainly by an increase in the volume of the left atrium, dilatation of the right ventricle, and development of myocardial hypertrophy of the left and right ventricles. The systolic function of the right ventricle and the diastolic dysfunction of the right and left ventricles decreased, and the systolic pressure in the pulmonary artery increased. A course of continuous constant positive inhalation pressure during sleep in the experimental group led to reverse remodeling of the heart chambers and improvement of the systolic function of the myocardium of both ventricles. A 3-month course of continuous constant positive pressure on inspiration during sleep led to a persistent decrease in systolic pressure in the pulmonary artery. The constant application of continuous, constant positive pressure on inhalation during sleep can prevent the progression of systolic and diastolic abnormalities and reverse these changes in the initial stages before serious structural changes can develop.