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Clinical InvestigationsLeftward Shift of the Interventricular Septum and Pulsus Paradoxus in Obstructive Sleep Apnea Syndrome
Section snippets
Population
Ten patients (nine men, one woman) previously diagnosed with OSAS participated in our study after signing an informed consent. They had a mean age of 43.3 ±3.8 years and a mean RDI of 60.1 ±56.6 (range: 11 to 189). The RDI is the number of apneas (complete airway occlusions) or hypopneas (partial airway occlusions) per hour of sleep. Most of the subjects were overweight; the mean BMI was 33.5 ±8.4 kg/m2 (up to 27.8 kg/m2 is considered normal for the US population). None of the subjects had any
RESULTS
All patients presented with symptoms of obstructive sleep apnea, but RDI and lowest SaO2 values during sleep varied, as indicated in Table 1. The greatest difference was in maximum Pes nadir during sleep, which oscillated between –4 and –80 cm H2O. The mean values of the different measurements taken with and without nasal CPAP are presented in Table 2.
When qualitative analysis was performed, patients 1 to 5 presented with marked LSIVS, while patients 6 to 10 had normal motion. We called the
DISCUSSION
Understanding the hemodynamic abnormalities associated with obstructive sleep apnea are of importance, considering the cardiovascular morbidity and mortality associated with OSAS which already has been reported.14,15 As reported before and as seen here, some OSAS patients can develop very negative Pes values during Muller maneuvers (as low as –80 cm H2O in our study, for example). Left ventricular end-diastolic volume, or preload, is thought to be reduced through ventricular interdependence
ACKNOWLEDGMENT:
We thank Laura Wilkinson for editing the manuscript.
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This work was supported by grant AG-7772 of the National Institute of Aging and General Clinical Research Center grant RR-00070 of the National Institutes of Health.