Chest
Volume 100, Issue 4, October 1991, Pages 894-902
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Clinical Investigations
Leftward Shift of the Interventricular Septum and Pulsus Paradoxus in Obstructive Sleep Apnea Syndrome

https://doi.org/10.1378/chest.100.4.894Get rights and content

Echocardiograms were taken from the parasternal long axis view during nocturnal sleep in ten patients diagnosed with OSAS. A table designed to support the echocardiographic probe prevented significant sleep disturbances during monitoring and allowed continuous data collection with and without nasal CPAP administration. In five of ten patients, there was before CPAP treatment a diastolic LSIVS during NREM sleep, inducing a flattening of the left ventricle. Arterial blood pressure recordings showed pulsus paradoxus when LSIVS was occurring. Nasal CPAP led to normal, unobstructed breathing, significant decrease in Pes nadir and disappearance of LSIVS and pulsus paradoxus. Increase in left ventricular afterload and increase in total peripheral resistance could lead to hypertrophy and hypertension in some OSAS patients. The presence of pulsus paradoxus in OSAS indicates a marked increase in Pes nadir, and its disappearance with nasal CPAP may be one of the signs of effective treatment of OSAS.

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.

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