Avaliação dos marcadores ecocardiográficos de pacientes com doença pulmonar obstrutiva crônica e síndrome da apneia obstrutiva do sono (overlap syndrome)
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2023-02-28
Autores
Barros, Jefferson Luis de [UNESP]
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Universidade Estadual Paulista (Unesp)
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Introdução: Pacientes com sobreposição da doença pulmonar obstrutiva crônica (DPOC) e síndrome da apneia obstrutiva do sono (SAOS) (overlap syndrome – OVS) podem estar mais propensos a desenvolver doenças cardiovasculares, portanto, a avaliação ecocardiográfica desses indivíduos é de grande relevância para propostas terapêuticas e de intervenção mais direcionadas. Objetivo: Avaliar os marcadores ecocardiográficos de pacientes com sobreposição de DPOC e SAOS. Métodos: Trata-se de estudo observacional retrospectivo, realizado por meio de análise de prontuários de todos os pacientes no período de dois anos com diagnóstico de DPOC com/sem SAOS. Foram avaliadas a função pulmonar, comorbidades, exames laboratoriais, polissonografia e ecocardiograma transtorácico. Resultados: Foram incluídos 74 pacientes na análise final e, destes 44 com OVS e 30 com diagnóstico apenas de DPOC. Dentre os pacientes avaliados, 54% eram do sexo masculino, com idade de 68,810 anos e VEF1 de 41(32-55)%. Os pacientes com DPOC sem SAOS apresentaram maior obstrução das vias aéreas pelo VEF1 em litros [0,9 (0,7-1,3) vs 1,1 (0,9-1,5); p=0,047], maior porcentagem na oximetria de pulso [93 (89,5-95) vs 90 (86,2-92,7); p=0,016] e maior necessidade de oxigenoterapia domiciliar (p=0,001). Em relação aos exames laboratoriais, viu-se apenas que o T4 livre foi maior no grupo com OVS (1,04±0,18 vs 1,18±0,25; p=0,038). Em relação à polissonografia, foi encontrada melhor porcentagem da saturação mínima [84 (75,2-88) vs 76,5(69,2-83); p=0,02] e menor índice de dessaturação [1,9(0-4,8) vs 11,1(7,4-31,3); p<0,001]. Quanto às variáveis ecocardiográficas, viu-se que as variáveis diastólicas estavam alteradas tanto nos pacientes com DPOC quanto naqueles com OVS e, além disso, os pacientes com OVS apresentaram maior diâmetro do átrio esquerdo (37±7,9 vs 41,5±6,4; p=0,02) e maior espessura da parede posterior do VE na diástole [9(8-10)mm vs 10 (9-12);p=0,03]. As demais mensurações não apresentaram diferenças significativas. Conclusão: Pacientes com OVS, mesmo apresentando menor obstrução das vias aéreas, eram aqueles com mais dessaturação e, sobre as variáveis ecocardiográficas, embora observadas nos dois grupos, aqueles com OVS apresentaram variações mais sugestivas de disfunção diastólica, em especial pelo aumento do diâmetro do átrio esquerdo e da espessura da parede posterior do ventrículo esquerdo na diástole.
Introduction: Patients with overlapping of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea syndrome (OSAS) (overlap syndrome - OVS) may be more likely to develop cardiovascular diseases, therefore, the echocardiographic evaluation of these individuals is of great relevance for therapeutic proposals and more targeted interventions. Objective: Evaluate the echocardiographic markers of patients with overlapping of COPD and OSA. Methods: This is a retrospective observational study, carried out by analyzing the medical records of patients diagnosed with COPD with/without OSA over two-years. Pulmonary function, comorbidities, laboratory tests, polysomnography and transthoracic echocardiography were evaluated. Results: A total of 74 patients were included in the final analysis, of which 44 had OVS and 30 were diagnosed only with COPD. Among the evaluated patients, 54% were male, aged between 68.810 years and FEV1 of 41(32-55)%. Patients with COPD without OSA had greater airway obstruction by FEV1 in liters [0.9 (0.7-1.3) vs 1.1 (0.9-1.5); p=0.047], higher percentage in pulse oximetry [93 (89.5-95) vs 90 (86.2-92.7); p=0,016] and greater need for long-term home oxygen therapy (p=0.001). Regarding laboratory tests, it was only seen that free T4 was higher in the group with OVS (1.04±0.18 vs 1.18±0.25; p=0.038). On polysomnography, a better percentage of minimum saturation was found [84 (75.2-88) vs 76.5(69.2-83); p=0,02] and lower desaturation index [1.9(04.8) vs 11.1(7.4-31.3); p<0.001]. As for the echocardiographic variables, it was seen that the diastolic variables were altered both in patients with COPD and in those with OVS and, in addition, patients with OVS had a larger left atrial diameter (37±7.9 vs 41.5±6.4; p=0,.2) and greater LV posterior wall thickness in diastole [9(8-10) mm vs 10 (9-12);p=0.03]. The other measurements did not show significant differences. Conclusion: Patients with OVS, even with less airway obstruction, were those with more desaturation and, regarding the echocardiographic variables, although observed in both groups, those with OVS showed variations more suggestive of diastolic dysfunction, especially due to the increase in left atrial diameter and left ventricular posterior wall thickness in diastole.
Introduction: Patients with overlapping of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea syndrome (OSAS) (overlap syndrome - OVS) may be more likely to develop cardiovascular diseases, therefore, the echocardiographic evaluation of these individuals is of great relevance for therapeutic proposals and more targeted interventions. Objective: Evaluate the echocardiographic markers of patients with overlapping of COPD and OSA. Methods: This is a retrospective observational study, carried out by analyzing the medical records of patients diagnosed with COPD with/without OSA over two-years. Pulmonary function, comorbidities, laboratory tests, polysomnography and transthoracic echocardiography were evaluated. Results: A total of 74 patients were included in the final analysis, of which 44 had OVS and 30 were diagnosed only with COPD. Among the evaluated patients, 54% were male, aged between 68.810 years and FEV1 of 41(32-55)%. Patients with COPD without OSA had greater airway obstruction by FEV1 in liters [0.9 (0.7-1.3) vs 1.1 (0.9-1.5); p=0.047], higher percentage in pulse oximetry [93 (89.5-95) vs 90 (86.2-92.7); p=0,016] and greater need for long-term home oxygen therapy (p=0.001). Regarding laboratory tests, it was only seen that free T4 was higher in the group with OVS (1.04±0.18 vs 1.18±0.25; p=0.038). On polysomnography, a better percentage of minimum saturation was found [84 (75.2-88) vs 76.5(69.2-83); p=0,02] and lower desaturation index [1.9(04.8) vs 11.1(7.4-31.3); p<0.001]. As for the echocardiographic variables, it was seen that the diastolic variables were altered both in patients with COPD and in those with OVS and, in addition, patients with OVS had a larger left atrial diameter (37±7.9 vs 41.5±6.4; p=0,.2) and greater LV posterior wall thickness in diastole [9(8-10) mm vs 10 (9-12);p=0.03]. The other measurements did not show significant differences. Conclusion: Patients with OVS, even with less airway obstruction, were those with more desaturation and, regarding the echocardiographic variables, although observed in both groups, those with OVS showed variations more suggestive of diastolic dysfunction, especially due to the increase in left atrial diameter and left ventricular posterior wall thickness in diastole.
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Doença pulmonar obstrutiva crônica, Síndrome de apneia do sono, Doenças cardiovasculares, Chronic obstructive pulmonary disease, Sleep apnea syndrome, Cardiovascular diseases