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Ventricular hypertrophy in sleep apnoea
1Cardiology Division, The Pennsylvania State University College of Medicine, Hershey, USA.
Insights
Ventricular hypertrophy increases cardiovascular risk. Right ventricular hypertrophy, unlike left, is distinctly linked to obstructive sleep apnea severity, potentially leading to heart failure.
Area of Science:
- Cardiology
- Sleep Medicine
- Physiology
Background:
- Ventricular hypertrophy elevates cardiovascular mortality risk.
- Hypertrophy can be eccentric (volume overload) or concentric (pressure overload).
- Age, weight, blood pressure, and cardiovascular disease influence hypertrophy prevalence.
Purpose of the Study:
- To investigate the relationship between obstructive sleep apnea (OSA) and ventricular hypertrophy.
- To differentiate the associations of left and right ventricular hypertrophy with OSA.
- To explore the potential of right ventricular hypertrophy as a marker for severe OSA.
Main Methods:
- Echocardiography for quantifying ventricular mass and hypertrophy.
- Review of existing reports on ventricular hypertrophy in OSA patients.
- Analysis of confounding variables such as age, weight, and blood pressure.
Main Results:
- Left ventricular hypertrophy in OSA is often attributable to confounding factors like age and blood pressure.
- Right ventricular hypertrophy shows a distinct association with OSA presence and severity.
- Right ventricular hypertrophy may precede cor pulmonale and right heart failure in OSA patients.
Conclusions:
- Right ventricular hypertrophy is a significant finding in obstructive sleep apnea.
- Further research is needed to confirm RVH as a marker for severe OSA and its role in heart failure development.
- Future studies on LVH in OSA must control for confounding variables like age, weight, and blood pressure.
Abstract:
Ventricular hypertrophy is associated with an increased risk of cardiovascular death and cardiac events. In response to a haemodynamic load, ventricular hypertrophy may either be eccentric (dilation in response to volume overload) or concentric (increase in wall thickness in response to pressure overload). Ventricular hypertrophy increases with age, weight, blood pressure, and the presence of cardiovascular disease. It is greater in men than in women when adjusting for other variables. Echocardiography is the best method for accurate quantification of left ventricular mass and for detecting right ventricular hypertrophy. In obstructive sleep apnoea there are reports of both eccentric and concentric hypertrophy of the left ventricle. However, many of these reports have failed to control for patient weight or age. More recent reports indicate that much of the hypertrophy of the left ventricle reported in obstructive sleep apnoea can be related to patients' age, blood pressure, or size. However, right ventricular hypertrophy appears to be distinctly associated with the presence and severity of obstructive sleep apnoea. Right ventricular hypertrophy secondary to obstructive sleep apnoea may be the substrate for the eventual development of cor pulmonale and right heart failure. Its pathophysiological significance and potential use as a marker of severe OSA requires further investigation. Further investigation into left ventricular hypertrophy and sleep apnoea must control for the potentially confounding variables listed above and will require population-based and/or carefully matched case control studies.