Clinical Characteristics of Hypertensive Patients with Obstructive Sleep Apnoea Syndrome Developing Different Types of Left Ventricular Geometry.

OBJECTIVE: The objective of the study was to compare polygraphic parameters and selected laboratory parameters in patients with obstructive sleep apnoea (OSA) who develop various types of left ventricular (LV) geometry. Material and Methods. The research covered 122 patients with obstructive sleep apnoea and coexisting effectively treated systemic hypertension (95 men, 27 women, average age: 54 ± 10.63). Overnight polygraphy, echocardiography, carotid artery ultrasonography, and laboratory measurements were performed. The patients were classified into four groups, depending on LV geometry. Group 1 comprised patients with normal LV geometry, group 2 included those with LV concentric remodelling. Group 3 and group 4 were patients with LV hypertrophy, concentric or eccentric, respectively. RESULTS: The most frequent type of LV geometry in the examined population was eccentric hypertrophy (36%). The highest average values of BMI and T-Ch were observed in the group of patients with concentric remodelling (group 2). The most severe respiratory disorders were found in the group of patients developing LV concentric hypertrophy (group 3); however, these differences were not statistically significant in comparison to other groups. Patients with LV eccentric hypertrophy had significantly decreased LV ejection fraction (p = 0.0008). CONCLUSIONS: LV eccentric hypertrophy is the most frequent type of LV geometry in OSA patients. Patients with severe sleep-disordered breathing are more likely to develop concentric hypertrophy, while concentric remodelling occurs more frequently among OSA patients with other coexisting conditions, such as obesity or lipid-related disorders.

Obstructive sleep apnea may increase the risk of Alzheimer's disease.

OBJECTIVES: Amyloid-ß 1-40 (Aß 1-40) and amyloid-ß 1-42 (Aß 1-42) are the proteins known to be involved in the pathogenesis of Alzheimer's disease (AD)-the most common cause of dementia in the elderly. Hypoxia is suspected to be one of conditions associated with Aß plasma level increase. A common reason of hypoxia is obstructive sleep apnea (OSA), characterized by recurrent episodes of apnea. AIM: The aim of the study was to evaluate plasma Aß 1-40 and Aß 1-42 concentrations in patients with OSA. METHODS: Patients with suspected OSA (n = 112) underwent polygraphic examinations Patients with confirmed OSA (n = 81) showed apnea/hypopnea index greater than or equal to 5. Mild and moderate form of the disease was defined when AHI was 5-30 (n = 38, OSA+), severe-when AHI was >30 (n = 43, OSA++). Individuals with AHI<5 (n = 31) served as control group (OSA-). RESULTS: Aß 1-40 concentrations in OSA++ (191.1 pg/ml) group was significantly (p<0.05) higher compared with OSA- (76.9 pg/ml) and OSA+ (159.4 pg/ml) and correlated with selected parameters of hypoxemia severity. There were no differences in Aß 1-42 concentration between the groups. CONCLUSION: In patients with severe OSA Aß 1-40 plasma concentrations are significantly higher compared with OSA- and OSA+ and seem to be related to hypoxia severity, which may indicate increased risk of AD development in this group of patients.

Spatial QRS-T angle in patients with newly diagnosed obstructive sleep apnea syndrome.

PURPOSE: The aim of the study was to assess the spatial QRS-T angle (QRS-TA) in a group of newly diagnosed and untreated adult patients with obstructive sleep apnea syndrome (OSAS) and to identify potential factors affecting this parameter. PATIENTS AND METHODS: The study group (PSG-confirmed OSAS) included 62 individuals, aged 51.7±10.3 years. The control group consisted of 25 individuals, aged 46.6±16.6 years with no sleep-disordered breathing. The diagnosis of OSAS and assessment of its severity was based on unattended all-night screening polysomnography. The spatial QRS-TA was reconstructed from 12-lead ECG using Kors' regression method. RESULTS: Significant differences of spatial QRS-TA values were found between patients with severe OSAS (36.9±18.9°) and the controls (20.3±13.4°; p<0.01) and between patients with mild or moderate OSAS (32.3±20.1°) and the controls (p=0.01). Statistically significant correlations were found between spatial QRS-TA and polysomnographic indices (i.e. AHI, AI, RDT and RDTI). CONLUSIONS: Spatial QRS-TA values are significantly higher in patients with OSAS than in controls, thus indicating increased heterogeneity of myocardial action potential. Further long-term prospective studies evaluating the prognostic value of spatial QRS-TA in OSAS patients are needed.

Reliability of the Epworth Sleepiness Scale and the Berlin Questionnaire for screening obstructive sleep apnea syndrome in the context of the examination of candidates for drivers.

BACKGROUND: The aim of the study has been to assess the usefulness of the Epworth Sleepiness Scale (ESS) and the Berlin Questionnaire (BQ) for obstructive sleep apnea syndrome (OSAS) screening. The capacity of both tests to discriminate between healthy individuals or with mild OSAS (apnea-hypopnea index (AHI) < 15/h) vs. patients with moderate or severe OSAS (AHI ≥ 15/h) was evaluated. MATERIAL AND METHODS: The study encompassed 223 patients with a suspicion of the OSAS. The ESS and BQ were completed by patients unassisted. Screening polysomnography was performed using the Porti SleepDoc. The OSAS was diagnosed when AHI ≥ 15/h or AHI ≥ 5/h with simultaneous occurrence of clinical symptoms. RESULTS: The ESS score was found to be significantly higher in the study group compared to the control group (8.9±5.9 vs. 11.6±5.2 pt, p < 0.0001). Otherwise, there were no significant inter-group differences in the percentage of high-risk individuals according to the BQ (83.7% vs. 92.3%, p > 0.05). Sensitivity of the ESS and BQ was 53.2% and 93.1%, respectively while specificity was 58.8% and 16.2%, respectively. Poor correlation between the ESS score and AHI and apnea index were noticed (r = 0.22, p = 0.001 and r = 0.24, p < 0.001, respectively). CONCLUSIONS: Considering its low sensitivity, the ESS should not be used as a screening test for the OSAS diagnosis amongst candidates for drivers. The BQ is characterised by high sensitivity for the OSAS diagnosis with AHI ≥ 15/h, however, due to low specificity, the questionnaire may increase the number of healthy individuals referred for needless diagnostic procedures. Med Pr 2016;67(6):721-728.

Evaluation of Fibrinolytic Inhibitors: Alpha-2-Antiplasmin and Plasminogen Activator Inhibitor 1 in Patients with Obstructive Sleep Apnoea.

Obstructive sleep apnoea (OSA) induces thrombophilia and reduces fibrinolysis. Alpha-2-antiplasmin (a-2-AP) and plasminogen activator inhibitor 1 (PAI-1) are major inhibitors of the fibrinolytic system. Increased concentrations of these factors are associated with a higher risk of cardiovascular diseases. The aim of this study was to assess plasma a-2-AP and PAI-1 in patients with OSA and evaluate correlations with the polysomnographic record and selected risk factors of cardiovascular diseases. The study group comprised 45 patients with OSA, and the control group consisted of 19 patients who did not meet the diagnostic criteria of OSA. Plasma a-2-AP and PAI-1 concentrations were assessed by enzyme-linked immunosorbent assay (ELISA). In the study group, the median value of plasma a-2-AP was higher than that of the control group (157.34 vs. 11.89 pg/ml, respectively, P<0.0001). A-2-AP concentration increased proportionally to the severity of OSA. The concentration of a-2-AP was positively correlated with the apnoea-hypopnoea index (AHI), apnoea index (AI), respiratory disturbances time (RDT), and desaturaion index (DI), and negatively correlated with mean and minimal oxygen saturation (SpO2 mean, SpO2 min, respectively). The median value of PAI-1 was higher in the study group than the control group (12.55 vs. 5.40 ng/ml, respectively, P = 0.006) and increased along with OSA severity. PAI-1 concentration was positively correlated with AHI, AI, RDT, DI, and body mass index (BMI) and negatively correlated with SpO2 mean and SpO2 min. Higher plasma concentrations of a-2-AP and PAI-1 in patients with OSA indicated that these patients had increased prothrombotic activity. OSA increases the risk of cardiovascular complications as it enhances prothrombotic activity.

[Difficulty in diagnosis of primary hyperaldosteronism as the cause of resistant hypertension and severe hypokalemia--case report]. / Trudnosci diagnostyczne pierwotnego hiperaldosteronizmu, jako przyczyny opornego na leczenie nadcisnienia tetniczego i hipokaliemii--opis przypadku.

The most common endocrinological cause of secondary hypertension is primary hyperaldosteronism. Despite great progress in laboratory and imaging techniques, its identification is often difficult. We report the case of the 52-year-old man with resistant hypertension and severe hypokalemia. Renovascular hypertension, Cushing syndrome and pheochromocytoma were excluded as potential causes of drug-resistant hypertension in the presented case. Renal potassium excretion was significantly high. The results of plasma aldosterone concentration measured in supine position as well as in standing position were ambiguous. Computed tomography revealed abnormal round solid mass with a maximum diameter of 11 mm in the left adrenal. As there were not diagnostic results of laboratory research and ambiguous character of pathological structure in research computed tomography we have decided to carry adrenal cortex scintigraphy with iodomethyl-norcholesterol 131I. The result of this research was consistent with left adrenal scan of computed tomography and left adrenal adenoma has been confirmed. Normal blood pressure and normokalemia were restored after surgical treatment.

Are patients undergoing treatment of hyperlipidaemia with statins the best candidates for early cardiac rehabilitation?

The role of statins in the primary and secondary prevention of cardiovascular events is well known. An important adverse event associated with statin treatment is myopathy; intensive physical effort in patients treated with statins increases the risk of muscle injury/myopathy. In this article we discuss the benefits and risks associated with statin treatment in patients undergoing cardiac rehabilitation after acute coronary syndromes and/or coronary revascularization procedures. In our opinion, the benefits of the secondary prevention of coronary heart disease achieved with statins seem to outweigh the hazards associated with statin therapy. The careful selection of patients for both treatment with statins and the gradual intensification of physical training in the course of cardiac rehabilitation appears to constitute an important element of the therapeutic approach.

[Cardiac manifestation of Morgagni hernia--a case report]. / Kardiologiczne objawy przepukliny Morgagniego--opis przypadku.

The Morgagni hernia is a rare condition caused by the disturbances in the embryonal development of the diaphragm. The high pressure in the abdominal cavity during the persistent constipations or in pregnant women seems to be important predisposing factor apart from advanced age, obesity, vertebral column deformities and the connective tissue diseases. That is why the Morgagni hernia is very rarely diagnosed in children but usually in women in their fifties. We present the case report of our patent who was admitted to the Department of Internal Diseases for the diagnostics of lasting for 3-4 months weakness, chest pains and the episodes of palpitations. During her stay in our Department the routine chest X-ray examination was performed, that showed the unexpected result. The diagnosis of Morgagni hernia was afterwards confirmed in the computed tomography. Even though the risk of the acute abdominal conditions in the dislocated parts of gastro-intestinal tract our patient did not agree to proposed operation.

[Myopathy in the course of hypolipemic theraphy in patient undergoing early cardiac rehabilitation after the percutaneous coronary intervention--a case report]. / Miopatia w przebiegu leczenia hipolipemizujacego u chorej poddanej wczesnej rehabilitacji kardiologicznej po zabiegu angioplastyki wiencowej--opis przypadku.

The role of statins in primary and secondary prevention of cardiovascular incidents cannot be questioned. However, it is commonly known, that their use, especially in high doses, can cause side effects. Our study reports the case of female patient who because of an episode of unstable angina underwent the percutaneous coronary intervention (PCI) of right coronary artery (RCA), and afterwards received the hypolipemic treatment of simvastatin in the dose of 80 mg/day. After the PCI she participated in the programme of early sanatory cardiac rehabilitation. After some days of her stay she started to notice the generalized muscle pain, that she initially linked with the intensification of exercise. Two days after finishing the rehabilitation programme she was admitted to our Department with the symptoms of generalized muscle injury. Laboratory test revealed very high serum level of creatine kinase, myoglobin and transaminases. Data obtained from anamnesis and results of laboratory testing enabled to diagnose myopathy being the result of hypolipemic treatment with high dose of simvastatin. After the treatment we observed gradual regression of muscle pain, and in 12th day of the stay in our clinic the normalization of biochemical parameters was stated. Our patient reported she was not informed about the possible complications of undertaken treatment. This case report emphasizes the necessity to precisely inform the patients about the possible drugs side effects.

[Pancytopenia after methotrexate treatment]. / Pancytopenia po leczeniu metotreksatem.

The use of methotrexate is associated with the risk of numerous, sometimes life-threatening, side effects. We describe a 76-year-old female patient treated with methotrexate (MTX) due to vertebral joint disease of unknown etiology. During the outpatient therapy, which was not conformed to doctor's recommendations, acute liver failure and symptoms of bone marrow damage developed. Despite intensive hospital treatment, the patient died.

[Cardiovascular abnormalities in patients with obstructive sleep apnoea syndrome]. / Zaburzenia czynnosci ukladu sercowo-naczyniowego u chorych z zespolem obturacyjnego bezdechu sennego.

The activation of adrenergic and renin-angiotensin-aldosterone (RAA) systems observed in patients with obstructive sleep apnoea syndrome (OSA) strongly affects functional status of the cardiovascular system. In this paper we discuss the link between obstructive sleep apnoea syndrome and common cardiovascular diseases such as systemic and pulmonary hypertension, ischaemic heart disease, stroke, arrhythmia and ventricular hypertrophy. We also present the importance of early pharmacologic treatment in preventing cardiac hypertrophy and ventricular dysfunction in patients with obstructive sleep apnoea syndrome.