ABC | Volume 113, Nº6, December 2019

Original Article Risk of Obstructive Sleep Apnea and Echocardiographic Parameters Adson Renato Leite, Diana Maria Martinez , Maria Luiza Garcia-Rosa , Erica de Abreu Macedo, Antonio José Lagoeir o, Wolney de Andrade Martin s, D elvo Vasques-Netto, Cárita Cunha dos Santos Universidade Federal Fluminense - Medicina Clinica, Niterói, RJ – Brazil Mailing Address: Diana Maria Martinez Ceron • Universidade Federal Fluminense - Rua Marques do Paraná, 303. Postal Code 24033-900, Centro, Niterói, RJ – Brazil E-mail: mcdianamaria@gmail.com Manuscript received June 19, 2018, revised manuscript January 27, 2019, accepted February 13, 2019 DOI: 10.5935/abc.20190181 Abstract Background: Obstructive sleep apnea (OSA) is a chronic progressive disorder with high mortality and morbidity rate, associated with cardiovascular diseases (CVD), especially heart failure (HF). The pathophysiological changes related to OSA can directly affect the diastolic function of the left ventricle. Objectives: To assess the association of the risk ofOSA, evaluatedby the BerlinQuestionnaire (BQ), and echocardiographic (ECHO) parameters related to diastolic dysfunction in individuals without HF assisted in primary care. Methods: A cross-sectional study that included 354 individuals (51% women) aged 45 years or older. All individuals selected were submitted to an evaluation that included the following procedures: consultation, filling out the BQ, clinical examination, laboratory examination and transthoracic Doppler echocardiography (TDE). Continuous data are presented as medians and interquartile intervals, and categoric variables in absolute and relative frequencies. The variables associated with risk of OSA and at the 0.05 level integrated the gamma regression models with a log link function. A value of p < 0.05 was considered an indicator of statistical significance. Exclusion criteria were presence of HF, to fill out the BQ and patients with hypertension and obesity not classified as high risk for OSA by other criteria. All individuals were evaluated on a single day with the following procedures: medical appointment, BQ, laboratory tests and ECHO. Results: Of the 354 individuals assessed, 63% were classified as having high risk for OSA. The patients with high risk for OSA present significantly abnormal diastolic function parameters. High risk for OSA confirmed positive and statistically significant association, after adjustments, with indicators of diastolic function, such as indexed left atrium volume LAV-i (p = 0.02); E’/A’ (p < 0.01), A (p = 0.02), E/A (p < 0.01). Conclusion: Our data show that patients at high risk for OSA present worsened diastolic function parameters measured by TDE. (Arq Bras Cardiol. 2019; 113(6):1084-1089) Keywords: Cardiovascular Diseases; Sleep Apnea, Obstruction; Indicators, Morbimortality; Heart Failure; Ecocardiography/methods; Polysonography/methods. Introduction Obstructive sleep apnea (OSA) is a chronic progressive disorder with highmortality andmorbidity rate and is associated with cardiovascular diseases (CVD), including heart failure (HF). 1 The physiopathological interaction between OSA and cardiovascular disease is complex and involves sympathetic activation, oxidative stress and inflammation, endothelial disfunction and disfunction of the Circadian clock gene. 2-4 Besides polysomnography, considered the gold standard for the diagnosis of OSA, there are different scales which do not diagnose the disease, but indicate the people at risk, among which is the Berlin Questionnaire (BQ). 5 A meta‑analysis published in 2017 estimated that the sensitivity of the Questionnaire to detect OSA was 76%, 77% and 84% and its specificity was 59%, 44% and 38% for patients with mild, moderate and severe OSA, respectively. It is necessary to point out the adequate sensitivity which enables the BQ as a tracking too, making early diagnosis of OSA possible. 6 The prevalence of diastolic disfunction in patients with OSA ranges from 23% to 56% and there is a dose-response relation between the severity of diastolic disfunction and the severity of strong physiopathological basis demonstrated for a continuum of diastolic disfunction and heart failure in their two phenotypes, which means a greater risk for these patients to develop HF. The association of OSA with diastolic disfunction was observed even in its initial stages. 7 We have not yet found studies of the association of characteristic echocardiographic parameters of diastolic disfunction and the presence of the risk of OSA in patients with no signs or symptoms of heart failure. The purpose of this study was to assess the association of the risk of OSA and echocardiographic parameters related to diastolic disfunction in patients without HF assisted by “ Programa Médico de Família ” (PMF – Family Doctor Program) in the city of Niterói. 1084