ABC | Volume 113, Nº6, December 2019

Original Article Leite et al. Risk of sleep apnea and echocardiographic parameters Arq Bras Cardiol. 2019; 113(6):1084-1089 Table 1 – Median with interquartile* range or absolute and relative frequency ** of clinical characteristics according to the presence of high risk for OSA modified*** High risk of OSA modified* Value Yes n = 223 No n = 131 Gender 0.01 Male 79 (35.4) 66 (50.4) Female 114 (64.6) 65 (49.6) Age (in years) 57.0 (51.0–63) 54.0 (49.0–61.0) 0.01 BMI kg/m 2 29.4 (26.1–33.0) 24.6 (22.4–27.3) < 0.01 Glucose (mg/dL) 102.5 (92.0–117.2) 97.0 (88.0–108.0) < 0.02 Urea (mg/dL) 31.0 (26.0–37.0) 31.0 (25.2–36.0) 0.69 Creatinine (mg/dL) 0.82 (0.71–0.99) 0.85 (0.74–0.96) 0.56 Uric acid (mg/dL) 5.6 (4.4–6.6) 4.7 (3.9–5.6) < 0.01 Cholesterol (mg/dL) 219.0 (193.0–250.0) 213.0 (187.0–239.0) 0.17 LDL-cholesterol(mg/dL) 135.8 (117.7–163.5) 134.1 (107.3–159.1) 0.19 HDL-cholesterol (mg/dL) 41.0 (51.5 (63.0) 55.0 (44.0–63.0) 0.23 Triglycerides (mg/dL) 126.5 (96.0 (183.7) 106.0 (73.0–153.0) < 0.01 Urine albumin-to-creatinine ratio 9.9 (5.7–22.3) 7.7 (4.7–13.6) < 0.01 Mean heart rate (bpm) 71.0 (63.0–80.0) 69.0 (62.5–76.5) 0.19 Systolic arterial pressure l (mmHg) 137.33 (122.5–152.0) 122.0 (113.3–129.5) < 0.01 Diastolic arterial pressure (mmHg) 84.0 (76.3–92.67) 75.5 (70.3–80.7) < 0.01 Myocardial infarction Yes 9 (4.0) 4 (3.1) 0.86 No 214 (96.4) 127 (96.9) Stroke Yes 11 (4.9) 1 (0.8) 0.07 No 212 (95.1) 130 (99.2) OSA: obstructive sleep apnea; BMI: body mass index; bpm: beats per minute. *Differences tested by the Mann-Whitney test; ** Differences tested by Pearson’s qui‑square test with continuity correction or Fisher’s exact test when necessary; *** Individuals who were classified as at risk only in category 3 were excluded (Adapted from Netzer et al., 1999). 5 The exponentials of the coefficients for each gamma regression model are presented in table 3. In all cases, the exponentials of the coefficients were adjusted for gender, age, BMI, fasting glucose, triglycerides, uric acid, urine albumin- to-creatinine ratio and systolic and diastolic blood pressure in their continuous forms. Association of the high risk of OSA with less effective diastolic function was confirmed for: LAV-i (+), E/A (+), E’/A’(+), A (+) association with DT (+) E’ (+), which reached a significance of 0.10 (Table 3). Discussion The present study evaluated the presence of abnormalities on TDE, associated with diastolic disfunction, in individuals without signs or symptoms of HF, according to the presence of risk of OSA. The BQ was used as a tool and the individuals with obesity and high blood pressure who did not present other criteria for OSA were excluded. In primary care, selective methods for OSA are more easily applied than standard polysomnography, being useful in the stratification of risk, as they have lower costs and are easily accessible. 7 Using the BQ in the population assisted in primary care programs, such as the “ Médico de Família ” program, would help to select patients at risk for OSA, who should then be referred for TDE and polysomnography investigation. OSA is related to different physiopathological mechanisms triggered by hypoxia and sleep fragmentation, involving sympathetic hyperactivity, inflammation, endothelial disfunction and oxidative stress, among other factors leading to arterial hypertension, atrial fibrillation, stroke and HF outcomes. 10 Various studies have demonstrated alterations of different markers of diastolic function of the LV in patients with OSA as an indexed increase in left atrial size (LAV-i), 11,12,13 altered E/A ratio, 14,15 early diastolic mitral annular velocity (E’) 16,17 and increase in E/E ratio. 14,18 Our data show alterations in some of these markers: LAV-i, E’/A’ ratio, A wave, E’ and E/A ratio in patients at risk for OSA. 1086