การทำงานของหัวใจในผู้ป่วยเด็กที่มีภาวะหยุดหายใจขณะหลับจากการอุดกั้น
ผู้ป่วยเด็กที่มีภาวะหยุดหายใจขณะหลับจากการอุดกั้น
คำสำคัญ:
เด็ก, การตรวจคลื่นเสียงสะท้อนหัวใจ, การทำงานของหัวใจ, ภาวะหยุดหายใจขณะหลับจากการ อุดกั้น, ภาวะนอนกรนบทคัดย่อ
ภาวะหยุดหายใจขณะหลับจากการอุดกั้นอาจส่งผลต่อการทำงานของหัวใจในผู้ป่วยเด็ก การศึกษาแบบวิเคราะห์ชนิดมีกลุ่มเปรียบเทียบครั้งนี้มีวัตถุประสงค์เพื่อประเมินการทำงานของหัวใจในผู้ป่วยเด็กที่มีภาวะหยุดหายใจขณะหลับจากการอุดกั้น โดยตรวจภาวะหยุดหายใจขณะหลับจากการอุดกั้นร่วมกับตรวจการทำงานของหัวใจด้วยเครื่องคลื่นเสียงสะท้อนหัวใจ มีผู้เข้าร่วมวิจัย 80 คน อายุ 4-15 ปี (อายุเฉลี่ย 7.79 ± 3.12 ปี) แบ่งเป็น 3 กลุ่ม ได้แก่ กลุ่มนอนกรนธรรมดา 39 ราย (ร้อยละ 48.8) กลุ่มหยุดหายใจขณะหลับจากการอุดกั้นน้อย 11 ราย (ร้อยละ 13.8) และกลุ่มหยุดหายใจขณะหลับจากการอุดกั้นปานกลางถึงรุนแรง 30 ราย (ร้อยละ 37.5) ผลการตรวจคลื่นเสียงสะท้อนหัวใจมาตรฐานไม่พบความแตกต่างของการทำงานของหัวใจแต่เมื่อใช้วิธี tissue Doppler imaging พบว่าการทำงานของหัวใจในกลุ่มหยุดหายใจขณะหลับจากการอุดกั้นปานกลางถึง รุนแรงแย่กว่ากลุ่มนอนกรนธรรมดา โดยมีค่า right ventricular myocardial performance index (RV MPI-TDI) เท่ากับ 0.46 ± 0.10 และ 0.38 ± 0.07 ตามลำดับ (p < 0.001) และค่า peak early diastolic lateral mitral annular velocity (MV Ea) เท่ากับ 17.3 ± 3.51และ 19.21 ± 3.29 ตาม ลำดับ (p = 0.029) สรุปได้ว่าความรุนแรงของภาวะหยุดหายใจขณะหลับจากการอุดกั้นในเด็กไม่ส่งผลกับการทำงานหลักของหัวใจ โดยพบเพียงความผิดปกติแบบไม่แสดงอาการของหัวใจ
References
1. Dehlink E, Tan HL. Update on paediatric obstructive sleep apnoea. J Thorac Dis 2016;8(2):224-35.
2. Capdevila OS, Kheirandish-Gozal L, Dayyat E, Gozal D. Pediatric obstructive sleep apnea: complications, management, and long-term outcomes. Proc Am Thorac Soc 2008;5(2):274-82.
3. Zamarron C, Garcia Paz V, Riveiro A. Obstructive sleep apnea syndrome is a systemic disease. Current evidence. Eur J Intern Med 2008;19(6):390-8.
4. Wang J, Zhang H, Wu C, Han J, Guo Z, Jia C, et al. Correlation of left ventricular diastolic function and left ventricular geometry in patients with obstructive sleep apnoea syndrome. West Indian Med J 2015;64(2):92-8.
5. Aslan K, Deniz A, Cayli M, Bozdemir H, Sarica Y, Seydaoglu G. Early left ventricular functional alterations in patients with obstructive sleep apnea syndrome. Cardiol J 2013;20(5):519-25.
6. Alawami M, Mustafa A, Whyte K, Alkhater M, Bhikoo Z, Pemberton J. Echocardiographic and electrocardiographic findings in patients with obesity hypoventilation syndrome. Intern Med J 2015;45(1):68-73.
7. Bodez D, Lang S, Meuleman C, Boyer-Chatenet L, Nguyen XL, Soulat-Dufour L, et al. Left ventricular diastolic dysfunction in obstructive sleep apnoea syndrome by an echocardiographic standardized approach: an observational study. Arch Cardiovasc Dis 2015;108(10):480-90.
8. Almeneessier AS, Nashwan SZ, Al-Shamiri MQ, Pandi-Perumal SR, BaHammam AS. The prevalence of pulmonary hypertension in patients with obesity hypoventilation syndrome: a prospective observational study. J Thorac Dis 2017;9(3):779-88.
9. Buonauro A, Galderisi M, Santoro C, Canora A, Bocchino ML, Lo Iudice F, et al. Obstructive sleep apnoea and right ventricular function: a combined assessment by speckle tracking and three-dimensional echocardiography. Int J Cardiol 2017;243:544-9. doi:10.1016/j.ijcard.2017.05.002
10. Zhou NW, Pan CZ, Kong DH, Li Z, Li WJ, Gong X, et al. A novel method for sensitive determination of subclinical right ventricular systolic dysfunction in patients with obstructive sleep apnea. Clin Respir J 2017;11(6):951-9.
11. Chan JY, Li AM, Au CT, Lo AF, Ng SK, Abdullah VJ, et al. Cardiac remodelling and dysfunction in children with obstructive sleep apnoea: a community based study. Thorax 2009;64(3):233-9.
12. Attia G, Ahmad MA, Saleh AB, Elsharkawy A. Impact of obstructive sleep apnea on global myocardial performance in children assessed by tissue Doppler imaging. Pediatr Cardiol 2010;31(7):1025-36.
13. Friesen RM, Schafer M, Burkett DA, Cassidy CJ, Ivy DD, Jone PN. Right ventricular tissue doppler myocardial performance index in children with pulmonary hypertension: relation to invasive hemodynamics. Pediatr Cardiol 2018;39(1):98-104.
14. Fonarow GC, Hsu JJ. Left ventricular ejection fraction: what is "normal"?. JACC Heart Fail 2016;4(6):511-3
15. Koestenberger M, Ravekes W, Everett AD, Stueger HP, Heinzl B, Gamillscheg A, et al. Right ventricular function in infants, children and adolescents: reference values of the tricuspid annular plane systolic excursion (TAPSE) in 640 healthy patients and calculation of z score values. J Am Soc Echocardiogr 2009;22(6):715-9.
16. Bano M, Kanaan UB, Ehrlich AC, McCracken C, Morrow G, Oster ME, et al. Improvement in tricuspid annular plane systolic excursion with pulmonary hypertension therapy in pediatric patients. Echocardiography 2015;32(8):1228-32.
17. Ho CY, Solomon SD. A clinician's guide to tissue Doppler imaging. Circulation 2006;113(10):e396-8. doi: 10.1161/CIRCULATIONAHA.105.579268
18. Dallaire F, Slorach C, Hui W, Sarkola T, Friedberg MK, Bradley TJ, et al. Reference values for pulse wave Doppler and tissue Doppler imaging in pediatric echocardiography. Circ Cardiovasc Imaging 2015;8(2):e002167. doi:10.1161/CIRCIMAGING.114.002167
19. Cincin A, Sakalli E, Bakirci EM, Dizman R. Relationship between obstructive sleep apnea-specific symptoms and cardiac function before and after adenotonsillectomy in children with adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 2014;78(8):1281-7.
20. Mottram PM, Marwick TH. Assessment of diastolic function: what the general cardiologist needs to know. Heart 2005;91(5):681-95.
21. Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 2017;1140(3):e20171904. doi:10.1542/peds.2017-1904
22. Freet CS, Stoner JF, Tang X. Baroreflex and chemoreflex controls of sympathetic activity following intermittent hypoxia. Auton Neurosci 2013;174(1-2):8-14.
23. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 2000;284(23):3015-21.
24. Huo Z, Shi J, Shu Y, Xiang M, Lu J, Wu H. The relationship between allergic status and adenotonsillar regrowth: a retrospective research on children after adenotonsillectomy. Sci Rep 2017;7(1):46615. doi: 10.1038/srep46615
25. Wang J, Zhao Y, Yang W, Shen T, Xue P, Yan X, et al. Correlations between obstructive sleep apnea and adenotonsillar hypertrophy in children of different weight status. Sci Rep 2019;9(1):11455. doi: 10.1038/srep46615
26. Lucena TFdLG, Lianza AC, de Araujo RPC, de Carvalho JF. Subclinical myocardial dysfunction by tissue Doppler echocardiography in primary antiphospholipid syndrome:preliminary results. Egypt Rheumatol 2018;40(1):35-8.
27. Lotrionte M, Palazzoni G, Natali R, Comerci G, Abbate A, Loperfido F, et al. Assessment of left ventricular systolic dysfunction by tissue Doppler imaging to detect subclinical cardiomyopathy early after anthracycline therapy. Minerva Cardioangiol 2007;55(6):711-20.
28. Kim H, Yoon H-J, Park H-S, Cho Y-K, Nam C-W, Hur S-H, et al. Usefulness of tissue Doppler imaging-myocardial performance index in the evaluation of diastolic dysfunction and heart failure with preserved ejection fraction. Clin Cardiol 2011;34(8):494-9.
29. Fernandes JMG, de Oliveira Romao B, Rivera IR, Mendonca MA, de Assis Costa F, de Souza Lira Handro M, et al. Clinical value of myocardial performance index in patients with isolated diastolic dysfunction. Cardiovasc Ultrasound 2019;17(1):17.doi:10.1186/s12947-019-0167-x
30. Lee JH, Park JH. Role of echocardiography in clinical hypertension. Clin Hypertens 2015;21:9. doi: 10.1186/s40885-015-0015-8
31. Kibar AE, Pac FA, Balli S, Oflaz MB, Ece I, Bas VN, et al. Early subclinical left-ventricular dysfunction in obese nonhypertensive children: a tissue Doppler imaging study. Pediatr Cardiol 2013;34(6): 1482-90.
32. Barbosa JAA, Rodrigues AB, Mota CCC, Barbosa MM, Simoes e Silva AC. Cardiovascular dysfunction in obesity and new diagnostic imaging techniques: the role of noninvasive image methods. Vasc Health Risk Manag 2011;7:287-95. doi: 10.2147/VHRM.S17801
33. Kaditis AG, Alexopoulos EI, Dalapascha M, Papageorgiou K, Kostadima E, Kaditis DG, et al. Cardiac systolic function in Greek children with obstructive sleep-disordered breathing. Sleep Med 2010;11(4):406-12.
34. Cowie MR, Gallagher AM. Sleep disordered breathing and heart failure: what does the future hold? JACC Heart Fail 2017;5(10):715-23.
2. Capdevila OS, Kheirandish-Gozal L, Dayyat E, Gozal D. Pediatric obstructive sleep apnea: complications, management, and long-term outcomes. Proc Am Thorac Soc 2008;5(2):274-82.
3. Zamarron C, Garcia Paz V, Riveiro A. Obstructive sleep apnea syndrome is a systemic disease. Current evidence. Eur J Intern Med 2008;19(6):390-8.
4. Wang J, Zhang H, Wu C, Han J, Guo Z, Jia C, et al. Correlation of left ventricular diastolic function and left ventricular geometry in patients with obstructive sleep apnoea syndrome. West Indian Med J 2015;64(2):92-8.
5. Aslan K, Deniz A, Cayli M, Bozdemir H, Sarica Y, Seydaoglu G. Early left ventricular functional alterations in patients with obstructive sleep apnea syndrome. Cardiol J 2013;20(5):519-25.
6. Alawami M, Mustafa A, Whyte K, Alkhater M, Bhikoo Z, Pemberton J. Echocardiographic and electrocardiographic findings in patients with obesity hypoventilation syndrome. Intern Med J 2015;45(1):68-73.
7. Bodez D, Lang S, Meuleman C, Boyer-Chatenet L, Nguyen XL, Soulat-Dufour L, et al. Left ventricular diastolic dysfunction in obstructive sleep apnoea syndrome by an echocardiographic standardized approach: an observational study. Arch Cardiovasc Dis 2015;108(10):480-90.
8. Almeneessier AS, Nashwan SZ, Al-Shamiri MQ, Pandi-Perumal SR, BaHammam AS. The prevalence of pulmonary hypertension in patients with obesity hypoventilation syndrome: a prospective observational study. J Thorac Dis 2017;9(3):779-88.
9. Buonauro A, Galderisi M, Santoro C, Canora A, Bocchino ML, Lo Iudice F, et al. Obstructive sleep apnoea and right ventricular function: a combined assessment by speckle tracking and three-dimensional echocardiography. Int J Cardiol 2017;243:544-9. doi:10.1016/j.ijcard.2017.05.002
10. Zhou NW, Pan CZ, Kong DH, Li Z, Li WJ, Gong X, et al. A novel method for sensitive determination of subclinical right ventricular systolic dysfunction in patients with obstructive sleep apnea. Clin Respir J 2017;11(6):951-9.
11. Chan JY, Li AM, Au CT, Lo AF, Ng SK, Abdullah VJ, et al. Cardiac remodelling and dysfunction in children with obstructive sleep apnoea: a community based study. Thorax 2009;64(3):233-9.
12. Attia G, Ahmad MA, Saleh AB, Elsharkawy A. Impact of obstructive sleep apnea on global myocardial performance in children assessed by tissue Doppler imaging. Pediatr Cardiol 2010;31(7):1025-36.
13. Friesen RM, Schafer M, Burkett DA, Cassidy CJ, Ivy DD, Jone PN. Right ventricular tissue doppler myocardial performance index in children with pulmonary hypertension: relation to invasive hemodynamics. Pediatr Cardiol 2018;39(1):98-104.
14. Fonarow GC, Hsu JJ. Left ventricular ejection fraction: what is "normal"?. JACC Heart Fail 2016;4(6):511-3
15. Koestenberger M, Ravekes W, Everett AD, Stueger HP, Heinzl B, Gamillscheg A, et al. Right ventricular function in infants, children and adolescents: reference values of the tricuspid annular plane systolic excursion (TAPSE) in 640 healthy patients and calculation of z score values. J Am Soc Echocardiogr 2009;22(6):715-9.
16. Bano M, Kanaan UB, Ehrlich AC, McCracken C, Morrow G, Oster ME, et al. Improvement in tricuspid annular plane systolic excursion with pulmonary hypertension therapy in pediatric patients. Echocardiography 2015;32(8):1228-32.
17. Ho CY, Solomon SD. A clinician's guide to tissue Doppler imaging. Circulation 2006;113(10):e396-8. doi: 10.1161/CIRCULATIONAHA.105.579268
18. Dallaire F, Slorach C, Hui W, Sarkola T, Friedberg MK, Bradley TJ, et al. Reference values for pulse wave Doppler and tissue Doppler imaging in pediatric echocardiography. Circ Cardiovasc Imaging 2015;8(2):e002167. doi:10.1161/CIRCIMAGING.114.002167
19. Cincin A, Sakalli E, Bakirci EM, Dizman R. Relationship between obstructive sleep apnea-specific symptoms and cardiac function before and after adenotonsillectomy in children with adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 2014;78(8):1281-7.
20. Mottram PM, Marwick TH. Assessment of diastolic function: what the general cardiologist needs to know. Heart 2005;91(5):681-95.
21. Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 2017;1140(3):e20171904. doi:10.1542/peds.2017-1904
22. Freet CS, Stoner JF, Tang X. Baroreflex and chemoreflex controls of sympathetic activity following intermittent hypoxia. Auton Neurosci 2013;174(1-2):8-14.
23. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 2000;284(23):3015-21.
24. Huo Z, Shi J, Shu Y, Xiang M, Lu J, Wu H. The relationship between allergic status and adenotonsillar regrowth: a retrospective research on children after adenotonsillectomy. Sci Rep 2017;7(1):46615. doi: 10.1038/srep46615
25. Wang J, Zhao Y, Yang W, Shen T, Xue P, Yan X, et al. Correlations between obstructive sleep apnea and adenotonsillar hypertrophy in children of different weight status. Sci Rep 2019;9(1):11455. doi: 10.1038/srep46615
26. Lucena TFdLG, Lianza AC, de Araujo RPC, de Carvalho JF. Subclinical myocardial dysfunction by tissue Doppler echocardiography in primary antiphospholipid syndrome:preliminary results. Egypt Rheumatol 2018;40(1):35-8.
27. Lotrionte M, Palazzoni G, Natali R, Comerci G, Abbate A, Loperfido F, et al. Assessment of left ventricular systolic dysfunction by tissue Doppler imaging to detect subclinical cardiomyopathy early after anthracycline therapy. Minerva Cardioangiol 2007;55(6):711-20.
28. Kim H, Yoon H-J, Park H-S, Cho Y-K, Nam C-W, Hur S-H, et al. Usefulness of tissue Doppler imaging-myocardial performance index in the evaluation of diastolic dysfunction and heart failure with preserved ejection fraction. Clin Cardiol 2011;34(8):494-9.
29. Fernandes JMG, de Oliveira Romao B, Rivera IR, Mendonca MA, de Assis Costa F, de Souza Lira Handro M, et al. Clinical value of myocardial performance index in patients with isolated diastolic dysfunction. Cardiovasc Ultrasound 2019;17(1):17.doi:10.1186/s12947-019-0167-x
30. Lee JH, Park JH. Role of echocardiography in clinical hypertension. Clin Hypertens 2015;21:9. doi: 10.1186/s40885-015-0015-8
31. Kibar AE, Pac FA, Balli S, Oflaz MB, Ece I, Bas VN, et al. Early subclinical left-ventricular dysfunction in obese nonhypertensive children: a tissue Doppler imaging study. Pediatr Cardiol 2013;34(6): 1482-90.
32. Barbosa JAA, Rodrigues AB, Mota CCC, Barbosa MM, Simoes e Silva AC. Cardiovascular dysfunction in obesity and new diagnostic imaging techniques: the role of noninvasive image methods. Vasc Health Risk Manag 2011;7:287-95. doi: 10.2147/VHRM.S17801
33. Kaditis AG, Alexopoulos EI, Dalapascha M, Papageorgiou K, Kostadima E, Kaditis DG, et al. Cardiac systolic function in Greek children with obstructive sleep-disordered breathing. Sleep Med 2010;11(4):406-12.
34. Cowie MR, Gallagher AM. Sleep disordered breathing and heart failure: what does the future hold? JACC Heart Fail 2017;5(10):715-23.
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2021-08-06
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