Skip to main content
Erschienen in: Wiener klinische Wochenschrift 5-6/2016

01.03.2016 | original article

Epicardial fat thickness regression with continuous positive airway pressure therapy in patients with obstructive sleep apnea: assessment by two-dimensional echocardiography

verfasst von: Süha Çetin, MD, Mustafa Gökhan Vural, Hüseyin Gündüz, Ramazan Akdemir, Hikmet Fırat

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 5-6/2016

Einloggen, um Zugang zu erhalten

Summary

Background

Obstructive sleep apnea (OSA) is a common syndrome in patients with metabolic syndrome (MetS). Epicardial fat thickness (EFT), an indicator of visceral adiposity, is a novel parameter for studying patients with OSA. Our aim was to investigate the effects of continuous positive airway pressure therapy (CPAP) therapy on EFT.

Methods

A total of 162 subjects (68 women and 94 men) were included and divided into three groups: Group I: Apnea–hypopnea index (AHI) < 5 (n  = 45), Group II: AHI 5–15 (n  = 22), and Group III: AHI > 15 (n  = 95). All participants underwent full-night polysomnography and transthoracic echocardiography. There were 28 symptomatic patients with AHI > 15 who received compliant CPAP therapy for 24 weeks.

Results

MetS was more frequent, and systolic blood pressure (SBP), diastolic blood pressure (DBP), blood glucose were higher in Group III compared with I (p  < 0.05). High-density lipoprotein (HDL) levels were lower in Group III compared with I (p < 0.05). Triglyceride levels and waist circumference were higher in Group III compared with I and II (p  < 0.05). EFT was higher in Group III compared with I and higher in Group II compared with I (p < 0.05). EFT was predicted by MetS and AHI. After CPAP therapy high-sensitive C-reactive protein (hsCRP) and EFT were reduced (p < 0.05).

Conclusion

EFT was significantly higher in patients with AHI > 15 and predicted by MetS and AHI. CPAP therapy reduced hsCRP levels and EFT.
Literatur
1.
Zurück zum Zitat Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea. Am J Respir Crit Care. 2002;154:1217–39.CrossRef Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea. Am J Respir Crit Care. 2002;154:1217–39.CrossRef
2.
Zurück zum Zitat Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Nieto FJ, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001;163:19–25.CrossRefPubMed Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Nieto FJ, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001;163:19–25.CrossRefPubMed
3.
Zurück zum Zitat Partinen M, Guilleminault C. Daytime sleepiness and vascular morbidity at seven-year follow-up in obstructive sleep apnea patients. Chest. 1990;97:27–32.CrossRefPubMed Partinen M, Guilleminault C. Daytime sleepiness and vascular morbidity at seven-year follow-up in obstructive sleep apnea patients. Chest. 1990;97:27–32.CrossRefPubMed
4.
Zurück zum Zitat Akilli H, Kayrak M, Bekci TT, Erdoğan HI, Aribas A, Yildirim O, et al. Gender-related changes of the epicardial fat thickness and leptin in obstructive sleep apnea. Echocardiography. 2014;31:411–9.CrossRefPubMed Akilli H, Kayrak M, Bekci TT, Erdoğan HI, Aribas A, Yildirim O, et al. Gender-related changes of the epicardial fat thickness and leptin in obstructive sleep apnea. Echocardiography. 2014;31:411–9.CrossRefPubMed
5.
Zurück zum Zitat Coughlin SR, Mawdsley L, Mugarza JA, Carverley PMA, Wilding JPH. Obstructive apnoea is independently associated with increased prevalence of metabolic syndrome. Eur Heart J. 2004;25:735–41.CrossRefPubMed Coughlin SR, Mawdsley L, Mugarza JA, Carverley PMA, Wilding JPH. Obstructive apnoea is independently associated with increased prevalence of metabolic syndrome. Eur Heart J. 2004;25:735–41.CrossRefPubMed
6.
Zurück zum Zitat Kano M, Tatsumi K, Saibara T, Nakamur A, Tanabe N, Takiguchi Y, et al. Obstructive sleep apnoea syndrome is associated with some components of metabolic syndrome. Chest. 2007;131:1387–92.CrossRef Kano M, Tatsumi K, Saibara T, Nakamur A, Tanabe N, Takiguchi Y, et al. Obstructive sleep apnoea syndrome is associated with some components of metabolic syndrome. Chest. 2007;131:1387–92.CrossRef
7.
Zurück zum Zitat Nakamura T, Takunaga K, Shimomura I, Nishida M, Yoshida S, Kotani K, et al. Contribution of visceral fat accumulation to the development of coronary artery disease in non-obese men. Atherosclerosis. 1994;107:239–46.CrossRefPubMed Nakamura T, Takunaga K, Shimomura I, Nishida M, Yoshida S, Kotani K, et al. Contribution of visceral fat accumulation to the development of coronary artery disease in non-obese men. Atherosclerosis. 1994;107:239–46.CrossRefPubMed
8.
9.
Zurück zum Zitat Mariani S, Fiori D, Barbaro G, Basciani S, Saponara M, D’Arcangelo E, et al. Association of epicardial fat thickness with the severity of obstructive sleep apnea in obese patients. Int J Cardiol. 2013;167:2244–9.CrossRefPubMed Mariani S, Fiori D, Barbaro G, Basciani S, Saponara M, D’Arcangelo E, et al. Association of epicardial fat thickness with the severity of obstructive sleep apnea in obese patients. Int J Cardiol. 2013;167:2244–9.CrossRefPubMed
10.
Zurück zum Zitat Lubrano C, Saponara M, Barbaro G, Specchia P, Addressi E, Constantini D, et al. Relationships between body fat distribution, epicardial fat and obstructive sleep apnea in obese patients with and without metabolic syndrome. PLoS One. 2012;7:e47059.CrossRefPubMedPubMedCentral Lubrano C, Saponara M, Barbaro G, Specchia P, Addressi E, Constantini D, et al. Relationships between body fat distribution, epicardial fat and obstructive sleep apnea in obese patients with and without metabolic syndrome. PLoS One. 2012;7:e47059.CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Park JS, Ahn SG, Hwang JW, Lim HS, Choi BJ, Choi SJ, et al. Impact of body mass index on the relationship of epicardial adipose tissue to metabolic syndrome and coronary artery disease in Asian population. Cardiovasc Diabetol. 2010;9:29.CrossRefPubMedPubMedCentral Park JS, Ahn SG, Hwang JW, Lim HS, Choi BJ, Choi SJ, et al. Impact of body mass index on the relationship of epicardial adipose tissue to metabolic syndrome and coronary artery disease in Asian population. Cardiovasc Diabetol. 2010;9:29.CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat Park JH, Park JS, Kim YJ, Lee IS, Kim JH, Choi SW, et al. Effects of statins on the epicardial fat thickness in patients coronary artery stenosis underwent percutaneous coronary intervention: comparison of atorvastatin with simvastatine/ezetimibe. J Cardiovasc Ultrasound. 2010;18:121–6.CrossRefPubMedPubMedCentral Park JH, Park JS, Kim YJ, Lee IS, Kim JH, Choi SW, et al. Effects of statins on the epicardial fat thickness in patients coronary artery stenosis underwent percutaneous coronary intervention: comparison of atorvastatin with simvastatine/ezetimibe. J Cardiovasc Ultrasound. 2010;18:121–6.CrossRefPubMedPubMedCentral
13.
Zurück zum Zitat Chin K, Shimuzu K, Nakamura T, Narai N, Masuzaki H, Ogawa Y, et al. Changes in intra-abdominal visceral fat and serum leptin levels in patients with obstructive sleep apnea syndrome following nasal continuous positive airway therapy. Circulation. 1999;100:706–12.CrossRefPubMed Chin K, Shimuzu K, Nakamura T, Narai N, Masuzaki H, Ogawa Y, et al. Changes in intra-abdominal visceral fat and serum leptin levels in patients with obstructive sleep apnea syndrome following nasal continuous positive airway therapy. Circulation. 1999;100:706–12.CrossRefPubMed
14.
Zurück zum Zitat National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third report of the National Cholesterol Education Program (NCEP) expert panel on detection. evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Final report. Circulation. 2002;106:3143–421. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third report of the National Cholesterol Education Program (NCEP) expert panel on detection. evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Final report. Circulation. 2002;106:3143–421.
15.
Zurück zum Zitat Kushida CA, Chediak A, Berry RB, Brown LK, Gozal D, Iber C, Positive Airway Pressure Titration Task Force; American Academy of Sleep Medicine, et al. Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med. 2008;4:157–71.PubMed Kushida CA, Chediak A, Berry RB, Brown LK, Gozal D, Iber C, Positive Airway Pressure Titration Task Force; American Academy of Sleep Medicine, et al. Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med. 2008;4:157–71.PubMed
16.
Zurück zum Zitat Iacobellis G, Ribaudo MC, Assael F, Vecci E, Tiberti C, Zappatereno A, et al. Echocardiographic epicardial adipose tissue is related to anthropometric and clinical parameters of metabolic syndrome: a new indicator of cardiovascular risk. J Clin Endocrinol Metab. 2003;88:5163–8.CrossRefPubMed Iacobellis G, Ribaudo MC, Assael F, Vecci E, Tiberti C, Zappatereno A, et al. Echocardiographic epicardial adipose tissue is related to anthropometric and clinical parameters of metabolic syndrome: a new indicator of cardiovascular risk. J Clin Endocrinol Metab. 2003;88:5163–8.CrossRefPubMed
17.
Zurück zum Zitat Drager LF, Lopes HF, Maki-Nunes C, Trombetta IC, Toschi-Dias E, Alves MJ, et al. The impact of obstructive sleep apnea on metabolic and inflammatory markers in consecutive patients with metabolic syndrome. PLoS One. 2010; 5:e12065.CrossRefPubMedPubMedCentral Drager LF, Lopes HF, Maki-Nunes C, Trombetta IC, Toschi-Dias E, Alves MJ, et al. The impact of obstructive sleep apnea on metabolic and inflammatory markers in consecutive patients with metabolic syndrome. PLoS One. 2010; 5:e12065.CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; International Association for the Study of Obesity, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation. International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120:1640–5.CrossRefPubMed Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; International Association for the Study of Obesity, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation. International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120:1640–5.CrossRefPubMed
19.
Zurück zum Zitat Nishimura S, Manabe I, Nagai R. Adipose tissue inflammation in obesity and metabolic syndrome. Discov Med. 2009;8:55–60.PubMed Nishimura S, Manabe I, Nagai R. Adipose tissue inflammation in obesity and metabolic syndrome. Discov Med. 2009;8:55–60.PubMed
20.
Zurück zum Zitat Berg AH, Scherer PE. Adipose tissue, inflammation, and cardiovascular disease. Circ Res. 2005;96:939–49.CrossRefPubMed Berg AH, Scherer PE. Adipose tissue, inflammation, and cardiovascular disease. Circ Res. 2005;96:939–49.CrossRefPubMed
21.
Zurück zum Zitat Marchington JM, Mattacs CA, Pond CM. Adipose tissue in the mammalian heart and pericardium: structure, foetal development and biochemical properties. Comp Biochem Physiol B. 1989;94(2):225–32.CrossRefPubMed Marchington JM, Mattacs CA, Pond CM. Adipose tissue in the mammalian heart and pericardium: structure, foetal development and biochemical properties. Comp Biochem Physiol B. 1989;94(2):225–32.CrossRefPubMed
22.
Zurück zum Zitat Tanındı A, Kocaman SA, Erkan AF, Uğurlu M, Alhan A, Töre HF. Epicarial adipose tissue thickness is associated with myocardial infarction and impaired coronary perfusion. Anatol J Cardiol. 2015;15:224–31.CrossRefPubMed Tanındı A, Kocaman SA, Erkan AF, Uğurlu M, Alhan A, Töre HF. Epicarial adipose tissue thickness is associated with myocardial infarction and impaired coronary perfusion. Anatol J Cardiol. 2015;15:224–31.CrossRefPubMed
23.
Zurück zum Zitat Çullu N, Kantarcı M, Kızrak Y, Pirimoğlu B, Ü B, Oğul H, et al. Does epicarial adipose tissue volume provide information about the presence and localization of coronary artery disease? Anatol J Cardiol. 2015;15:355–9.CrossRefPubMed Çullu N, Kantarcı M, Kızrak Y, Pirimoğlu B, Ü B, Oğul H, et al. Does epicarial adipose tissue volume provide information about the presence and localization of coronary artery disease? Anatol J Cardiol. 2015;15:355–9.CrossRefPubMed
24.
Zurück zum Zitat Iacobellis G. Local and systemic effects of the multifaceted epicardial adipose tissue depot. Nat Rev Endocrinol. 2015;11:363–71.CrossRefPubMed Iacobellis G. Local and systemic effects of the multifaceted epicardial adipose tissue depot. Nat Rev Endocrinol. 2015;11:363–71.CrossRefPubMed
25.
Zurück zum Zitat Kostopoulos K, Alhanatis E, Pampoukas K, Georgiopoulos G, Zourla A, Panoutsopoulos A, et al. CPAP therapy induces favorable short-term changes in epicardial thickness and vascular and metabolic markers in apparently healthy subjects with obstructive sleep apnea-hypopnea syndrome (OSAHS). Sleep Breath. doi:10.1007/s11325-015-1236-5. Kostopoulos K, Alhanatis E, Pampoukas K, Georgiopoulos G, Zourla A, Panoutsopoulos A, et al. CPAP therapy induces favorable short-term changes in epicardial thickness and vascular and metabolic markers in apparently healthy subjects with obstructive sleep apnea-hypopnea syndrome (OSAHS). Sleep Breath. doi:10.​1007/​s11325-015-1236-5.
26.
Zurück zum Zitat Alexopoulos N, Melek BH, Arepalli CD, Hartlage GR, Chen Z, Kim S, et al. Effect of intensive versus moderate lipid-lovering therapy on epicardial adipse tissue in hyperlipidemic post-menopausal women: a substudy of the BELLES trial (Beyond Endorsed Lipid Lowering with EBT Scanning). J Am Coll Cardiol. 2013;14:1956–61.CrossRef Alexopoulos N, Melek BH, Arepalli CD, Hartlage GR, Chen Z, Kim S, et al. Effect of intensive versus moderate lipid-lovering therapy on epicardial adipse tissue in hyperlipidemic post-menopausal women: a substudy of the BELLES trial (Beyond Endorsed Lipid Lowering with EBT Scanning). J Am Coll Cardiol. 2013;14:1956–61.CrossRef
27.
Zurück zum Zitat Koenig W, Sund M, Fröhlich M, Fischer HG, Löwel H, Döring A, et al. C-Reactive protein, a sensitive marker of inflammation, predicts future risk of coronary heart disease in initially healthy middle-aged men: results from the MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) Augsburg Cohort Study, 1984 to 1992. Circulation. 1999;99:237–42.CrossRefPubMed Koenig W, Sund M, Fröhlich M, Fischer HG, Löwel H, Döring A, et al. C-Reactive protein, a sensitive marker of inflammation, predicts future risk of coronary heart disease in initially healthy middle-aged men: results from the MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) Augsburg Cohort Study, 1984 to 1992. Circulation. 1999;99:237–42.CrossRefPubMed
28.
Zurück zum Zitat Haverkate F, Thompson SG, Pyke SD, Gallimore JR, Pepys MB. Production of C-reactive protein and risk of coronary events in stable and unstable angina. European Concerted Action on Thrombosis and Disabilities Angina Pectoris Study Group. Lancet. 1997;349:462–6.CrossRefPubMed Haverkate F, Thompson SG, Pyke SD, Gallimore JR, Pepys MB. Production of C-reactive protein and risk of coronary events in stable and unstable angina. European Concerted Action on Thrombosis and Disabilities Angina Pectoris Study Group. Lancet. 1997;349:462–6.CrossRefPubMed
29.
Zurück zum Zitat Steiropoulos P, Tsara V, Nena E, Fitili C, Kataropoulou M, Froudarakis M, et al. Effect of continuous positive airway pressure treatment on serum cardiovascular risk factors in patients with obstructive sleep apnea-hypopnea syndrome. Chest. 2007;132:843–51.CrossRefPubMed Steiropoulos P, Tsara V, Nena E, Fitili C, Kataropoulou M, Froudarakis M, et al. Effect of continuous positive airway pressure treatment on serum cardiovascular risk factors in patients with obstructive sleep apnea-hypopnea syndrome. Chest. 2007;132:843–51.CrossRefPubMed
30.
Zurück zum Zitat Iacobellis G, Assael F, Ribaudo MC, Zappaterreno A, Alessi G, Di Mario U, et al. Epicardial fat from echocardiography: a new method for visceral adipose tissue prediction. Obes Res. 2003;11:304–10.CrossRefPubMed Iacobellis G, Assael F, Ribaudo MC, Zappaterreno A, Alessi G, Di Mario U, et al. Epicardial fat from echocardiography: a new method for visceral adipose tissue prediction. Obes Res. 2003;11:304–10.CrossRefPubMed
31.
Zurück zum Zitat Janik M, Hartlage G, Alexopoulos N, Mirzoyev Z, McLean DS, Arepalli CD, et al. Epicardial adipose tissue volume and coronary artery calcium to predict myocardial ischemia on positron emission tomography-computed tomography studies. J Nucl Cardiol. 2010;17:841–7.CrossRefPubMed Janik M, Hartlage G, Alexopoulos N, Mirzoyev Z, McLean DS, Arepalli CD, et al. Epicardial adipose tissue volume and coronary artery calcium to predict myocardial ischemia on positron emission tomography-computed tomography studies. J Nucl Cardiol. 2010;17:841–7.CrossRefPubMed
32.
Zurück zum Zitat Liang KW, Tsai IC, Lee WJ, Lee IT, Lin SY, Wan CJ, et al. MRI measured epicardial adipose tissue thickness at the right AV groove differentiates inflammatory status in obese men with metabolic syndrome. Obesity. 2012;20:525–32.CrossRefPubMed Liang KW, Tsai IC, Lee WJ, Lee IT, Lin SY, Wan CJ, et al. MRI measured epicardial adipose tissue thickness at the right AV groove differentiates inflammatory status in obese men with metabolic syndrome. Obesity. 2012;20:525–32.CrossRefPubMed
33.
Zurück zum Zitat Iacobellis G, Corradi D, Sharma AM. Epicardial adipose tissue: anatomic, bimolecular and clinical relationships with the heart. Nat Clin Pract Cardiovasc Med. 2005;2:536–43.CrossRefPubMed Iacobellis G, Corradi D, Sharma AM. Epicardial adipose tissue: anatomic, bimolecular and clinical relationships with the heart. Nat Clin Pract Cardiovasc Med. 2005;2:536–43.CrossRefPubMed
Metadaten
Titel
Epicardial fat thickness regression with continuous positive airway pressure therapy in patients with obstructive sleep apnea: assessment by two-dimensional echocardiography
verfasst von
Süha Çetin, MD
Mustafa Gökhan Vural
Hüseyin Gündüz
Ramazan Akdemir
Hikmet Fırat
Publikationsdatum
01.03.2016
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 5-6/2016
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-016-0975-z

Weitere Artikel der Ausgabe 5-6/2016

Wiener klinische Wochenschrift 5-6/2016 Zur Ausgabe

mitteilungen der gesellschaft der ärzte in wien

Veranstaltungen