ASSESSMENT OF AORTIC STIFFNESS WHICH IS A NEW CARDIOVASCULAR MORBIDITY AND MORTALITY PREDICTOR IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA SYNDROME AND RELATION WITH SEVERITY OF THE DISEASEYusuf Tavil1, Ouz Kktrk2, Tansu Ulukavak ifti2, Asiye Kanbay2, Nihat en1, M.Rdvan Yaln1, Atiye engel1 Gazi University Faculty of Medicine, Departments of Cardiology1 and Pulmonary Medicine2, Ankara

OSAS & Heart (1)The recurrent sleep arousal in association with intermittent hypoxia and hypercapnia has been implicated in the occurrence of adverse cardiovascular outcomes

OSAS & Heart (2)Hypertension Ischemic heart disease Cardiac arrhythmias Cerebral infarction Pulmonary hypertension Subclinic Right&left heart failure

OSAS & Heart (3)Associations between sleep apnea, hypertension, heart disease, and stroke raise the possibility of common factors and/or causal relationships between sleep apnea and cardiovascular disordersSuch links may be related to biochemical factors such as insulin, catecholamine, or cortisol that are increased in stressAlternately obesity, sleep apnea, and other cardiovascular risk factors may share common metabolic pathways and therefore may be genetically determined

Arterial & Aortic Stiffness(1)Arterial stiffness in large arteries has been reported to be the best predictor of cardiovascular morbidity and mortalityThe measurement of arterial stiffness;Pressure/distension changesPulse wave velocityPulse wave analysis

Arterial & Aortic Stiffness(2)Pulse pressure was measured by cuff sphygmomanometry of the brachial artery and not invasively in the ascending-Ao. However, several reports have demonstrated the excellent correlation of the non-invasively calculated aortic function indexes with indexes derived from aortography

PWV and PWA are subject to confoundingfactors Blood pressure increases PWV and AIx Heart rate may increase PWV and decrease Body height decreases AIx

Arterial & Aortic Stiffness(3) Aortic distensibility is an important determinant of left ventricular (LV) function and coronary blood flow Additionally, aortic distensibility has been related to increased cardiovascular mortality in different populations.

Study protocol:40 patients with OSAS and 25 age and BMI-matched control without heart and pulmonary diseaseBoth groups have the same basal characteristicsCorelation analysis have made independent from age and body mass index

Aortic distensibility was determined non-invasively based on the relationship between changes in aortic diameter and pressure with each cardiac pulse. Ascending aorta was recorded at a level 3 cm above the aortic valve in the M-mode tracing guided by the two-dimensional echocardiogram in the parasternal long-axis view.

Aortic strain (%) = (aortic systolic diameter - diastolicdiameter) x100 / diastolic diameter

Distensibility (10-6 cm2 dyn1) = (2x Aortic strain) / (systolicpressure - diastolic pressure)

Results:* p

AHI ile Aortic strain ilikisiAHI ile aotic distensibilite ilikisi

In conclusion, decreased aortic stiffness parameters in OSAS patients according to severity of disease, is a new markers of elevated cardiovascular risk in these patients.