Association between left atrial enlargement and obstructive sleep apnea in a general population of 71‐year‐old men

Abstract

Left atrial enlargement has been shown to be associated with obstructive sleep apnea in patients with coronary artery disease and in sleep clinic cohorts. However, data from the general population are limited. The aim of this study was to investigate whether there is an association between obstructive sleep apnea and left atrial enlargement in a random sample from a general population of 71-year-old men. As part of the longitudinal population study The Study of Men Born in 1943, we analysed cross-sectional data for 411 men, all 71 years old, who had participated in an overnight home sleep study and a standardized echocardiographic examination. Of the 411 men, 29.4% had moderate to severe obstructive sleep apnea [apnea-hypopnea index score of ≥15 (n = 121)]. These participants showed a significantly higher frequency of systolic heart failure, hypertension, overweight, had greater waist circumference as well as higher left atrial areas compared with men with no or mild obstructive sleep apnea (23.7 ± 5.5 cm versus 21.6 ± 4.5 cm , P < 0.001). In a linear regression analysis, obstructive sleep apnea was significantly associated with left atrial enlargement after adjusting for overweight, atrial fibrillation, heart failure with reduced ejection fraction, hypertension and mitral regurgitation. Compared with individuals without obstructive sleep apnea, the mean left atrial area was 1.7 ± 1.5 cm larger in men with severe obstructive sleep apnea (P < 0.05) and 1.3 ± 1.1 cm larger among men with moderate obstructive sleep apnea (P < 0.05). In this cross-sectional study of 71-year-old men from the general population, left atrial area was independently associated with prevalence and severity of obstructive sleep apnea.

Particularities of Older Patients with Obstructive Sleep Apnea and Heart Failure with Mid-Range Ejection Fraction

“…Often, patients with HFpEF present only increased wall thickness of the LV or the size of LA, which makes it even more difficult to diagnose. In our study, LA diameter was higher in patients with HFmrEF ( p = 0.0002), similar to other publications [40]. Moreover, the role of the left atrium in modulating LV function is well-known [41], and there are considerable amounts of data demonstrating that the size of the LA is directly proportional to the increased risk of cardiovascular events; this parameter is not used enough in clinical practice to determine the HF progression [42].…”

Review of Echocardiographic Findings in Patients with Obstructive Sleep Apnea

“…Left atrial enlargement is reported in 18% of newly diagnosed OSA patients [7], being more common among subjects with moderate-to-severe OSA (52.1%) than in patients with the apnea-hypopnea index (AHI) <15 (31%; p < 0.001) [8]. The left atrial diameter is higher in patients with severe OSA than in subjects with mild sleep apnea (36.1 ± 5.7 mm versus 32.8 ± 2.3 mm; p < 0.01) [9].…”

“…The left atrial diameter is higher in patients with severe OSA than in subjects with mild sleep apnea (36.1 ± 5.7 mm versus 32.8 ± 2.3 mm; p < 0.01) [9]. Several studies showed that both indexed left atrial volume (LAVI) [10–14] and left atrial area (LAA) [8] increase with OSA severity (Table 1).…”

“…Zhou et al also found a significant difference regarding IVS thickness in subjects with severe and moderate OSA versus controls ( p =0.001, p =0.002, respectively) [15]. The LVM index is significantly higher in subjects with severe OSA than in controls [7, 9], but no statistically significant changes in LV end-systolic and end-diastolic diameters were reported [8, 9]. Left ventricular hypertrophy appears to be correlated to mean nocturnal oxygen saturation.…”

“…Some publications show normal LV-EF (59 ± 10%) among patients with OSA [9, 16], and several studies reported no significant differences between OSA severity and left ventricular EF or fractional shortening [9–11]. However, a study of 411 men, average age of 71 years old, showed that LV-EF is slightly lower in patients with moderate-to-severe OSA (61.0 ± 8.9%) than in subjects with AHI <15 (62.7 ± 6.3%; p =0.028) [8], and another recent report found that OSA severity is significantly correlated with a reduction in LV-EF ( p =0.005) [19] (Table 3). These results are confirmed by another study of 119 OSA patients monitored over 18 years, showing that, for every tenfold increase in AHI, the left ventricular ejection fraction showed a 1.3% independent decrease [18].…”