Impact of continuous positive airway pressure treatment on left atrial volume and function in patients with obstructive sleep apnoea assessed by real-time three-dimensional echocardiography

Structural and functional integrity of the right heart is important in the prognosis after acute myocardial infarction (AMI). The objective of this study was to assess the impact of sleep disordered breathing (SDB) on structure and function of the right heart early after AMI.54 patients underwent cardiovascular magnetic resonance 3-5 days and 12 weeks after AMI, and were stratified according to the presence of SDB, defined as an apnoea-hypopnoea index of ≥15 events·h −1 . 12 weeks after AMI, end-diastolic volume of the right ventricle had increased significantly in patients with SDB (n=27) versus those without (n=25) (mean±SD 14±23% versus 0±17%, p=0.020). Multivariable linear regression analysis accounting for age, sex, body mass index, smoking, left ventricular mass and left ventricular end-systolic volume showed that the apnoea-hypopnoea index was significantly associated with right ventricular end-diastolic volume (B-coefficient 0.315 (95% CI 0.013-0.617); p=0.041). From baseline to 12 weeks, right atrial diastolic area increased more in patients with SDB (2.9±3.7 cm 2 versus 1.0±2.4 cm 2 , p=0.038; when adjusted for left ventricular end systolic volume, p=0.166).SDB diagnosed shortly after AMI predicts an increase of right ventricular end-diastolic volume and possibly right atrial area within the following 12 weeks. Thus, SDB may contribute to enlargement of the right heart after AMI. @ERSpublications Sleep disordered breathing may predispose to enlargement of the right heart after acute myocardial infarction http://ow.ly/Cc6vv

show abstract

“…Such data complement previous studies showing an increased left atrial area in patients with SDB and without known cardiac disease [23,24].…”

Section: Discussionsupporting

confidence: 79%

Sleep disordered breathing and enlargement of the right heart after myocardial infarction

et al. 2014

View full text Add to dashboard Cite

show abstract

“…The potential of CPAP therapy to reverse functional and structural remodelling of the heart has been confirmed in several studies [16][17][18][19]. However, it is currently unclear whether OSA is an independent risk factor for diastolic dysfunction and diastolic heart failure.…”

mentioning

confidence: 90%

Impact of obstructive sleep apnoea on diastolic function

et al. 2012

View full text Add to dashboard Cite

We investigated whether obstructive sleep apnoea (OSA) independently affects diastolic function in a primary care cohort of patients with cardiovascular risk factors.378 study participants with risk factors for diastolic dysfunction were prospectively included and a polygraphy was performed in all patients. Diastolic dysfunction was assessed by comprehensive echocardiography including tissue Doppler. Sleep apnoea was classified according to apnoea/ hypopnoea index (AHI) as none (AHI ,5 events?h ). Patients with central sleep apnoea (n514) and patients with previously diagnosed sleep apnoea (n512) were excluded. In the remaining 352 subjects, 21.6% had an AHI o15 events?h -1 . The prevalence of diastolic dysfunction increased with the severity of sleep apnoea from 44.8% (none) to 56.8% (mild) to 69.7% (moderate-to-severe sleep apnoea) (p50.002). The degree of diastolic dysfunction also increased with sleep apnoea severity (p50.004). In univariate regression analysis, age, desaturation index, AHI, cardiac frequency, angiotensin receptor 1 antagonist therapy, body mass index (BMI) and left ventricular mass were associated with diastolic dysfunction. In multivariate regression analysis, only age, BMI, AHI and cardiac frequency were independently associated with diastolic dysfunction.Moderate-to-severe OSA is independently associated with diastolic dysfunction in patients with classical risk factors for diastolic dysfunction.

show abstract

“…[24][25][26][27][28][29][30] In spite of the fact that these tools are widely available and frequently introduced in clinical settings, the cardiac structural and functional remodeling studied by utilizing TDI and RT3D has rarely been conducted in patients with OSAS to evaluate their cardiac function. [31][32][33][34][35][36][37] In addition, the frequent coexistence of OSAS and congestive heart failure in clinical scenarios make it difficult to clearly define the exact impact of OSAS on cardiac remodeling and function, and vice versa. In order to answer these unresolved issues regarding the impact of OSAS itself on cardiac structure and function, it is crucial to conduct a study enrolling subjects exclusively without clinical symptoms of heart failure.…”

Section: Brief Summarymentioning

confidence: 99%

Influence and Predicting Variables of Obstructive Sleep Apnea on Cardiac Function and Remodeling in Patients without Congestive Heart Failure

Chen

Liu

et al. 2014

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

Study Objective: Obstructive sleep apnea syndrome (OSAS) has been considered to be an important predisposing factor for cardiovascular disease. This study aims to investigate the impact of OSAS on cardiac function and remodeling in patients without congestive heart failure. Methods: A total of 79 patients with sleep disordered breathing, preserved systolic function, and normal pro-brain natriuretic peptide level were enrolled. Sixty-fi ve patients were classifi ed to have moderate to severe OSAS (apnea-hypopnea index [AHI] ≥ 15/h), while the other 14 patients with mild or no OSAS (AHI < 15/h) served as control subjects. Baseline clinical and polysomnographic variables as well as tissue Doppler imaging and three-dimensional echocardiographic parameters were obtained. Results:The body mass index, neck circumference, Epworth Sleepiness Scale, desaturation index, arousal index, and snoring index were signifi cantly higher in patients with moderate to severe OSAS than those without (p < 0.05). The left atrial size, mitral A-wave velocity, and left ventricular end-diastolic volume were signifi cantly larger, while E/A ratio was lower in patients with moderate to severe OSAS than those without (p < 0.05). Notably, AHI in REM sleep was signifi cantly correlated with the aortic root size, E/A ratio, left ventricular volume, and stroke volume. In addition, the area under the receiver operator characteristic curve for AHI in REM sleep ≥ 32.3/h was 0.647 (95% CI [0.525, 0.769]) in predicting the development of left ventricular diastolic dysfunction. AHI in REM sleep ≥ 32.3/h was the only independent variant in predicting diastolic dysfunction after adjusting the variables including age, gender, hypertension, and body mass index. Conclusions: Patients with moderate to severe OSAS tend to have cardiac dysfunction revealed by echocardiography. High AHI in REM sleep is signifi cantly associated with cardiovascular remodeling and ventricular diastolic dysfunction, and may be a potential variable to predict cardiac dysfunction. Keywords: Echocardiography, sleep apnea syndrome, diastolic dysfunction, cardiovascular remodeling Citation: Chen YL; Su MC; Liu WH; Wang CC; Lin MC; Chen MC. Infl uence and predicting variables of obstructive sleep apnea on cardiac function and remodeling in patients without congestive heart failure.

show abstract

Impact of continuous positive airway pressure treatment on left atrial volume and function in patients with obstructive sleep apnoea assessed by real-time three-dimensional echocardiography

Cited by 63 publications

References 29 publications

Sleep disordered breathing and enlargement of the right heart after myocardial infarction

Sleep disordered breathing and enlargement of the right heart after myocardial infarction

Impact of obstructive sleep apnoea on diastolic function

Influence and Predicting Variables of Obstructive Sleep Apnea on Cardiac Function and Remodeling in Patients without Congestive Heart Failure

Contact Info

Product

Resources

About