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

Abstract

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.

The impact of obstructive sleep apnoea on the aorta

“…Six cross-sectional studies investigating patients referred for a sleep evaluation reported a positive association between the aortic root diameter and parameters of OSA severity (either AHI or oxygen desaturation index (ODI)) [45,[48][49][50][51][52]. Notably, one study found an association with AHI in rapid eye movement sleep only where the severity of OSA becomes greater, partly due to a decreased respiratory muscle tone [52]. Another study reported this association in patients with hypertrophic cardiomyopathy [48].…”

“…Most of the studies investigated the association between OSA and the aortic root diameter [44][45][46][47][48][49][50][51][52]. Six cross-sectional studies investigating patients referred for a sleep evaluation reported a positive association between the aortic root diameter and parameters of OSA severity (either AHI or oxygen desaturation index (ODI)) [45,[48][49][50][51][52]. Notably, one study found an association with AHI in rapid eye movement sleep only where the severity of OSA becomes greater, partly due to a decreased respiratory muscle tone [52].…”

Sleep Difficulties and Cognition for 10 Years in a National Sample of U.S. Older Adults

“…We controlled for a number of covariates that are known to be associated with cognitive function ( 13 ) and sleep difficulties ( 16 ). Several covariates were taken from the respondent’s baseline interview including age in years; gender coded as 1 = female, 0 = male; race coded as 1 = white, 0 = nonwhite; ethnicity coded as 1 = Hispanic, 0 = non-Hispanic; marital status coded as 1 = married or living with a partner, 0 = unmarried (never married, widowed, and divorced); education coded as years of schooling (0–17 years or more); and total self-reported financial assets coded by quartile (1 = <$55,000, 2 = $55,000 to $182,999, 3 = $183,000 to $464,999, and 4 = $465,000 or higher).…”

Sleep and Stroke: New Updates on Epidemiology, Pathophysiology, Assessment, and Treatment

“…Several recent studies showed that short-term CPAP treatment can improve cardiac function and structure, however further studies are needed to confirm its theoretical benefit on stroke risk. (54)(55)(56)(57)(58)(59) Studies have reported an association between SBD and carotid atherosclerosis. Interestingly asymptomatic carotid stenosis is associated with central, but not obstructive apneas.…”