Sleep Apnea and Physical Movement During Sleep, But Not Sleep Duration, Are Independently Associated With Progression of Left Ventricular Diastolic Dysfunction: Prospective Hyogo Sleep Cardio‐Autonomic Atherosclerosis Cohort Study

Abstract

Background Although co‐occurrence of sleep disorder with heart failure is known, it is not clear whether that condition is a cause or consequence of heart failure. The present study was conducted as a longitudinal examination of the predictive value of sleep parameters on progression of left ventricular diastolic dysfunction. Methods and Results Four‐hundred fifty‐two subjects were followed for a mean of 34.7 months. An outcome of diastolic dysfunction was defined as increase in early inflow velocity/early diastolic tissue velocity >14. Sleep apnea‐hypopnea index, minimal oxygen saturation, sleep duration, and activity index (physical movement during sleep time, a potential parameter of poor sleep quality) were determined using apnomonitor and actigraphy findings, while heart rate variability was measured with a 24‐hour active tracer device. Sixty‐six of the patients developed diastolic dysfunction during the follow‐up period, with a median time of 25 months. Kaplan–Meier analysis results revealed that those with sleep apnea classified as moderate (apnea‐hypopnea index 15 to <30, P <0.01 versus none) or severe (apnea‐hypopnea index ≥30, P <0.01 versus none), and with a high activity index (Q3 or Q4, P <0.01 versus Q1), but not short sleep duration ( P =0.27) had a significantly greater risk for a diastolic dysfunction event. Results of multivariable Cox proportional hazards regression analysis indicated that moderate to severe sleep apnea after a follow‐up period of 3 years (hazard ratio [HR], 9.26 [95% CI, 1.89–45.26], P <0.01) and high activity index (HR, 1.85 [95% CI, 1.01–3.39], P =0.04) were significantly and independently associated with future diastolic dysfunction. Moreover, significant association of high activity index with the outcome was not confounded by either minimal oxygen saturation or heart rate variability. Conclusions Sleep apnea and physical movement during sleep, but not sleep duration and autonomic nervous dysfunction, are independent important predictors for progression of left ventricular diastolic dysfunction.

The causality between obstructive sleep apnea and ventricular structure and function: a bidirectional Mendelian randomization study

“…In the last few decades, there has been a lot of observational evidence connecting OSA to the emergence of LV dysfunction. For instance, a prospective trial of 425 participants discovered that the risk of developing LV diastolic dysfunction was considerably enhanced in participants with moderate to severe OSA ( Kidawara et al, 2022 ). These findings imply that OSA is a substantial and independent indicator of LV diastolic dysfunction progression, helping to improve disease prediction and prevention.…”

Nocturnal Hypertension and Left Ventricular Diastolic Dysfunction in Patients With Diabetes With the Absence of Heart Failure: Prospective Cohort HSCAA Study

“…LV function was evaluated by echocardiography, as previously described. 14,19,20 The primary outcome was the time to the LV diastolic dysfunction, which was defined as the time from registration into this study until the first development of E/e′>14 diagnosed at 1 to 5 years. E/e′>14 was previously recommended, as the value of 14 proved to be a good cutoff and is widely used in the world.…”

“…Following the measurement of cardiac function at enrollment, follow-up echocardiography was planned to be performed each year as much as possible (mandatory at 1, 3, and 5 years), as previously described. 14 The HSCAA study was approved by the Institutional Ethical Committee of the Hyogo College of Medicine (approval number 2351), and informed written consent was obtained from each participant.…”