Sleep disordered breathing is an independent risk factor for left atrial enlargement in patients with congestive heart failure

Mäuser, Wanda; Sandrock, Sarah; Demming, Thomas; Kotzott, Laura; Bonnemeier, Hendrik

doi:10.1016/j.ijcard.2012.11.017

Cited by 5 publications

(2 citation statements)

References 7 publications

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“…Diseases such as obesity, sleep apnoea, diabetes mellitus, and hypertension precipitate left atrial enlargement (33)(34)(35)(36), but these diseases are also important potential stand-alone causes of ischaemic stroke (37)(38)(39)(40). Hence, left atrial enlargement may serve merely as a proxy for the severity of other predisposing or coexisting cardiovascular disorders, including obesity, obstructive sleep apnoea, hypertension, carotid atherosclerosis, or diabetes mellitus, suggesting that such comorbidities are likely to be the underlying cause of some of the excess stroke risk observed among patients with left atrial enlargement.…”

Section: Possible Explanations For the Findingsmentioning

confidence: 99%

Left atrial size and risk of stroke in patients in sinus rhythm

Overvad¹,

Nielsen²,

Larsen³

et al. 2016

Thromb Haemost

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Little is known about the risk of stroke associated with left atrial enlargement in patients in sinus rhythm, and whether such patients may have an unmet need for thromboprophylaxis. In this systematic review we summarise the existing evidence concerning left atrial size and risk of stroke in patients in sinus rhythm. Nine cohort studies were identified, analysing a total of 67,875 participants and 3,093 stroke outcomes. Rates of stroke per 100 person-years in patients with left atrial enlargement and in sinus rhythm ranged from 0.59 in a population-based cohort to 2.06 in patients referred for echocardiography. All studies reported a higher risk of stroke with larger/enlarged left atrium compared to smaller/normal sized left atrium. Two studies found indications of modification by sex, with only positive associations observed in women. Left atrial enlargement may represent an important predictor of stroke across a variety of patient populations in sinus rhythm. The underlying aetiology explaining this observed higher risk is likely to be multifactorial and not confined to a potential direct effect of left atrial enlargement on thromboembolic risk. Formal stroke risk stratification among patients with left atrial enlargement may further help identify patients who stand to gain from preventive antithrombotic therapy.

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Section: Possible Explanations For the Findingsmentioning

confidence: 99%

Left atrial size and risk of stroke in patients in sinus rhythm

Overvad¹,

Nielsen²,

Larsen³

et al. 2016

Thromb Haemost

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“…Is observed in patients with more severe SDB a higher prevalence of left atrial enlargement (LAE), suggesting that SDB may cause LAE. The SDB leads to nocturnal hypoxemia, excitement reactions and consecutive repetitive bursts of sympathetic activity (2).…”

Section: Introductionmentioning

confidence: 99%

Nocturnal oxyhemoglobin desaturation during sleep in congestive heart failure patients

et al. 2016

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Nocturnal oxyhemoglobin desaturation during sleep in congestive heart failure patients [I] Dessaturação da oxihemoglobina durante o sono em pacientes com insufi ciência cardíaca congestiva [A] Jéssica Julioti Urbano [a] , Lilian Nanami Uchiyama [b] , Anderson Soares Silva [a] , Roger André Oliveira Peixoto [a] , Sergio Roberto Nacif [a] , Luis Vicente Franco Oliveira[a]* [a] Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil [b] Universidade do Vale do Paraíba (UNIVAP), São José dos Campos, SP, Brazil [R] Abstract Introduction: Sleep breathing disorders occur in 45% of patients with heart failure, with 36%-50% manifesting Cheyne-Stokes respiration with central sleep apnea and 12% exhibiting obstructive sleep apnea. Several studies have shown that sleep pathophysiology may negatively affect the cardiovascular system and that cardiac dysfunction alters sleep and respiration. Objective: The aim of this study was to examine oxyhemoglobin desaturation during sleep in patients with congestive heart failure (CHF) using overnight pulse oximetry. Methods: Overnight pulse oximetry was conducted in the patients' homes with wrist pulse oximeters and inger probes that were placed around the fore ingers of 15 patients with CHF and ejection fractions less than 50%, who were classi ied as New York Heart Association functional classes II and III. Results: The patients were divided into two groups. The irst group consisted of seven patients with oxyhemoglobin desaturation Urbano JJ, Uchiyama LN, Silva AS, Peixoto RAO, Nacif SR, Oliveira LVF. 598 indices of over 5 events/h, and the second group contained eight patients with oxyhemoglobin desaturation indices of 5 or less events/h. Student's t-tests did not show any signi icant differences between the groups. The patients' body mass indices correlated positively with the total desaturation episodes and desaturation time less than 90% and correlated negatively with the arterial oxygen saturation nadir. Conclusion: Pulse oximetry monitoring during sleep can be used to detect sleep breathing disorders in stable patients with CHF.

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