Obstructive Sleep Apnea is Common and Associated with Heart Remodeling in Patients with Chagas Disease

Abstract

BackgroundChagas Disease (CD) is an important cause of morbimortality due to heart failure and malignant arrhythmias worldwide, especially in Latin America.ObjectiveTo investigate the association of obstructive sleep apnea (OSA) with heart remodeling and cardiac arrhythmias in patients CD.MethodsConsecutive patients with CD, aged between 30 to 65 years old were enrolled. Participants underwent clinical evaluation, sleep study, 24-hour Holter monitoring, echocardiogram and ambulatory blood pressure monitoring.ResultsWe evaluated 135 patients [age: 56 (45-62) years; 30% men; BMI: 26 ± 4 kg/m2, Chagas cardiomyopathy: 70%]. Moderate to severe OSA (apnea-hypopnea index, AHI, ≥ 15 events/h) was present in 21% of the patients. OSA was not associated with arrhythmias in this population. As compared to patients with mild or no OSA, patients with moderate to severe OSA had higher frequency of hypertension (79% vs. 72% vs. 44%, p < 0.01) higher nocturnal systolic blood pressure: 119 ± 17 vs. 113 ± 13 vs. 110 ± 11 mmHg, p = 0.01; larger left atrial diameter [37 (33-42) vs. 35 (33-39) vs. 33 (30-36) mm, p < 0.01]; and a greater proportion of left ventricular dysfunction [LVEF < 50% (39% vs. 28% vs. 11%), p < 0.01], respectively. Predictor of left atrial dimension was Log10 (AHI) (β = 3.86, 95% CI: 1.91 to 5.81; p < 0.01). Predictors of ventricular dysfunction were AHI > 15 events/h (OR = 3.61, 95% CI: 1.31 - 9.98; p = 0.01), systolic blood pressure (OR = 1.06, 95% CI: 1.02 - 1.10; p < 0.01) and male gender (OR = 3.24, 95% CI: 1.31 - 8.01; p = 0.01).ConclusionsOSA is independently associated with atrial and ventricular remodeling in patients with CD.

Menor Prevalência e Extensão da Aterosclerose Coronária na Doença de Chagas Crônica por Angiotomografia Coronária

“…A doença cardíaca geralmente inicia-se com anormalidades de condução, tais como bloqueio de ramo direito e/ou bloqueio fascicular anterior esquerdo, que pode ser seguido por cardiomiopatia dilatada anos depois. 8 A insuficiência cardíaca e outras anormalidades [9][10][11][12][13][14] associadas, tais como disautonomia simpática, 15 podem ser observadas nesta fase. Em estágios posteriores, aneurismas apicais e formação de trombos podem ser achados frequentes.…”