Comparison of Cardiac Structural and Functional Changes in Obese Otherwise Healthy Adults With Versus Without Obstructive Sleep Apnea

Otto, Maria Estefânia Bosco; Bělohlávek, Marek; Romero‐Corral, Abel; Gami, Apoor S.; Gilman, Gregory; Svatikova, Anna; Amin, Raouf S.; López-Jiménez, Francisco; Khandheria, Bijoy K.; Somers, Virend K.

doi:10.1016/j.amjcard.2006.12.052

Cited by 186 publications

(127 citation statements)

References 30 publications

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“…177 Responses to cytokines, catecholamines, endothelin, and other growth factors produced in OSA also may contribute to ventricular hypertrophy independently of hypertension. Indeed, there is evidence to suggest that OSA is associated with altered cardiac structure and function 121,123,178,179 and that some of these changes may be reversible with effective CPAP treatment.…”

Section: Osa and The Origin And Progression Of Heart Failurementioning

confidence: 99%

“…239 Sleep apnea has been associated with left atrial enlargement. 121,122 That OSA leads to atrial fibrillation is an appealing but presently unproven hypothesis. In a retrospective cohort study of Ͼ3500 adults without past or current atrial fibrillation who underwent complete overnight polysomnography, both obesity and nocturnal oxygen desaturation were independent predictors of incident atrial fibrillation, but only in subjects Յ65 years of age.…”

Section: Prevalence Of Arrhythmias In Sleep Apneamentioning

confidence: 99%

“…This negative intrathoracic pressure increases transmural gradients across the atria, ventricles, and aorta 118,119 and disrupts ventricular function 118 and autonomic and hemodynamic stability. 120 Consequences may include increased wall stress, increased afterload, increased atrial size, 121,122 impaired diastolic function, 121,123 thoracic aortic dilation, and propensity toward dissection. 124 Whether repetitive nocturnal increases in transmural gradients may contribute in the longer term to ventricular hypertrophy and remodeling and associated clinical consequences remains to be established.…”

Section: Intrathoracic Pressure Changesmentioning

confidence: 99%

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Sleep Apnea and Cardiovascular Disease

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Section: Osa and The Origin And Progression Of Heart Failurementioning

confidence: 99%

Section: Prevalence Of Arrhythmias In Sleep Apneamentioning

confidence: 99%

Section: Intrathoracic Pressure Changesmentioning

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“…In addition to increasing arterial stiffness, obesity is associated with 4‐fold greater prevalence of OSA, which contributes to the pathogenesis of HFpEF through multiple mechanisms: Sympathetic activation increases LV afterload, hypoxic pulmonary vasoconstriction reduces LV preload, oxidative stress stimulates inflammation, and hypoxia predisposes to atrial and ventricular arrhythmias 125, 126, 127, 128, 129…”

Section: Obesity Phenotypementioning

confidence: 99%

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Samson

Jaiswal

Ennezat

et al. 2016

JAHA

102

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“…Our study showed that patients with moderate-to-severe OSAS and preserved systolic function have cardiac remodeling with dilated left atrial size, decreased E/A ratio, increased A-wave velocity, and enlarged left ventricular end-diastolic volume when compared to those with mild or no OSAS. These changes could be induced by the repetitively and abruptly increased transmural gradients across the atria, [43][44][45] ventricles, and aorta, [46][47][48][49] caused by the very substantial negative intrathoracic pressure (possibly approaching -65 mm Hg) during pharyngeal collapse. 50 This study showed a novel finding in that AHI in REM sleep, but not NREM sleep, was significantly associated with cardiac remodeling (dilated aortic root size by 2D echocardiography, increased left ventricular end-diastolic volume, left ventricular end-systolic volume, and left ventricular stroke volume by 3D echocardiography) and ventricular diastolic dysfunction (high A-wave velocity and low E/A ratio).…”

mentioning

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

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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.

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Comparison of Cardiac Structural and Functional Changes in Obese Otherwise Healthy Adults With Versus Without Obstructive Sleep Apnea

Cited by 186 publications

References 30 publications

Sleep Apnea and Cardiovascular Disease

Sleep Apnea and Cardiovascular Disease

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

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

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