Impact of obstructive sleep apnea on left atrial functional and structural remodeling beyond obesity

Kim, Seong-Man; Cho, Kyoung-Im; Kwon, Jae Hwan; Lee, Hyeon-Gook; Kim, Tae-Ik

doi:10.1016/j.jjcc.2012.07.007

Cited by 51 publications

(45 citation statements)

References 33 publications

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“…A number of factors known to affect diameter of left atrium that include left ventricular diastolic dysfunction [6,20], arterial stiffness [21], apnea-hypopnea index [6], severity of OSA [8], diastolic blood pressure and use of positive airway pressure devices [22]. In present study, we found that left atrial diameter was higher among the OSA patients as compared to control group even after controlling for potential confounders like age, gender, obesity and systemic hypertension, which supports finding of earlier studies [8, 21,23].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with OSA have overactivation of sympathetic system and systemic hypertension can lead to atherosclerosis; through these mechanisms, OSA can lead to re-modeling of cardiovascular system [5][6][7]. These changes induce a variety of the effects, e.g., right ventricular dysfunction, pulmonary artery hypertension, increase in left atrial volume index and left ventricular diastolic dysfunction [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Effect of Severe Obstructive Sleep Apnea on Morphology of Left-Sided Heart and Pulmonary Artery Pressure

et al. 2017

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P = 0.003), higher left ventricular end-systolic volume (53.25 ± 16.69 vs. 38.82 ± 9.36 ml in controls; P = 0.01), higher mean pulmonary artery pressure (19.41 ± 7.89 vs 14.91 ± 3.55 mmHg in controls; P = 0.04), thicker left ventricular posterior wall (1.25 ± 0.13 vs 0.65 ± 0.25 cm in controls; P < 0.001) after controlling for confounders like age, gender, body mass index and systemic hypertension. An index was calculated for the left atrial size and left ventricular volumes with body surface area. Among these indices, only left ventricular end systolic volume index was found to be higher among subjects with severe OSA after controlling for confounders like age, gender, body mass index and systemic hypertension. Conclusion Severe OSA is associated with remodeling of pulmonary vasculature and left-sided chambers of the heart.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of Severe Obstructive Sleep Apnea on Morphology of Left-Sided Heart and Pulmonary Artery Pressure

et al. 2017

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“…Moreover, the elevated negative intrathoracic pressure 18 due to upper airway collapse and the consequent mechanical stretching of the LA wall, [19][20] the increased transmural cardiac pressure, and ventricular wall tension and afterload 21 may explain LV remodeling and diastolic and systolic cardiac dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic Findings in Healthy Elderly People with Unrecognized Sleep Disordered Breathing

Sforza

Sabri

Dacosta

et al. 2015

Journal of Clinical Sleep Medicine

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Objective: Sleep disordered breathing (SDB) is associated with cardiovascular disease such as hypertension and left ventricular hypertrophy in middle-aged patients; however, this association is not well described in the elderly. The aim of this study was to evaluate the impact of unrecognized SDB on cardiac function and remodeling in a population-based sample of healthy elderly without cardiac disease. Methodology: A total of 405 healthy elderly (age ≥ 65 years) were examined by echocardiography and respiratory polygraphy. According to the apnea-hypopnea index (AHI), subjects were stratifi ed in four categories: snorers (AHI < 5), mild (AHI: 5-15), moderate (AHI: 15-30), and severe (AHI > 30) cases. Results: Comparative analysis between snorers and SDB cases revealed that left atrial (LA) diameter and surface increased according to SDB severity (p < 0.05) without differences in LA mass index. In subjects with an AHI > 30, an increase was found for LV end-diastolic and end-systolic dimension (p < 0.001), as well as for LV mass (p < 0.03) and LV index (p < 0.05). The current study showed a weak but signifi cant correlation between altered LA and LV measurements versus AHI and hypoxemia indices (p < 0.001). In the regression analysis, AHI and hypoxemia had a minimal effect, body mass index and male gender being the most signifi cant predictors. Conclusions: In a population of healthy elderly with SDB, slight changes in left atrial and ventricular measurements occur in severe cases (AHI > 30). Irrespective of the lack of a strong association between SDB and cardiac dysfunction, the presence of slight cardiac pathology in severe SDB cases might be considered. Clinical Trial Registration: NCT 00759304 and NCT 00766584. Keywords: sleep disordered breathing, hypoxemia, echocardiography, elderly, left cardiac function, obesity Citation: Sforza E, Sabri M, DaCosta A, Isaaz K, Barthélémy JC, Roche F. Echocardiographic fi ndings in healthy elderly people with unrecognized sleep disordered breathing. J Clin Sleep Med 2015;11(9):975-980.pii: jc-00437-14 http://dx.doi.org/10.5664/jcsm.5006 S leep disordered breathing (SDB) is a common disease in adults affecting 9% of women and 24% of men aged 30-60 years, with an even higher prevalence reported in the elderly population.1,2 Several clinical and epidemiological studies have established an association of SDB with increased incidence of hypertension, coronary heart disease, stroke, heart failure, and mortality after adjustment for cardiovascular risk factors. 3,4 Animal models using intermittent hypoxemia have demonstrated that chronic exposure to hypoxia induces cardiac disturbances including an increase in left ventricular (LV) mass, as well as an interstitial fi brosis in LV myocardium. 5,6An experimental model of intermittent hypoxemia mimics the repetitive nocturnal hypoxemia occurring in SDB patients, inducing increased sympathetic nervous system activity, oxidative stress, systemic infl ammation, 7 elevated cardiac fi lling, hemodynamic overload, and increased ventricular...

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“…The severity of OSA was significantly correlated to structural and functional remodeling of left atrium (LA). The OSA group was characterized by larger LA volume and by an impaired LA wall compliance and passive contraction [46] . LVM and left ventricular hypertrophy (LVH) [47] were linked to the severity of OSA and are established as an important risk factor for cardiovascular morbidity and mortality [48] .…”

Section: Could the Link Be Clearer In Patients With Severe Osa?mentioning

confidence: 99%

Ventricular Remodeling after Myocardial Infarct: A Minireview on the Impact of Obstructive Sleep Apnea Syndrome

Solecki¹,

Lattuca²,

Leclercq³

et al. 2015

Journal of Cardiology and Therapy

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Obstructive sleep apnoea (OSA) is recognized as an important cardiovascular risk factor and is intricate with coronary disease. OSA could be involved in worsening the cardiac remodeling following the acute myocardial infarction (AMI). Cardiac remodeling is an important determinant of the clinical outcome of heart failure and is linked to disease progression and poor prognosis. The aims of this minireview are to address the frequency reported in the literature of OSA in patients with AMI and to summarize the main mechanisms of cardiac remodeling by OSA and its consequences on cardiovascular system. In addition, we aim to identify new strategies in the management of AMI. OSA is frequent in patients with AMI. OSA may have a role in cardiac remodeling after AMI and especially in relationship with the increased sensitivity of the reperfused tissue to all underlying mechanisms: a complex interplay of mechanical or haemodynamic factors, reactive oxygen species balance, sympathetic nerve activity, endothelial dysfunction, proinflammatory factors and coagulation abnormalities. Continuous positive airway pressure CPAP might represent a non pharmalogical treatment in addition to the global management of patients with AMI.

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Impact of obstructive sleep apnea on left atrial functional and structural remodeling beyond obesity

Abstract: LA structural and functional remodeling was significantly correlated with the severity of OSA and LV diastolic filling pressure. OSA impaired LA wall compliance and passive contraction independent of obesity.

Cited by 51 publications

References 33 publications

Effect of Severe Obstructive Sleep Apnea on Morphology of Left-Sided Heart and Pulmonary Artery Pressure

Effect of Severe Obstructive Sleep Apnea on Morphology of Left-Sided Heart and Pulmonary Artery Pressure

Echocardiographic Findings in Healthy Elderly People with Unrecognized Sleep Disordered Breathing

Ventricular Remodeling after Myocardial Infarct: A Minireview on the Impact of Obstructive Sleep Apnea Syndrome

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