Impact of obstructive sleep apnoea on diastolic function

Abstract

We investigated whether obstructive sleep apnoea (OSA) independently affects diastolic function in a primary care cohort of patients with cardiovascular risk factors.378 study participants with risk factors for diastolic dysfunction were prospectively included and a polygraphy was performed in all patients. Diastolic dysfunction was assessed by comprehensive echocardiography including tissue Doppler. Sleep apnoea was classified according to apnoea/ hypopnoea index (AHI) as none (AHI ,5 events?h ). Patients with central sleep apnoea (n514) and patients with previously diagnosed sleep apnoea (n512) were excluded. In the remaining 352 subjects, 21.6% had an AHI o15 events?h -1 . The prevalence of diastolic dysfunction increased with the severity of sleep apnoea from 44.8% (none) to 56.8% (mild) to 69.7% (moderate-to-severe sleep apnoea) (p50.002). The degree of diastolic dysfunction also increased with sleep apnoea severity (p50.004). In univariate regression analysis, age, desaturation index, AHI, cardiac frequency, angiotensin receptor 1 antagonist therapy, body mass index (BMI) and left ventricular mass were associated with diastolic dysfunction. In multivariate regression analysis, only age, BMI, AHI and cardiac frequency were independently associated with diastolic dysfunction.Moderate-to-severe OSA is independently associated with diastolic dysfunction in patients with classical risk factors for diastolic dysfunction.

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

“…Independently from hypertension and obesity, OSA impairs LV diastolic function, begets LVH, and thus may hasten HFpEF progression 126, 127, 252, 253, 254, 255, 256, 257, 258. Repetitive sleep arousals and hypoxic episodes heighten sympathetic activity and promote endothelial dysfunction, systemic inflammation, and arterial stiffness that may further increase blood pressure and accelerate atherosclerosis progression 128, 259, 260, 261, 262, 263, 264, 265…”

A Novel Method for Sensitive Determination of Subclinical Left-Ventricular Systolic Dysfunction in Subjects With Obstructive Sleep Apnea

“…On the other hand, diastolic function is often impaired in OSA. [4][5][6] Myocardial oxidative stress and ischemia are the main explanations for these disturbances. 7,8 The LV wall is not homogenous and is composed of 3 layers of fibers.…”

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

“…[24][25][26][27][28][29][30] In spite of the fact that these tools are widely available and frequently introduced in clinical settings, the cardiac structural and functional remodeling studied by utilizing TDI and RT3D has rarely been conducted in patients with OSAS to evaluate their cardiac function. [31][32][33][34][35][36][37] In addition, the frequent coexistence of OSAS and congestive heart failure in clinical scenarios make it difficult to clearly define the exact impact of OSAS on cardiac remodeling and function, and vice versa. In order to answer these unresolved issues regarding the impact of OSAS itself on cardiac structure and function, it is crucial to conduct a study enrolling subjects exclusively without clinical symptoms of heart failure.…”