Severe obstructive sleep apnea increases left atrial volume independently of left ventricular diastolic impairment

Imai, Yasuko; Tanaka, Nobuhiro; Usui, Yasuhiro; Takahashi, Nori; Kurohane, Saiko; Takei, Yasuyoshi; Takata, Yasuyuki; Yamashina, Akira

doi:10.1007/s11325-015-1153-7

Cited by 17 publications

(15 citation statements)

References 32 publications

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“…Left atrial (LA) dilation is associated with various cardiac disorders, such as valvular heart diseases [1, 2], left ventricular (LV) systolic [3] or diastolic dysfunction [4], obstructive sleep apnea [5, 6], and atrial fibrillation [7–9]. LA enlargement is a risk marker for the future development of atrial fibrillation [8, 10], and is associated with heart failure hospitalizations, stroke [11, 12], and death [13–15].…”

Section: Introductionmentioning

confidence: 99%

Association of left atrial volume index and all-cause mortality in patients referred for routine cardiovascular magnetic resonance: a multicenter study

Khan

Yang

Zhan

et al. 2019

Journal of Cardiovascular Magnetic Resonance

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BackgroundRoutine cine cardiovascular magnetic resonance (CMR) allows for the measurement of left atrial (LA) volumes. Normal reference values for LA volumes have been published based on a group of European individuals without known cardiovascular disease (CVD) but not on one of similar United States (US) based volunteers. Furthermore, the association between grades of LA dilatation by CMR and outcomes has not been established. We aimed to assess the relationship between grades of LA dilatation measured on CMR based on US volunteers without known CVD and all-cause mortality in a large, multicenter cohort of patients referred for a clinically indicated CMR scan.MethodWe identified 85 healthy US subjects to determine normal reference LA volumes using the biplane area-length method and indexed for body surface area (LAVi). Clinical CMR reports of patients with LA volume measures (n = 11,613) were obtained. Data analysis was performed on a cloud-based system for consecutive CMR exams performed at three geographically distinct US medical centers from August 2008 through August 2017. We identified 10,890 eligible cases. We categorized patients into 4 groups based on LAVi partitions derived from US normal reference values: Normal (21–52 ml/m2), Mild (52–62 ml/m2), Moderate (63–73 ml/m2) and Severe (> 73 ml/m2). Mortality data were ascertained for the patient group using electronic health records and social security death index. Cox proportional hazard risk models were used to derive hazard ratios for measuring association of LA enlargement and all-cause mortality.ResultsThe distribution of LAVi from healthy subjects without known CVD was 36.3 ± 7.8 mL/m2. In clinical patients, enlarged LA was associated with older age, atrial fibrillation, hypertension, heart failure, inpatient status and biventricular dilatation. The median follow-up duration was 48.9 (IQR 32.1–71.2) months. On univariate analyses, mild [Hazard Ratio (HR) 1.35 (95% Confidence Interval [CI] 1.11 to 1.65], moderate [HR 1.51 (95% CI 1.22 to 1.88)] and severe LA enlargement [HR 2.14 (95% CI 1.81 to 2.53)] were significant predictors of death. After adjustment for significant covariates, moderate [HR 1.45 (95% CI 1.1 to 1.89)] and severe LA enlargement [HR 1.64 (95% CI 1.29 to 2.08)] remained independent predictors of death.ConclusionLAVi determined on routine cine-CMR is independently associated with all-cause mortality in patients undergoing a clinically indicated CMR.

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Section: Introductionmentioning

confidence: 99%

Association of left atrial volume index and all-cause mortality in patients referred for routine cardiovascular magnetic resonance: a multicenter study

Khan

Yang

Zhan

et al. 2019

Journal of Cardiovascular Magnetic Resonance

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“…An increased AHI was associated with decreased mitral E wave [9] and increased mitral A wave velocities [9, 17] (Table 4). Although Varghese et al did not find a significant difference regarding mitral E/A ratio in patients with severe OSA (1.1 ± 0.2) versus controls (1.2 ± 0.2; p =0.09) [10], several other studies reported that mitral E/A ratio decreases with OSA severity [9, 13, 17]. Surprisingly, Altekin et al found significantly lower E/A ratio only in patients with mild OSA ( p =0.0009) but not in subjects with moderate or severe OSA [11].…”

Section: Introductionmentioning

confidence: 99%

Review of Echocardiographic Findings in Patients with Obstructive Sleep Apnea

Sascău

Zota

Stătescu

et al. 2018

Canadian Respiratory Journal

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Obstructive sleep apnea (OSA) causes recurrent apneas due to upper respiratory tract collapse, leading to sympathetic nervous system hyperactivation and increased cardiovascular risk. Moderate and severe forms of obstructive sleep apnea are associated with increased atrial volumes and affect left ventricular diastolic and then systolic function. Right ventricular ejection fraction can be accurately assessed via three-dimensional echocardiography, while bidimensional imaging can only provide a set of surrogate parameters to characterize systolic function (tricuspid annulus plane systolic excursion, right ventricular fractional area change, and lateral S'). Tissue Doppler imaging is a more sensitive tool in detecting functional ventricular impairment, but its use is limited by angle dependence and the unwanted influence of tethering forces. Two-dimensional speckle tracking echocardiography is considered more suitable for the assessment of ventricular function, as it is able to distinguish between active and passive wall motion. Abnormal strain values, a marker of subclinical myocardial dysfunction, can be detected even in patients with normal ejection fraction and chamber volumes. The left ventricular longitudinal strain is more affected by the presence of obstructive sleep apnea than circumferential strain values. Although the observed OSA-induced changes are subtle, the benefit of a detailed echocardiographic screening for subclinical heart failure in OSA patients on therapy adherence and outcome should be addressed by further studies.

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“…It has been shown that OSAHS treatment might reduce the risk of cardiovascular complications. CPAP treatment has been proven to reduce blood pressure 5,20 and correct left ventricular hypertrophy and systolic and diastolic dysfunctions caused by OSAHS 21,22 . There were limited data on the effects of oral appliance treatment on cardiac function.…”

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confidence: 99%

Mandibular Advancement Devices Prevent the Adverse Cardiac Effects of Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS)

Liu

Kang

Zhang

et al. 2020

Sci Rep

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Although considerable research highlights the interactions between obstructive sleep apnea-hypopnea syndrome (OSAHS) and cardiovascular diseases, the effect of mandibular advancement device (MAD) treatment on cardiovascular complications in OSAHS patients remains unclear. We evaluated the effect of OSAHS treatment with MADs on the myocardium. All methods in this study were in accordance with relevant guidelines and regulations of the medical ethics committee in Hospital of Stomatology, Hebei Medical University approved the work. Thirty New Zealand rabbits were randomized into three groups: the control group, Group OSAHS, and Group MAD. Hydrophilic polyacrylamide gel was injected into the soft palate of the rabbits to induce OSAHS. In Group MAD, a MAD was positioned after OSAHS induction. All animals were induced to sleep in a supine position for 4-6 h/day for 8 weeks. Echocardiography was used to determine the structure and function of the heart. The histological changes were detected by optical microscopy and transmission electron microscopy (TEM). The levels of ET-1(endothelin-1) and Ang II (Angiotensin II) in the plasma were measured by an enzyme-linked immunosorbent assay (ELISA). The expression of ET-1 mRNA in heart tissue was detected by RT-PCR. Histological abnormalities, left ventricular hypertrophy, and left ventricular dysfunctions were demonstrated in Group OSAHS, and the abnormities were rescued with MAD treatment. Higher levels of plasma ET-1 and Ang II and elevated expression of ET-1 mRNA in cardiac tissue were detected in Group OSAHS compared with Group MAD and the control group. The blood oxygen saturation was negatively correlated with the levels of ET-1 and Ang II. OSAHS-induced elevated levels of ET-1 and Ang II may be attributed to myocardial structural abnormalities and dysfunction. Early treatment of MADs may play an important role in preventing myocardial damage in OSAHS rabbit model.

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Severe obstructive sleep apnea increases left atrial volume independently of left ventricular diastolic impairment

Abstract: Severe OSA itself might directly increase LAVI, independently of LV diastolic function.

Cited by 17 publications

References 32 publications

Association of left atrial volume index and all-cause mortality in patients referred for routine cardiovascular magnetic resonance: a multicenter study

Association of left atrial volume index and all-cause mortality in patients referred for routine cardiovascular magnetic resonance: a multicenter study

Review of Echocardiographic Findings in Patients with Obstructive Sleep Apnea

Mandibular Advancement Devices Prevent the Adverse Cardiac Effects of Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS)

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