Subclinical decrease in cardiac autonomic and diastolic function in patients with metabolic disorders: HSCAA study

Morimoto, Akira; Kadoya, Masumi; Kakutani‐Hatayama, Miki; Kosaka‐Hamamoto, Kae; Miyoshi, Akio; Shoji, Takuhito; Goda, Akiko; Asakura, Masanori; Koyama, Hideki

doi:10.1016/j.metop.2020.100025

Cited by 9 publications

(11 citation statements)

References 45 publications

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“…LV diastolic dysfunction is an important cause of HFpEF in individuals with diabetes and epidemiologic studies have demonstrated the presence of diastolic dysfunction in type 2 diabetes patients [15,16]. In our recent study, diabetic patients exhibited higher E/e' as compared to those with either normal or impaired glucose tolerance [11]. Among the available parameters of LV diastolic function, E/e′ determined with a non-invasive approach has long been used to assess LV lling pressure in various patient populations [17].…”

Section: Diabetes and Cardiac Diastolic Dysfunctionmentioning

confidence: 63%

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Sleep Apnea and Diabetes Predict Progression of Cardiac Diastolic Dysfunction in Pre-heart Failure Patients: a Prospective Cohort HSCAA Study

Kidawara¹,

Kadoya²,

Morimoto³

et al. 2020

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[Background] Sleep apnea, a common co-morbid condition of diabetes, has been shown to be associated with established heart failure. However, its role in association of the presence of diabetes in the progression of cardiac diastolic function in pre-heart failure phase is not known. This prospective study is to longitudinally examine the predictive value of sleep apnea and diabetes on progression of left ventricular (LV) diastolic dysfunction in patients without heart disease.[Methods] Among 976 patients registered in HSCAA prospective cohort study, 517 without heart disease (175 type 2 diabetes, 342 non-diabetes) were followed with repeated echocardiography in every 1-3 years for a mean 34.7 months. LV diastolic dysfunction was determined by transmitral early inflow velocity/early diastolic tissue velocity (E/e´) >14. Annual change in E/e’ was calculated by using the slope of the linear regression line calculated from at least 3 echocardiographic measurements. Sleep apnea was determined by an apnomonitor device in conjunction with percutaneous oxygen saturation, and apnea hypopnea index (AHI) was calculated.[Results] Kaplan-Meier analyses revealed that subjects with diabetes or sleep apnea had a significantly (p<0.01) greater risk for LV diastolic dysfunction, with hazards ratio of 2.21 (1.41-3.47) and 2.23 (1.40-3.55), respectively. Subjects with sleep apnea exhibited significantly higher risk for LV diastolic dysfunction in non-diabetic subjects (p<0.01), while showed tendency of higher risk in diabetic subjects (p=0.10). The annual change of E/e’ was significantly and independently associated with both diabetes (β=0.278, p<0.01) and AHI (β=0.138, p<0.01). Finally, ROC analyses revealed that addition of AHI and diabetes to classical risk factors best predicted individuals with fast progression of diastolic dysfunction (annual change of E/e’ >1.0) with an AUC of 0.81.[Conclusions] In patients without heart disease, sleep apnea is an important predictor for progression of LV diastolic dysfunction. Its association is partly confounded, but still independent of the presence of diabetes.

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Section: Diabetes and Cardiac Diastolic Dysfunctionmentioning

confidence: 63%

“…LV function was evaluated by echocardiography as previously described [11]. Examinations were repeated every 1-3 years to determine changes in LV function.…”

Section: Assessment Of LV Diastolic Functionmentioning

confidence: 99%

Sleep Apnea and Diabetes Predict Progression of Cardiac Diastolic Dysfunction in Pre-heart Failure Patients: a Prospective Cohort HSCAA Study

Kidawara¹,

Kadoya²,

Morimoto³

et al. 2020

Preprint

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“…HRV using an Active Tracer device (AC-301A ® , Arm Electronics, Tokyo, Japan) was used for noninvasive determination of cardiac modulation based on autonomic balance, as previously described 14 , 22 – 24 . The final 24-h series of data from the 48-h recording was analyzed using a MemCalc Chiram 3 system, version 2.0 (Suwa Trust, Tokyo, Japan).…”

Section: Methodsmentioning

confidence: 99%

Sleep quality, autonomic dysfunction and renal function in diabetic patients with pre-CKD phase

Kadoya

Morimoto

Miyoshi

et al. 2021

Sci Rep

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Diabetes has been established as a strong risk factor for chronic kidney disease (CKD). Sleep apnea, poor sleep quality (PSQ), and autonomic imbalance are also considered to be potential risk factors for decline in renal function, though no known study has examined their integrated predictive value in diabetic and non-diabetic patients without CKD. The present cohort consisted of 754 serial patients (diabetes; n = 231, non-diabetes; n = 523) without CKD registered in the Hyogo Sleep Cardio-Autonomic Atherosclerosis (HSCAA) study. Patients underwent examinations to determine respiratory event index and objective sleep quality using actigraphy, as well as heart rate variability (HRV). Renal outcome was defined as a decline in estimated glomerular filtration rate to less than 60 ml/min/1.73 m2 for more than 3 months. Kaplan–Meier analysis showed that diabetic patients with PSQ or low HRV, but not sleep apnea, had a significantly increased risk for renal outcome. Furthermore, Cox proportional hazards analysis revealed that PSQ was significantly associated with elevated risk of renal outcome (HR: 2.57; 95% CI: 1.01–6.53, p = 0.045) independent of sleep apnea and classical risk factors. Low HRV tended to be, but not significantly (p = 0.065), associated with the outcome. In non-diabetic patients, PSQ was also significantly and independently associated with renal outcome, whereas sleep apnea and low HRV were not. In conclusion, PSQ and low HRV appear to be important predictors of decline in renal function in diabetic patients without CKD.

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“…2351). This cross-sectional study was conducted as part of the HSCAA Study, which was instituted to examine the impacts of sleep and autonomic imbalance on metabolic, renal, and cardiovascular events [25] , [26] . Patients with 1 or more cardiovascular risk factors, including obesity, smoking, presence of cardiovascular event history, hypertension, dyslipidemia, diabetes mellitus, and chronic kidney disease, and being treated at the Division of Diabetes, Endocrinology and Metabolism of Hyogo Medical College Hospital (Hyogo, Japan) were registered.…”

Section: Methodsmentioning

confidence: 99%

“…To analyze cardiac autonomic nervous activity, heart rate variability (HRV) was measured in a noninvasive manner with an Active Tracer device (AC-301A®, Arm Electronics, Tokyo, Japan) and a MemCalc Chiram 3 system, version 2.0 (Suwa Trust, Tokyo, Japan), as previously described [25] , [26] , [39] , [40] . According to the recommendations for clinical use of HRV [ 22 ], the standard deviation of the NN(RR) interval (SDNN) was calculated.…”

Section: Methodsmentioning

confidence: 99%

Associations of sleep quality, sleep apnea and autonomic function with insulin secretion and sensitivity: HSCAA study

et al. 2020

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Rationale and purpose Although sleep disorders are shown to be involved in occurrence of diabetes, impacts of several quantitative parameters related to sleep on insulin secretion and sensitivity is yet to be elucidated. We cross-sectionally examined relationships among quantitative sleep quality, sleep apnea, and autonomic function with insulin secretion and sensitivity in 399 patients without previous diagnosed diabetes who underwent 75-g oral glucose tolerance test (75gOGTT). Method Poor sleep quality (PSQ) was defined as an activity index ≥50 by actigraphy. Sleep apnea was measured by apnomonitor, while standard deviation of all normal-to-normal R-R intervals (SDNN) was measured by active tracer. Parameters of insulin secretion and sensitivity were measured by 75gOGTT. Results Patients with PSQ exhibited significantly lower insulinogenic index (r = 0.155, p < 0.01), a parameter of insulin secretion, with the association independent of other clinical factors including apnea and SDNN (β = −0.156, p < 0.01). In contrast, presence of sleep apnea (r = −0.143, p < 0.05) and the lower SDNN (r = −0.150, p < 0.01) were significantly and inversely associated with BIGTT-S, an insulin sensitivity parameter, with the association of SDNN with BIGTT-S remaining significant even after adjustments for PSQ and sleep apnea (β = −0.111, p < 0.05). Conclusion Poor sleep quality is an independent predictor of pancreatic β-cell function, which could be involved in occurrence of type 2 diabetes.

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Subclinical decrease in cardiac autonomic and diastolic function in patients with metabolic disorders: HSCAA study

Cited by 9 publications

References 45 publications

Sleep Apnea and Diabetes Predict Progression of Cardiac Diastolic Dysfunction in Pre-heart Failure Patients: a Prospective Cohort HSCAA Study

Sleep Apnea and Diabetes Predict Progression of Cardiac Diastolic Dysfunction in Pre-heart Failure Patients: a Prospective Cohort HSCAA Study

Sleep quality, autonomic dysfunction and renal function in diabetic patients with pre-CKD phase

Associations of sleep quality, sleep apnea and autonomic function with insulin secretion and sensitivity: HSCAA study

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Subclinical decrease in cardiac autonomic and diastolic function in patients with metabolic disorders: HSCAA study

Cited by 9 publications

References 45 publications

Sleep Apnea and Diabetes Predict Progression of Cardiac Diastolic Dysfunction in Pre-heart Failure Patients: a Prospective Cohort HSCAA&nbsp;Study

Sleep Apnea and Diabetes Predict Progression of Cardiac Diastolic Dysfunction in Pre-heart Failure Patients: a Prospective Cohort HSCAA&nbsp;Study

Sleep quality, autonomic dysfunction and renal function in diabetic patients with pre-CKD phase

Associations of sleep quality, sleep apnea and autonomic function with insulin secretion and sensitivity: HSCAA study

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Sleep Apnea and Diabetes Predict Progression of Cardiac Diastolic Dysfunction in Pre-heart Failure Patients: a Prospective Cohort HSCAA Study

Sleep Apnea and Diabetes Predict Progression of Cardiac Diastolic Dysfunction in Pre-heart Failure Patients: a Prospective Cohort HSCAA Study