The association of sleep disordered breathing with left ventricular remodeling in CAD patients: a cross-sectional study

Abstract

BackgroundThere is still insufficient knowledge on the potential effect of mild to moderate sleep-disordered breathing (SDB) that is widely prevalent, often asymptomatic, and largely undiagnosed in patients with stable coronary artery disease (CAD). SDB affects 34% of men and 17% of women aged between 30 and 70. The objective of this study was to evaluate the association between SDB and left ventricular (LV) hypertrophy as well as structural remodeling in stable CAD patients.MethodsThe study was based on a cross-sectional design. Echocardiography and polysomnography was performed in 772 patients with CAD and with untreated sleep apnea. All study participants underwent testing by Epworth Sleepiness Scale questionnaire. Their mean age, NYHA and left ventricular ejection fraction were, respectively: 57 ± 9 years, 2.1 ± 0.5 and 51 ± 8%, and 76% were men. Sleep apnea (SA) was defined as an apnea-hypopnea-index (AHI) ≥5 events/h, and, non-SA, as an AHI <5.ResultsSleep apnea was present in 39% of patients, and a large fraction of those patients had no complaints on excessive daytime sleepiness. The patients with SA were older, with higher body mass and higher prevalence of hypertension. LV hypertrophy (LVH), defined by allometrically corrected (LV mass/height2.7) gender-independent criteria, was more common among the patients with SA than those without (86% vs. 74%, p < 0.001). The frequency of LVH by wall thickness criteria (interventricular septal thickness or posterior wall thickness ≥ 12 mm: 49% vs. 33%, p < 0.001) and concentric LVH (61% vs. 47%, p = 0.001) was higher in CAD patients with SA. The patients with SA had significantly higher values of both interventricular septal thickness and posterior wall thickness. Multiple logistic regression analysis showed that even mild sleep apnea was an independent predictor for LVH by wall thickness criteria and concentric LVH (OR = 1.5; 95% CI 1.04–2.2 and OR = 1.9; 1.3–2.9 respectively).ConclusionsWe concluded that unrecognized sleep apnea was highly prevalent among patients with stable CAD, and the majority of those patients did not report daytime sleepiness. Mild to moderate sleep apnea was associated with increased LV wall thickness, LV mass, and with higher prevalence of concentric LV hypertrophy independently of coexisting obesity, hypertension, diabetes mellitus or advancing age.

Heart failure is not a determinant of central sleep apnea in the pediatric population

“…However, these parameters did not correlate with CAHI or OAHI. This finding contrasts the adult literature, where sleep disordered breathing is associated with left ventricular remodeling 20 . However, this is supported by previous studies in pediatric literature which suggest that pediatric sleep disordered breathing is not associated with significant cardiovascular strain and the majority of cardiovascular parameters in children with sleep disordered breathing are within the normal range at baseline 21 …”

Left ventricular myocardial mass index associated with cardiovascular and renal prognosis in IgA nephropathy

“…In contrast to these studies, we found that the presence of concentric hypertrophy in IgAN patients was the worst prognostic LV geometry in both sexes. Other studies found concentric hypertrophy the most common LV geometry alteration and the worst in terms of progression in general, in the case of hypertension, obesity, sleep apnea syndrome, and CV disease [ 34 , 35 ]. Our data suggest that, like in other diseases, concentric hypertrophy is the worst prognosis in IgAN (and possibly in other CKDs).…”

Obstructive sleep apnoea in acute coronary syndrome

“…Parameters of left ventricular hypertrophy, including left ventricular mass/height relationship, wall thickness criteria and concentric left ventricular hypertrophy, were all higher in OSA. Even mild OSA independently predicted left ventricular hypertrophy after multiple logistic regression [61].…”

“…Structural changes of the myocardium may influence the long-term outcome of patients with OSA and CAD. ALONDERIS et al [61] investigated the impact of SDB on left ventricular hypertrophy in stable CAD patients. They performed a cross-sectional study in 772 patients with CAD and untreated OSA.…”