Higher baseline obstructive sleep apnea severity was independently associated with lower future left ventricular ejection fraction and higher odds of TAPSE ≤ 15 mm (OR 6.3; 95% CI 1.3-30.5; P=0.02).
Cohort (n=601)
Does obstructive sleep apnea lead to adverse cardiac remodeling and reduced ventricular function over long-term follow-up?
Long-term exposure to obstructive sleep apnea is independently associated with reduced left and right ventricular systolic function, highlighting the need for early detection and integrated treatment.
Effect estimate: OR 6.3 (95% CI 1.3-30.5)
p-value: p=0.02
To characterize the prospective associations of obstructive sleep apnea (OSA) with future echocardiographic measures of adverse cardiac remodeling This was a prospective long-term observational study. Participants had overnight polysomnography followed by transthoracic echocardiography a mean (standard deviation) of 18.0 (3.7) y later. OSA was characterized by the apnea-hypopnea index (AHI, events/hour). Echocardiography was used to assess left ventricular (LV) systolic and diastolic function and mass, left atrial volume and pressure, cardiac output, systemic vascular resistance, and right ventricular (RV) systolic function, size, and hemodynamics. Multivariate regression models estimated associations between log10(AHI+1) and future echocardiographic findings. A secondary analysis looked at oxygen desaturation indices and future echocardiographic findings. At entry, the 601 participants were mean (standard deviation) 47 (8) y old (47% female). After adjustment for age, sex, and body mass index, baseline log10(AHI+1) was associated significantly with future reduced LV ejection fraction and tricuspid annular plane systolic excursion (TAPSE) ≤ 15 mm. After further adjustment for cardiovascular risk factors, participants with higher baseline log10(AHI+1) had lower future LV ejection fraction (β = −1.35 standard error = 0.6/log10(AHI+1), P = 0.03) and higher odds of TAPSE ≤ 15 mm (odds ratio = 6.3/log10(AHI+1), 95% confidence interval = 1.3–30.5, P = 0.02). SaO2 desaturation indices were associated independently with LV mass, LV wall thickness, and RV area (all P < 0.03) OSA is associated independently with decreasing LV systolic function and with reduced RV function. Echocardiographic measures of adverse cardiac remodeling are strongly associated with OSA but are confounded by obesity. Hypoxia may be a stimulus for hypertrophy in individuals with OSA. Obstructive sleep apnea is highly prevalent and often under-diagnosed especially during its initial years. The Wisconsin Sleep Cohort provided an opportunity to study the natural history of sleep apnea in the general population and its effects on the heart. In this observational study, we identified an association between long term exposure to sleep apnea and a reduction in the strength of cardiac contraction independent of cumulative exposure to traditional cardiovascular disease risk factors. Studies of early detection and integrated treatment of OSA and obesity on long-term morbidity and mortality are needed.
Korcarz et al. (Tue,) conducted a cohort in Obstructive sleep apnea (n=601). Obstructive sleep apnea was evaluated on Reduced LV ejection fraction and tricuspid annular plane systolic excursion (TAPSE) ≤ 15 mm (OR 6.3, 95% CI 1.3-30.5, p=0.02). Higher baseline obstructive sleep apnea severity was independently associated with lower future left ventricular ejection fraction and higher odds of TAPSE ≤ 15 mm (OR 6.3; 95% CI 1.3-30.5; P=0.02).
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