What is the clinical evidence from this study?

Study design: Observational. Population: Obstructive sleep apnea and obesity (n=99). Intervention: Obesity in obstructive sleep apnea vs. Non-obese obstructive sleep apnea. Primary outcome: Global longitudinal strain (GLS) (p=0.002).

What does this research mean for the field?

Obese patients with obstructive sleep apnea have significantly worse left ventricular global longitudinal strain compared to non-obese patients with the condition, indicating early and more severe impairment of cardiac function. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

March 23, 2022Open Access

Evaluation of Left Ventricular Function in Obese Patients with Obstructive Sleep Apnea by Three-dimensional Speckle Tracking Echocardiography

Key Result

Obese patients with obstructive sleep apnea had significantly worse left ventricular global longitudinal strain compared to non-obese patients with the condition (-11.12 vs -13.86, p=0.002).

Study Design

Type

Observational (n=99)

Multicenter

Structured PICO

Does obstructive sleep apnea and coexisting obesity impair left ventricular systolic function measured by 3D-STE in patients without overt heart disease?

Population

99 subjects, including 79 with obstructive sleep apnea (33 obese, 46 non-obese) and 20 healthy controls, evaluated for subclinical left ventricular dysfunction using 3D speckle-tracking echocardiography.

Exposure

Obstructive sleep apnea (OSA) with or without coexisting obesity (observational exposure)

Comparator

Healthy subjects without OSA (n=20) and non-obese OSA patients (n=46)

Outcome

Left ventricular systolic function evaluated by three-dimensional speckle tracking echocardiography (3D-STE) parameters including global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS)surrogate

In patients with obstructive sleep apnea, subclinical left ventricular systolic dysfunction (measured by 3D-STE) occurs before LVEF declines, and this impairment is significantly exacerbated by coexisting obesity.

Main Result

Absolute Event Rate: -11.12% vs -13.86%

p-value: p=0.002

Abstract

Abstract Purpose Both obstructive sleep apnea (OSA)and obesity can cause myocardial remodeling and cardiac insufficiency via corresponding pathophysiological pathways. Therefore, it is speculated that the superposition of OSA and obesity may cause more severe impairment of cardiac function. The objective of our study was to evaluate the early changes of left ventricular systolic function in obese patients with OSA with three-dimensional speckle tracking echocardiography(3D-STE). Methods This study was conducted with33 obese OSA, 46 non-obese OSA, and 20 healthy subjects. Demographic, biochemical, and Polysomnography(PSG) data were collected, and their relation with the left ventricular strain was measured and analyzed with 3D-STE. Results The Left ventricular strain was significantly worse in the OSA group compared to the control group(P < 0.05). The global longitudinal strain(GLS) was significantly worse in the OSA obese group compared to non-obese OSA group (P < 0.05). The GLS value positively correlated with body mass index(BMI) (r = 0.406, P < 0.001),Apnea-hypopnea index(AHI)(r = 0.610, P < 0.001)and homeostasis model assessment of insulin resistance(HOME-IR) (r = 0.431, P < 0.001) in patients with OSA. Multiple linear regression analysis showed BMI as a predictor of GLS and global circumferential strain(GCS), AHI as a predictor of GLS, and HOME-IR as a predictor of global area strain(GAS) and global radial strain(GRS). Conclusion In OSA patients, the myocardial strain was impaired before the damages in left ventricular ejection fraction, suggesting that the left ventricular systolic function is damaged early. The coexistence of obesity and OSA can lead to severe impairment of cardiac function through hypoxia and insulin resistance.

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