Association between Obstructive Sleep Apnea and Left Ventricular Structure by Age and Gender: the Multi-Ethnic Study of Atherosclerosis

The presence and severity of obstructive sleep apnea (OSA) are associated with impaired left ventricular (LV) structure and function. Our goal was to quantify the associations between LV systolic function and mass with severity of OSA in an ethnically diverse cohort, assessing variations by age and sex. We conducted a cross-sectional analysis of data from 1,412 racially/ethnically diverse participants across 6 US communities from the Multi-Ethnic Study of Atherosclerosis who underwent both overnight polysomnography and cardiac magnetic resonance imaging from 2010–2012. We evaluated the association between the obstructive apnea-hypopnea index (AHI) by clinical category (< 5, 5–15, 15–30, 30–50, > 50) and secondary measures of sleep apnea with the outcomes left ventricular (LV) mass adjusted for height, LV mass/volume ratio, and LV ejection fraction. After adjusting for potential confounders and mediators, LV mass was significantly increased with increasing AHI category for subjects age 65 y or younger (β = 1.84 ± 0.47 g/m, P = 0.0001). The association between the AHI and LV mass appeared stronger in whites and Chinese compared to blacks and Hispanics, although interaction terms were not statistically significant. Additionally, while both LV mass and LV mass/volume ratio were significantly associated with hypoxia, ejection fraction was not associated with any OSA severity index. Comparable associations were observed in men and women. Independent of confounders, higher levels of AHI are significantly associated with increased LV mass in both men and women younger than 65 y from a community-based cohort. This study demonstrated significant associations between severity of obstructive sleep apnea (OSA) and left ventricular (LV) structure using cardiac magnetic resonance imaging. While prior research has demonstrated an association between obstructive sleep apnea and increased LV mass in men, this study extends the literature by demonstrating comparable associations between OSA severity and LV mass as well as LV mass/volume ratio in both men and women from an ethnically diverse, community-based cohort. Further, this association is significantly modified by age such that the associations are present in those 65 and younger but are attenuated in those > 65 years of age.