Nocturnal hypoxia indexes are associated with left ventricular remodeling and diastolic dysfunction in obstructive sleep apnea patients

Feb 22, 2023Sleep medicine

Low oxygen levels at night are linked to heart muscle changes and pumping problems in sleep apnea patients

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Abstract

Patients with moderate-severe obstructive sleep apnea showed a left ventricular end-diastolic volume of 54.1 ± 14.0 ml/m2 compared to 48.4 ± 11.5 ml/m2 in those without OSA.

Moderate-severe OSA is linked to higher left ventricular end-diastolic volume and lower left ventricular ejection fraction.
No significant differences were observed in left ventricular mass index or filling velocity ratios between OSA and non-OSA patients.
Two specific markers related to oxygen levels during sleep—percentage of time with O2 saturation below 90% and oxygen desaturation index—were identified as independent predictors of cardiac remodeling.
These findings suggest that nocturnal hypoxia may contribute to cardiac changes in patients with obstructive sleep apnea.

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BACKGROUND AND OBJECTIVE: Obstructive sleep apnea (OSA) is associated with heart derangements detected at echocardiography as higher left ventricular mass index (LVMI), higher left ventricular end-diastolic diameter, lower left ventricular ejection fraction (LVEF), and impaired diastolic function. However, the currently used parameter to define OSA diagnosis and severity, the apnea/hypopnea index (AHI), poorly predicts cardiovascular damage, cardiovascular events, and mortality. Our study aimed to assess if other polygraphic indices of OSA presence and severity, in addition to AHI, might better predict echocardiographic cardiac remodeling.

METHODS AND RESULTS: We enrolled two cohorts of individuals referred for suspected OSA to the outpatient facilities of the IRCCS Istituto Auxologico Italiano, Milano, and of the Clinica Medica 3, Padova. All patients underwent home sleep apnea testing and echocardiography. Based on the AHI the cohort was divided into no-OSA (AHI<15 events/hour) and moderate-severe OSA (AHI≥15 events/hour). We recruited 162 patients and found that compared to patients with no-OSA, those with moderate-severe OSA showed higher LV remodeling [left ventricular end-diastolic volume (LVEDV) 48.4 ± 11.5 ml/m2 vs. 54.1 ± 14.0 ml/m2, respectively, p = 0.005] and lower LVEF (65.3 ± 5.8% vs. 61.6 ± 7.8%, respectively, p = 0.002), whereas we could not find any difference in LVMI and early and late ventricular filling velocity ratio (E/A). At multivariate linear regression analysis two polygraphic hypoxic burden-related markers were independent predictors of LVEDV and E/A, i.e., the percentage of time with O2 saturation below 90% (β = 0.222) and ODI (β = -0.422), respectively.

CONCLUSIONS: Our study shows that nocturnal hypoxia-related indexes were associated with left ventricular remodeling and diastolic dysfunction in OSA patients.

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Nocturnal hypoxia indexes are associated with left ventricular remodeling and diastolic dysfunction in obstructive sleep apnea patients

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