Effects of Obstructive Sleep Apnea and Obesity on Cardiac Remodeling: The Wisconsin Sleep Cohort Study

Apr 20, 2016Sleep

How Sleep Apnea and Obesity May Change Heart Structure

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Abstract

In a study of 601 participants with a mean age of 47 years, obstructive sleep apnea (OSA) is associated with lower future left ventricular ejection fraction and higher odds of reduced right ventricular function.

Higher baseline levels of obstructive sleep apnea, measured by the apnea-hypopnea index, are linked to a significant decrease in left ventricular ejection fraction.
Participants with elevated obstructive sleep apnea levels have 6.3 times higher odds of reduced right ventricular function, indicated by a tricuspid annular plane systolic excursion of 15 mm or less.
Oxygen desaturation indices are independently associated with increased left ventricular mass, left ventricular wall thickness, and right ventricular area.
The findings suggest that OSA may lead to adverse changes in heart structure and function, potentially driven by hypoxia.

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STUDY OBJECTIVES: To characterize the prospective associations of obstructive sleep apnea (OSA) with future echocardiographic measures of adverse cardiac remodeling.

METHODS: 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.

RESULTS: 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).

CONCLUSIONS: 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.

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Effects of Obstructive Sleep Apnea and Obesity on Cardiac Remodeling: The Wisconsin Sleep Cohort Study

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