Severe obstructive sleep apnea increases left atrial volume independently of left ventricular diastolic impairment

Mar 18, 2015Sleep & breathing = Schlaf & Atmung

Severe sleep apnea is linked to larger left atrium size regardless of heart relaxation problems

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Abstract

Patients with severe obstructive sleep apnea exhibited a larger left atrial volume index (LAVI) compared to those with moderate obstructive sleep apnea (20 ± 5 vs. 23 ± 5 mL/m², P < 0.001).

Severe obstructive sleep apnea (OSA) is associated with increased LAVI, which is a predictor of cardiovascular events.
The LAVI was significantly larger in patients with severe OSA compared to those with moderate OSA.
Diastolic function, measured by the E/A ratio, was significantly lower in patients with severe OSA.
The E/e' ratio, another measure of diastolic function, was significantly higher in the severe OSA group.
AHI showed a significant correlation with LAVI, indicating a relationship between OSA severity and left atrial size.
Severe OSA was independently linked to increased LAVI, even after adjusting for potential confounding factors.

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PURPOSE: Severe obstructive sleep apnea (OSA) directly impairs left ventricular (LV) diastolic function. Left atrial volume index (LAVI), an independent predictor of future cardiovascular events, is also related to OSA severity. This study aimed to assess whether OSA is associated with an increase in LAVI independently of LV diastolic function.

METHODS: Two hundred six OSA patients (apnea hypopnea index, AHI ≥ 5/h) without cardiac disease, hypertension, and diabetes were enrolled. They underwent overnight fully attended polysomnography and 2-dimensional echocardiography in order to estimate LA volumes and LV diastolic function which was assessed by the ratio of transmitral early diastolic flow velocity to late diastolic flow velocity (E/A), deceleration time, and mitral annular velocity (e') which was derived from tissue Doppler imaging. Patients were divided into two groups based on AHI, namely, group M (5 ≤ AHI < 30/h) and group S (AHI ≥ 30/h).

RESULTS: The LAVI value in group S was significantly larger than that in group M (20 ± 5 vs. 23 ± 5 mL/m(2), P < 0.001). E/A in group S was significantly lower than that in group M (P < 0.001), whereas the ratio of E to e' (E/e') in group S was significantly higher than that in group M (P < 0.001). AHI showed a statistically significant correlation with LAVI (P < 0.001). On multivariate linear regression analysis, severe OSA was independently related with LAVI even after adjusting for age, sex, systolic blood pressure, body mass index, and measurements of LV diastolic function (P = 0.04).

CONCLUSIONS: Severe OSA itself might directly increase LAVI, independently of LV diastolic function.

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Severe obstructive sleep apnea increases left atrial volume independently of left ventricular diastolic impairment

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