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Published on: December 6, 2016
Obstructive sleep apnea is independently associated with worse diastolic function in coronary artery disease
Helena Glantz1, Erik Thunström2, Magnus C Johansson3
1Department of Internal Medicine, Skaraborg Hospital, Lidköping, Sweden; Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Insights
Obstructive sleep apnea (OSA) is linked to worse diastolic function in coronary artery disease (CAD) patients with preserved ejection fraction. This association persists even when accounting for other common risk factors.
Area of Science:
- Cardiology
- Sleep Medicine
- Internal Medicine
Background:
- Diastolic dysfunction is a prevalent issue in patients diagnosed with coronary artery disease (CAD).
- The potential impact of obstructive sleep apnea (OSA) on diastolic function in CAD patients with preserved left ventricular ejection fraction (LVEF) requires further investigation.
Purpose of the Study:
- To investigate the association between obstructive sleep apnea (OSA) and diastolic function in patients with coronary artery disease (CAD) and preserved left ventricular ejection fraction (LVEF).
- To determine if OSA independently predicts worse diastolic function in this patient population.
Main Methods:
- Analysis of sleep-study recordings and echocardiographic data from 431 revascularized CAD patients with LVEF ≥50% within the RICCADSA trial.
- Obstructive sleep apnea (OSA) was defined by an apnea-hypopnea-index (AHI) ≥15 events/h; worse diastolic function was determined by elevated left ventricular filling pressure criteria (E/é ratio).
Main Results:
- Worse diastolic function was significantly more common in patients with OSA (54.4%) compared to those without (41.0%) (p=0.019).
- Multivariate analysis revealed OSA as an independent predictor of worse diastolic function (OR 1.90, 95% CI 1.13; 3.18), even after adjusting for female sex, hypertension, and diabetes mellitus.
Conclusions:
- Obstructive sleep apnea (OSA) is independently associated with worse diastolic function in patients with coronary artery disease (CAD) and preserved left ventricular ejection fraction (LVEF).
- These findings highlight OSA as a critical, often overlooked, factor contributing to diastolic dysfunction in CAD patients.
Background:
Diastolic dysfunction is common in patients with coronary artery disease (CAD). We hypothesize that patients with CAD and preserved left ventricular ejection fraction (LVEF) and obstructive sleep apnea (OSA) will have worse diastolic function than similar patients without OSA.
Material And Methods:
We analyzed sleep-study recordings and echocardiographic measurements obtained at baseline in a randomized controlled trial (RICCADSA) of revascularized patients with CAD who had LVEF of at least 50%. OSA was defined as an apnea-hypopnea-index (AHI) ≥15 events/h, and, no OSA, as an AHI <5. Worse diastolic function was defined as assumed elevated left ventricular filling pressure based on peak flow velocity in early diastole/Tissue Doppler of early diastolic ventricular filling (E/é) of >13 (or >9 in patients with an enlarged left atrial diameter [≥39 mm for women and ≥40 mm for men]).
Results:
Data from 431 patients were evaluated (mean age: 63.7 ± 8.8 y; men: 82.5%; OSA: n = 331). Worse diastolic function was more common among the patients with OSA than those without (54.4% vs 41.0%, p = 0.019). In multivariate analysis, OSA was associated with worse diastolic function (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.13; 3.18) adjusted for female sex (OR 2.28, 95% CI 1.28; 4.07), hypertension (OR 1.84, 95% CI 1.20; 2.82), and diabetes mellitus (OR 2.45, 95% CI 1.42; 4.23). Age ≥60 years, obesity, and current smoking were nonsignificant.
Conclusions:
In this cohort with CAD and preserved LVEF, OSA was associated with worse diastolic function independent of the traditionally recognized risk indicators.
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