Sleep Apnea as a Risk Factor for Diastolic Dysfunction: A Systematic Review and Meta-Analysis
Mohammed Al-Sadawi1, Kleanthis Theodoropoulos2, Farzane Saeidifard3,4
1Department of Cardiovascular Medicine, Stony Brook Medicine, Stony Brook, New York, USA.
Respiration; International Review of Thoracic Diseases
|August 30, 2022
Summary
Obstructive sleep apnea (OSA) is linked to diastolic dysfunction (DD) markers, including increased left atrial volume and left ventricular mass, independent of cardiovascular risk factors. Further research into continuous positive airway pressure therapy is recommended.
Area of Science:
- Cardiology
- Sleep Medicine
- Medical Research
Background:
- Investigates the association between obstructive sleep apnea (OSA) and diastolic dysfunction (DD).
- Focuses on echocardiographic parameters indicative of heart failure with preserved ejection fraction (HFpEF).
- Examines the relationship independent of traditional cardiovascular risk factors.
Approach:
- Conducted a meta-analysis of 18 studies involving 2,509 participants.
- Searched multiple databases (MEDLINE, Embase, Scopus, Web of Science, Google Scholar, CINAHL) up to December 2020.
- Assessed risk of bias using Cochrane collaboration tools and extracted data in duplicate.
Key Points:
- Patients with OSA showed significantly greater left atrial volume index (LAVI) and left ventricular mass index (LVMI).
- OSA was associated with prolonged deceleration time, increased isovolumic relaxation time (IVRT), and a lower E/A ratio, indicating early DD.
- The E/e' ratio was elevated in OSA patients, further suggesting diastolic impairment. Ejection fraction did not differ significantly.
Conclusions:
- A significant association exists between OSA and echocardiographic markers of DD, independent of conventional cardiovascular risk factors.
- Elevated left ventricular mass in OSA patients may contribute to the observed diastolic dysfunction.
- Continuous positive airway pressure (CPAP) therapy's role in mitigating or reversing DD warrants further investigation.
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