Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Sleep and Breathing
Published in: Sleep and Breathing 4/2021

01-12-2021 | Sleep Apnea | Sleep Breathing Physiology and Disorders • Original Article

Subclinical left ventricular systolic dysfunction detected in obstructive sleep apnea with automated function imaging and its association with nocturnal hypoxia

Authors: Chen-Yao Ma, John E. Sanderson, Qi Chen, Xiao-Jun Zhan, Chan Wu, Hu Liu, Lei Xiao, Xian-Fang Lin, Yong-Xiang Wei, Fang Fang

Published in: Sleep and Breathing | Issue 4/2021

Login to get access

Abstract

Background

Early detection of left ventricular (LV) dysfunction is crucial in obstructive sleep apnea (OSA) due to its close relationship with cardiovascular diseases. Global longitudinal strain (GLS) derived from automated function imaging (AFI) can precisely assess global longitudinal function. The aim of this study was to determine if LV GLS was reduced in patients with OSA and a normal LV ejection fraction (LVEF) and to assess any associated determinants.

Methods

Polysomnography (PSG) and echocardiography were done in consecutive patients with suspected OSA and normal LVEF in this prospective study. Patients were divided into two groups according to apnea-hypopnea index (AHI) (Group 1, normal or mild OSA: AHI < 15/h; Group 2, moderate-to-severe OSA: AHI ≥ 15/h). Clinical, PSG, and echocardiographic parameters were compared between the two groups and the associated factors were investigated.

Results

Of 425 consecutive patients, 244 were analyzed after exclusions. Patients in Group 2 had significantly worse GLS than those in Group 1 (p < 0.001). The prevalence of GLS reduction (defined as < − 19.7%) was 25% and 76%, respectively (χ2 = 34.19, p < 0.001). Nocturnal lowest pulse oxygen saturation (SpO2), AHI, body mass index (BMI), and gender were associated with GLS reduction (all p < 0.05). Further multivariate analysis showed that the lowest SpO2 (OR: 2.15), gender (OR: 2.45), and BMI (OR: 2.66) remained independent (all p < 0.05), and the lowest SpO2 was the most powerful determinant (χ2 = 33.0, p < 0.001) in forward regression analysis. The intra- and inter-operator variability for AFI and coefficient of repeatability was low even in those with relatively poor images.

Conclusions

In patients with normal LVEF, more severe OSA was associated with a worse GLS. The major determinants were lowest nocturnal SpO2, gender, and obesity, but not AHI. GLS can be rapidly and reliably assessed using AFI.
Literature
1.
Bibbins-Domingo K, Grossman DC, Curry SJ et al (2017) Screening for obstructive sleep apnea in adults: US Preventive Services Task Force Recommendation Statement. JAMA 317:407–414CrossRef
2.
Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, Hamilton GS, Dharmage SC (2017) Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev 34:70–81CrossRef
3.
Liu JH, Wei CZ, Huang LY, Wang W, Liang D, Lei Z, Wang F, Wang X, Hou X, Tang X (2014) Prevalence of signs and symptoms suggestive of obstructive sleep apnea syndrome in Guangxi, China. Sleep Breath 18:375–382CrossRef
4.
Sutherland K, Lee RW, Cistulli PA (2012) Obesity and craniofacial structure as risk factors for obstructive sleep apnoea: impact of ethnicity. Respirology 17:213–222CrossRef
5.
Sarkar P, Mukherjee S, Chai-Coetzer CL, McEvoy RD (2018) The epidemiology of obstructive sleep apnoea and cardiovascular disease. J Thorac Dis 10:S4189–S4200CrossRef
6.
Floras JS (2018) Sleep apnea and cardiovascular disease: an enigmatic risk factor. Circ Res 122:1741–1764CrossRef
7.
Cowie MR, Gallagher AM (2017) Sleep disordered breathing and heart failure: what does the future hold? JACC Heart Fail 5:715–723CrossRef
8.
D'Andrea A, Canora A, Sperlongano S et al (2020) Subclinical impairment of dynamic left ventricular systolic and diastolic function in patients with obstructive sleep apnea and preserved left ventricular ejection fraction. BMC Pulm Med 20:76–84CrossRef
9.
Barbier P, Mirea O, Cefalu C et al (2015) Reliability and feasibility of longitudinal AFI global and segmental strain compared with 2D left ventricular volumes and ejection fraction: intra- and inter-operator, test-retest, and inter-cycle reproducibility. Eur Heart J Cardiovasc Imaging 16:642–652CrossRef
10.
Calleja AM, Jiamsripong P, Alharthi MS, Cha S, Cho EJ, McMahon EM, Mookadam F, Khandheria BK, Belohlavek M (2009) Correlation of automated function imaging (AFI) to conventional strain analyses of regional and global right ventricular function. J Am Soc Echocardiogr 22:1031–1039CrossRef
11.
Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28:1–39CrossRef
12.
Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, Harrod CG (2017) Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 13:479–504CrossRef
13.
Mitchell C, Rahko PS, Blauwet LA, Canaday B, Finstuen JA, Foster MC, Horton K, Ogunyankin KO, Palma RA, Velazquez EJ (2019) Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr 32:1–64CrossRef
14.
15.
Yingchoncharoen T, Agarwal S, Popović ZB, Marwick TH (2013) Normal ranges of left ventricular strain: a meta-analysis. J Am Soc Echocardiog 26:185–191CrossRef
16.
Voigt JU, Pedrizzetti G, Lysyansky P, Marwick TH, Houle H, Baumann R, Pedri S, Ito Y, Abe Y, Metz S, Song JH, Hamilton J, Sengupta PP, Kolias TJ, d'Hooge J, Aurigemma GP, Thomas JD, Badano LP (2015) Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging 16:1–11CrossRef
17.
BeiFan Z (2002) Cooperative Meta-Analysis Group of the Working Group on Obesity in China, predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults--study on optimal cut-off points of body mass index and waist circumference in Chinese adults. Biomed Environ Sci 15:83–96
18.
Nagueh SF, Smiseth OA, Appleton CP, Byrd BF III, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, Marino P, Oh JK, Alexandru Popescu B, Waggoner AD, Houston, Texas; Oslo, Norway; Phoenix, Arizona; Nashville, Tennessee; Hamilton, Ontario, Canada; Uppsala, Sweden; Ghent and Liège, Belgium; Cleveland, Ohio; Novara, Italy; Rochester, Minnesota; Bucharest, Romania; and St. Louis, Missouri (2016) Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 17:1321–1360CrossRef
19.
Fung JW, Li TS, Choy DK et al (2002) Severe obstructive sleep apnea is associated with left ventricular diastolic dysfunction. Chest 121:422–429CrossRef
20.
Vitarelli A, D'Orazio S, Caranci F, Capotosto L, Rucos R, Iannucci G, Continanza G, Dettori O, de Cicco V, Vitarelli M, de Maio M, de Chiara S, Saponara M (2013) Left ventricular torsion abnormalities in patients with obstructive sleep apnea syndrome: an early sign of subclinical dysfunction. Int J Cardiol 165:512–518CrossRef
21.
Chen YL, Su MC, Liu WH, Wang CC, Lin MC, Chen MC (2014) Influence and predicting variables of obstructive sleep apnea on cardiac function and remodeling in patients without congestive heart failure. J Clin Sleep Med 10:57–64CrossRef
22.
Azarbarzin A, Sands SA, Stone KL, Taranto-Montemurro L, Messineo L, Terrill PI, Ancoli-Israel S, Ensrud K, Purcell S, White DP, Redline S, Wellman A (2019) The hypoxic burden of sleep apnoea predicts cardiovascular disease-related mortality: the Osteoporotic Fractures in Men Study and the Sleep Heart Health Study. Eur Heart J 40:1149–1157CrossRef
23.
Dias KA, Spence AL, Sarma S, Oxborough D, Timilsina AS, Davies PSW, Cain PA, Leong GM, Ingul CB, Coombes JS (2017) Left ventricular morphology and function in adolescents: relations to fitness and fatness. Int J Cardiol 240:313–319CrossRef
24.
Altekin RE, Yanikoglu A, Baktir AO, Karakas MS, Ozel D, Cilli A, Yildirim AB, Yilmaz H, Yalcinkaya S (2012) Assessment of subclinical left ventricular dysfunction in obstructive sleep apnea patients with speckle tracking echocardiography. Int J Cardiovasc Imaging 28:1917–1930CrossRef
25.
Dobrowolski P, Klisiewicz A, Florczak E, Prejbisz A, Bieleń P, Śliwiński P, Kabat M, Rybicka J, Topór-Mądry R, Januszewicz A, Hoffman P (2014) Independent association of obstructive sleep apnea with left ventricular geometry and systolic function in resistant hypertension: the RESIST-POL study. Sleep Med 15:1302–1308CrossRef
26.
Lu J, Lu Y, Wang X, Li X, Linderman GC, Wu C, Cheng X, Mu L, Zhang H, Liu J, Su M, Zhao H, Spatz ES, Spertus JA, Masoudi FA, Krumholz HM, Jiang L (2017) Prevalence, awareness, treatment, and control of hypertension in China: data from 1·7 million adults in a population-based screening study (China PEACE Million Persons Project). The Lancet 390:2549–2558CrossRef
27.
Altekin RE, Yanikoglu A, Karakas MS et al (2012) Evaluation of subclinical left ventricular systolic dysfunction in patients with obstructive sleep apnea by automated function imaging method; an observational study. Anadolu Kardiyol Derg 12:320–330PubMed
28.
Varghese MJ, Sharma G, Shukla G, Seth S, Mishra S, Gupta A, Bahl VK (2017) Longitudinal ventricular systolic dysfunction in patients with very severe obstructive sleep apnea: a case control study using speckle tracking imaging. Indian Heart J 69:305–310CrossRef
29.
Opdahl A, Remme EW, Helle-Valle T, Lyseggen E, Vartdal T, Pettersen E, Edvardsen T, Smiseth OA (2009) Determinants of left ventricular early-diastolic lengthening velocity: independent contributions from left ventricular relaxation, restoring forces, and lengthening load. Circulation 119:2578–2586CrossRef
30.
YuTing T, Wenzelburger F, Lee E et al (2009) The pathophysiology of heart failure with normal ejection fraction: exercise echocardiography reveals complex abnormalities of both systolic and diastolic ventricular function involving torsion, untwist, and longitudinal motion. J Am Coll Cardiol 54:36–46CrossRef
31.
Yip GW, Yan Z, Tan PY et al (2002) Left ventricular long-axis changes in early diastole and systole: impact of systolic function on diastole. Clin Sci (Lond) 102:515–522CrossRef
32.
Parker JD, Brooks D, Kozar LF et al (1999) Acute and chronic effects of airway obstruction on canine left ventricular performance. Am J Respir Crit Care Med 160:1888–1896CrossRef
33.
Abboud F, Kumar R (2014) Obstructive sleep apnea and insight into mechanisms of sympathetic overactivity. J Clin Invest 124:1454–1457CrossRef
34.
35.
36.
Weber KT (1989) Cardiac interstitium in health and disease: the fibrillar collagen network. J Am Coll Cardiol 13:1637–1652CrossRef
37.
Pontiroli AE, Pizzocri P, Saibene A, Girola A, Koprivec D, Fragasso G (2004) Left ventricular hypertrophy and QT interval in obesity and in hypertension: effects of weight loss and of normalisation of blood pressure. Int J Obes Relat Metab Disord 28:1118–1123CrossRef
38.
Vitarelli A, Martino F, Capotosto L, Martino E, Colantoni C, Ashurov R, Ricci S, Conde Y, Maramao F, Vitarelli M, de Chiara S, Zanoni C (2014) Early myocardial deformation changes in hypercholesterolemic and obese children and adolescents: a 2D and 3D speckle tracking echocardiography study. Medicine (Baltimore) 93:e71. https://​doi.​org/​10.​1097/​MD.​0000000000000071​CrossRef
39.
Marwick TH (2018) Ejection fraction pros and cons: JACC State-of-the-Art Review. J Am Coll Cardiol 72:2360–2379CrossRef
40.
Sanderson JE, Fraser AG (2006) Systolic dysfunction in heart failure with a normal ejection fraction: echo-Doppler measurements. Prog Cardiovasc Dis 49:196–206CrossRef
41.
42.
McEvoy RD, Antic NA, Heeley E et al (2016) CPAP for prevention of cardiovascular events in obstructive sleep apnea. N Engl J Med 375:919–931CrossRef
43.
Kim D, Shim CY, Cho YJ, Park S, Lee CJ, Park JH, Cho HJ, Ha JW, Hong GR (2019) Continuous positive airway pressure therapy restores cardiac mechanical function in patients with severe obstructive sleep apnea: a randomized, sham-controlled study. J Am Soc Echocardiog 32:826–835CrossRef
44.
45.
Galvan T, Camuso J, Sullivan K, Kim S, White D, Redline S, Joffe H (2017) Association of estradiol with sleep apnea in depressed perimenopausal and postmenopausal women: a preliminary study. Menopause 24:112–117CrossRef
46.
Lin CM, Davidson TM, Ancoli-Israel S (2008) Gender differences in obstructive sleep apnea and treatment implications. Sleep Med Rev 12:481–496CrossRef
Metadata
Title
Subclinical left ventricular systolic dysfunction detected in obstructive sleep apnea with automated function imaging and its association with nocturnal hypoxia
Authors
Chen-Yao Ma
John E. Sanderson
Qi Chen
Xiao-Jun Zhan
Chan Wu
Hu Liu
Lei Xiao
Xian-Fang Lin
Yong-Xiang Wei
Fang Fang
Publication date
01-12-2021
Publisher
Springer International Publishing
Published in
Sleep and Breathing / Issue 4/2021
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI
https://doi.org/10.1007/s11325-021-02330-2

Other articles of this Issue 4/2021

Sleep and Breathing 4/2021 Go to the issue

Epidemiology • Original Article

Peripheral white blood cell counts mediated the associations of sleep duration with atherosclerotic cardiovascular disease risk: a cross-sectional study of middle-aged and older Chinese

Sleep Breathing Physiology and Disorders • Original Article

Dexmedetomidine-soaked nasal packing can reduce pain and improve sleep quality after nasal endoscopic surgery: a double-blind, randomized, controlled clinical trial

Sleep Breathing Physiology and Disorders • Original Article

Comorbid insomnia and sleep apnea: characterization of the syndrome and understanding its associations with comorbid sleep conditions

Sleep Breathing Physiology and Disorders • Original Article

Snoring increases the development of coronary artery disease: a systematic review with meta-analysis of observational studies

Psychiatrics • Original Article

Efficacy of simplified-cognitive behavioral therapy for insomnia(S-CBTI) among female COVID-19 patients with insomnia symptom in Wuhan mobile cabin hospital

Sleep Breathing Physiology and Disorders • Original Article

Levels of trace blood elements associated with severe sleep disturbance in maintenance hemodialysis patients
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits