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

  • Sleep Breathing Physiology and Disorders • Original Article
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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.

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Abbreviations

AFI:

Automated function imaging

AHI:

Apnea-hypopnea index

BMI:

Body mass index

BSA:

Body surface area

CPAP:

Continuous positive airway pressure

EDT:

E-wave deceleration time

EF:

Ejection fraction

GLS:

Global longitudinal strain

IVRT:

Isovolumic relaxation time

IVS:

Interventricular septum

LAV:

Left atrial volume

LAVI:

Left atrial volume index

LV:

Left ventricular

LVDd:

Left ventricular diastolic dimension

LVM:

Left ventricular mass

LVMI:

Left ventricular mass index

OSA:

Obstructive sleep apnea

OR:

Odds ratio

PSG:

Polysomnography

PWd:

Posterior wall dimension

RWT:

Relative wall thickness

SpO2 :

Pulse oxygen saturation

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Acknowledgments

This study was supported by the National Key Research and Development Program of China (2020YFC2003600), the project of Beijing Institute of Heart, Lung and Blood Vessel Diseases (2017–2018) (Clinical Trial: ChiCTR-ROC-17011027), and Beijing Medical Project 2016-4.

Authors’ contributions

F Fang contributed to the study conception and design. Material preparation, data collection, and analysis were performed by CY Ma, Q Chen, XJ Zhan, C Wu, H Liu, L Xiao, and XF Lin. The first draft of the manuscript was written by CY Ma. F Fang, J E Sanderson, and YX Wei supervised the research and revised the manuscript. All authors read and approved the final manuscript.

Author information

Authors and Affiliations

  1. Sleep Medicine Center, Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, 100029, China

    Chen-Yao Ma, Qi Chen, Hu Liu, Lei Xiao & Fang Fang

  2. Beijing Anzhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, 100029, China

    John E. Sanderson

  3. Sleep Medicine Center, Department of Otorhinolaryngology Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, 100029, China

    Xiao-Jun Zhan, Chan Wu & Yong-Xiang Wei

  4. Department of Ultrasound, Taizhou Hospital Affiliated to Wenzhou Medical University, Zhejiang, 317000, Taizhou, China

    Xian-Fang Lin

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  1. Chen-Yao Ma
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Correspondence to Yong-Xiang Wei or Fang Fang.

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Ma, CY., Sanderson, J.E., Chen, Q. et al. Subclinical left ventricular systolic dysfunction detected in obstructive sleep apnea with automated function imaging and its association with nocturnal hypoxia. Sleep Breath 25, 2015–2023 (2021). https://doi.org/10.1007/s11325-021-02330-2

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