Abstract P198: Short Sleep Duration, Greater Cognitive Arousal, And Eveningness Are Associated With Reduced Left Ventricular Function In Insomnia Disorder

Aim: Insomnia is associated with cardiovascular disease (CVD), particularly the phenotype with objective short sleep duration and associated physiological arousal. However, what objective sleep and arousal characteristics among patients with insomnia are related to markers of cardiovascular structure and function remains unknown. The present study examined the association of objective sleep metrics and self-reported arousability with arterial stiffness, endothelial function, and left ventricular function among patients with insomnia disorder. Methods: Sixteen young, healthy adults (age: M [ SD ]=30[7]; 56.3% women) meeting diagnostic criteria for insomnia disorder and reporting no history of CVD, underwent fasting vascular testing including carotid-femoral pulse wave velocity (cfPWV) to assess arterial stiffness (SphymocorXCEL TM ), brachial-artery flow mediated dilation (FMD) to assess endothelial function, and 2D echocardiography to assess left ventricular function (Terason uSmart 3300 TM ). Left ventricular function was assessed by ejection fraction (EF), global longitudinal strain (GLS), mitral valve E/e’ (MVE/e’), and lateral e’ using standardized methods. Ten participants wore a portable sleep monitor for 1 night (WatchPat200, Itamar Medical) and an actigraph for 8 nights (Actiwatch Spectrum Plus, Philips Respironics). All participants completed the Pre Sleep Arousal Scale (PSAS; somatic & cognitive subscales), and the Arousal Predisposition Scale (APS). Bivariate correlations and curvilinear regressions (total sleep time [TST] only) were conducted for the associations between actigraphy-assessed TST and WatchPat (WP) TST, actigraphy-assessed mean bedtime, and PSAS and APS scores with cardiovascular markers. Each set of one sleep metric with all six cardiovascular markers were Bonferroni corrected (α level: p <0.007). Results: On average, participants obtained 7h,9min of TST (range: 6h,26min - 8h,41min) and went to bed at 23:40 (range:21:47-2:13) via actigraphy, and slept 6h,51min via WP. Mean PSAS Somatic, PSAS Cognitive, and APS scores were 13.7(SD=4.5), 24.5(SD=7.5), and 27.9(SD=7.6), respectively. cfPWV (range:4.6-8.0), EF% (range:55.0-70.9), GLS% (range:-25- -19), and MVE/e’ (range:3.6-13.3) were all within age and sex normative ranges. Mean FMD was 7.8% (SD=2.6, range:4.4-14.6), and lateral e’ was 15 cm/s (SD=4.5, range:9-22). Correlations indicated that greater PSAS cognitive scores were related to worsening (less negative) GLS% ( r =0.77, p =0.001), later bedtimes were associated with lower lateral e’ ( r =-0.84, p =0.004), and shorter WPTST was associated with lower EF% (r=0.84, p=0 . 002). Conclusion: Among young adults with insomnia disorder, greater cognitive arousal, later bedtimes, and shorter objective total sleep time were associated with subclinical worsening of left ventricular strain, diastolic and systolic function.

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Abstract P548: Poorer Objective Sleep is Associated With Greater Arterial Stiffness and Worsening Cardiac Diastolic Function

Circulation ◽

10.1161/circ.141.suppl_1.p548 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Megan E Petrov ◽

Shawn Youngstedt ◽

Farouk Mookadam ◽

Nana Jiao ◽

Lance M Lim ◽

...

Keyword(s):

Arterial Stiffness ◽

Sleep Quality ◽

Left Ventricular Function ◽

Diastolic Function ◽

Ventricular Function ◽

Regression Models ◽

Sleep Time ◽

Left Ventricular ◽

History Of ◽

Curvilinear Regression

Aim: Few studies have examined the association between objective sleep metrics and arterial and echocardiographic (left ventricular systolic/diastolic function) markers of sub-clinical cardiovascular disease (CVD). The present study examined the association of wrist actigraphy-assessed sleep metrics with arterial stiffness, endothelial dysfunction, and left ventricular systolic/diastolic function. Methods: Fifteen young, healthy adults (21-39y; 60% women) with no history of CVD, and no current sleep-disordered breathing (WatchPat200, Itamar Medical) or sleep complaints wore Actiwatch Spectrum Plus actigraphs for eight nights (Philips Respironics, Bend OR) with accompanying sleep logs. Participants underwent fasting vascular testing including central augmented aortic pressure (AP), carotid-femoral pulse wave velocity (cfPWV) to assess arterial stiffness (SphymocorXCEL TM ), brachial artery flow mediated dilation (FMD) to assess endothelial function, and 2D echocardiography to assess left ventricular function (Terason uSmart 3300 TM ). Left ventricular function was assessed by ejection fraction (EF%), left atrial volume index (LAVI), deceleration time (DT), and mitral valve E/e’ ratio (MVE/e’) using standardized methods. Bivariate correlations investigating the association between mean total sleep time (TST), sleep efficiency % (SE), sleep-onset latency (SOL), and wake after sleep time (WASO) with cardiovascular indices were conducted. Curvilinear regression models examining quadratic relationships between TST and the cardiovascular indices were conducted. Results: On average, participants obtained 6 hrs 44 min of TST (SD=29.1), with 86.0% SE (SD=3.1), 10.6 min SOL (SD=8.5), and 37.0 min WASO (SD=11.6). cfPWV (range: 4.8-7.5), EF% (range: 60.0-72.0), LAVI (range: 15.0-26.7 mL/m 2 ), and MVE/e’ (range: 3.2-7.8) were all within normal ranges according to age and sex normative standards. Mean FMD was 9.2% (SD=4.62, range: 4.3-19.8). Correlations indicated that greater SOL was associated with greater cfPWV (r=.63, p=0.01), and AP (r=.57, p=0.03). Lower SE (r= -.70, p=0.003) and higher WASO (r=.71, p=0.003) were associated with higher MVE/e’. WASO was associated with higher DT (r=.57, p=0.04). Curvilinear regression models revealed a quadratic relationship between TST and cfPWV (F[2,11]=9.78, p=0.004) such that shorter and longer TST were associated with greater cfPWV. No sleep metrics were associated with FMD, EF%, or LAVI. Conclusions: Among normal sleeping, apparently healthy young adults, with no history of CVD, lower levels of objective sleep quality and both shorter and longer sleep duration were associated with greater arterial stiffness, whereas only lower levels of objective sleep quality were related to worsening left ventricular diastolic dysfunction. These data may have implications for CVD risk reduction in young, healthy adults.

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Endovascular treatment of peripheral artery disease is associated with improved central hemodynamics and ventricular function

European Heart Journal ◽

10.1093/ehjci/ehaa946.2381 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

D Messiha ◽

L Halfmann ◽

O Azizy ◽

M Steinmetz ◽

T Rassaf ◽

...

Keyword(s):

Arterial Stiffness ◽

Left Ventricular Function ◽

Endovascular Treatment ◽

Ventricular Function ◽

Peripheral Artery Disease ◽

Cardiovascular Mortality ◽

Left Ventricular ◽

Central Hemodynamics ◽

Peripheral Artery ◽

Artery Disease

Abstract Background Peripheral artery disease (PAD) is a major manifestation of atherosclerosis and a risk factor for morbidity and mortality. PAD itself is associated with increased arterial stiffness with impact on cardiac functions. Previous studies have demonstrated that augmentation index (AIx) and central blood pressure (CBP) correlate with increased cardiovascular mortality. This mechanism has been described as arterio-ventricular (AV) coupling with altered ventricular afterload and a depressed ventricular function, measured by global longitudinal strain (GLS). The impact of PAD-related endovascular treatment on arterial stiffness, central hemodynamics and potential impact on AV coupling has not been elucidated until now. Purpose Aim of the study was to investigate, if endovascular treatment of PAD improves cardiac function via enhanced central hemodynamics and AV coupling. Methods To this aim 77 patients with known symptomatic PAD who underwent interventions in the iliac and femoropopliteal arteries were included in a cross-sectional study. AIx, CBP and GLS were determined using dedicated waveform analysis and echocardiography before and after endovascular treatment. Results Mean age was 65.1±10.4 years with 66.2% male patients. Symptoms were classified by Fontaine classification (stage IIb 80.7%, stage III 5.8% and stage IV 13.5%). Iliac vessel intervention was performed in 16 and femoropopliteal intervention in 61 cases. A stentless approach was feasible in 55 patients with DCB treatment and atherectomy. After endovascular treatment, peripheral perfusion was enhanced (ABI 0.45±0.6 vs 0.81±0.5, p<0.0001). Moreover, central hemodynamics were improved (AIX 33.7±3% vs 27.9±2%, p=0.0008; AP 17.8±2 mmHg vs 14.0±2 mmHg, p=0.0004; central PP 52.4±6 mmHg vs 46.4±6 mmHg, p=0.0001). Impressively, left ventricular function was also significantly improved (GLS −15.7±2.3% vs −17.1±2.8%, p=0.005) with an improvement in AV coupling (PWV/GLS ratio −0.58m/sec% vs −0.56m/sec%, p<0.01). Conclusion Our results demonstrate that endovascular treatment of the peripheral vessels is associated with an improvement of central hemodynamics and left ventricular function via enhanced AV coupling. These prognostic relevant markers of cardiovascular disease could point to an overall potential mortality benefit through PAD treatment. Further investigation of the underlying mechanisms of AV coupling in the setting of endovascular treatment of PAD with impact on cardiovascular mortality is needed in this high-risk population. Funding Acknowledgement Type of funding source: None

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