Subclinical impairment of dynamic left ventricular systolic and diastolic function in patients with obstructive sleep apnea and preserved left ventricular ejection fraction

Background: Obstructive sleep apnea (OSA) occurs when the airway is repeatedly blocked during sleep, resulting in frequent brief awakenings throughout the night. OSA has been found to increase the risk of many cardiovascular diseases, especially heart failure (HF). HF with reduced, preserved, and borderline ejection fraction (HFrEF, HFpEF, and HFbEF) are three subtypes common in OSA patients. The aim of this study is to further explore the relationship between OSA and HF and the influence of specific OSA measures. Methods: Electronic medical data was collected from health histories, echocardiograms, and polysomnography studies. Observations were sorted into three categories based on left ventricular ejection fraction: HFpEF (n=334), HFrEF (n=77), and HFbEF (n=37). Multinomial logistic regression was then conducted to determine the relative risk of HFpEF and HFrEF from each variable as compared to the baseline HFbEF. Results: Pacemaker presence, previous stroke, BMI, and a measure of left ventricular dysfunction (LVD), called relative wall thickness, all raised the risk of HFpEF compared to HFbEF, while another LVD measure, left ventricular end-systolic dimension, reduced it. These factors also increased risk for HFrEF, except for previous stroke and pacemaker presence, which were not significant. Relevant OSA metrices included average blood oxygen saturation and three measures of sleep apnea severity, named central apnea index, hypopnea index per hour, and the Epworth Sleepiness Scale (ESS). These all decreased relative HFpEF risk, other than ESS, which raised it. Conclusions: As was expected, several standard HF predictors increased the risk of both types of HF. Surprisingly, few OSA indices had the same effect. This suggests that targeting specific OSA markers may not be effective in treating patients with any of these HF types. Future work could involve the influence of OSA and its indices on mortality, or the responses of these indicators to treatment, both topics with limited previous findings.

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Usefulness of B-type natriuretic peptide in hypertensive patients with exertional dyspnea and normal left ventricular ejection fraction and correlation with new echocardiographic indexes of systolic and diastolic function

The American Journal of Cardiology ◽

10.1016/j.amjcard.2003.08.053 ◽

2003 ◽

Vol 92 (12) ◽

pp. 1434-1438 ◽

Cited By ~ 88

Author(s):

Philip M Mottram ◽

Rodel Leano ◽

Thomas H Marwick

Keyword(s):

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Diastolic Function ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Exertional Dyspnea ◽

Ventricular Ejection Fraction ◽

Hypertensive Patients ◽

Normal Left Ventricular ◽

Systolic And Diastolic Function

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Predictors of an adverse course of heart failure with preserved left ventricular ejection fraction in patients with obstructive sleep apnea syndrome

Bulletin of Siberian Medicine ◽

10.20538/1682-0363-2021-2-102-112 ◽

2021 ◽

Vol 20 (2) ◽

pp. 102-112

Author(s):

A. T. Teplyakov ◽

A. V. Yakovlev ◽

S. N. Shilov ◽

N. F. Yakovleva ◽

E. N. Berezikova ◽

...

Keyword(s):

Heart Failure ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Left Ventricular Ejection Fraction ◽

Sleep Apnea Syndrome ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Obstructive Sleep ◽

Apnea Syndrome

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Cardiac Function in Obstructive Sleep Apnea Patients following Uvulopalatopharyngoplasty

Otolaryngology ◽

10.1177/019459989210700308 ◽

1992 ◽

Vol 107 (3) ◽

pp. 390-394 ◽

Cited By ~ 17

Author(s):

Yuval Zohar ◽

Yoav P. Talmi ◽

Haya Frenkel ◽

Yehuda Finkelstein ◽

Carlos Rudnicki ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Ejection Fraction ◽

Cardiac Function ◽

Left Ventricular ◽

Ventricular Ejection ◽

Treatment Modalities ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Obstructive Sleep

Obstructive sleep apnea syndrome (OSAS) is associated with severe cardiac arrhythmias and conduction abnormalities. Cor pulmonale and right-sided heart failure may ensue. Uvulopalatopharyngoplasty (UPPP) is one of several treatment modalities suggested for OSAS. Tracheotomy and CPAP treatment in adult OSAS patients and adenotonsillectomy in children with OSAS were shown to lead to improvement in some cardiac parameters. Cardiac function was prospectively evaluated in 19 OSAS patients before and after UPPP. No significant changes after surgery were noted on electrocardiographic studies. Improvement in global and regional function of both ventricles was seen in 91% of the patients. A trend toward significant elevation in left ventricular ejection fraction and a statistically significant increase in right ventricular ejection fraction were observed (45% = 9% to 50% = 7% [p = 0.007]). Our results support performance of UPPP in selected OSAS patients for relief of potentially life-threatening cardiac pathologies

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Improved Diastolic Function Is Associated With Higher Cardiac Output in Patients With Heart Failure Irrespective of Left Ventricular Ejection Fraction

Journal of the American Heart Association ◽

10.1161/jaha.116.003389 ◽

2017 ◽

Vol 6 (3) ◽

Cited By ~ 2

Author(s):

Tomoyuki Tobushi ◽

Masatsugu Nakano ◽

Kazuya Hosokawa ◽

Hidenobu Koga ◽

Akira Yamada

Keyword(s):

Heart Failure ◽

Cardiac Output ◽

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Diastolic Function ◽

Left Ventricular ◽

Ventricular Ejection ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Patients With Heart Failure

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Prevalence of Undiagnosed Obstructive Sleep Apnea Among Patients Hospitalized for Cardiovascular Disease and Associated In-Hospital Outcomes: A Scoping Review

Journal of Clinical Medicine ◽

10.3390/jcm9040989 ◽

2020 ◽

Vol 9 (4) ◽

pp. 989

Author(s):

Colin Suen ◽

Jean Wong ◽

Clodagh M. Ryan ◽

Samuel Goh ◽

Tiffany Got ◽

...

Keyword(s):

Cardiovascular Disease ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Scoping Review ◽

Left Ventricular ◽

Cardiac Biomarkers ◽

Left Ventricular Ejection ◽

Hospital Outcomes ◽

Ventricular Ejection Fraction ◽

Obstructive Sleep

Background: Obstructive sleep apnea (OSA) is associated with long-term cardiovascular morbidity and is highly prevalent in patients with cardiovascular disease (CVD). The objectives of this scoping review were to determine the prevalence of OSA inpatients hospitalized for CVD and to map the range of in-hospital outcomes associated with OSA. Methods: We searched MEDLINE(R), Embase, and Cochrane Databases for articles published from 1946–2018. We included studies involving non-surgical adults with OSA or at high risk of OSA who were hospitalized for CVD. The outcomes were considered as in-hospital if they were collected from admission up to 30 days post-discharge from hospital. Results: After the screening of 4642 articles, 26 studies were included for qualitative synthesis. Eligible studies included patients presenting with acute coronary syndromes (n = 19), congestive heart failure (n = 6), or any cardiovascular disease (n = 1). The pooled prevalence of OSA in cardiac inpatients was 48% (95% CI: 42–53). The in-hospital outcomes reported were mortality (n = 4), length of stay (n = 8), left ventricular ejection fraction (n = 8), peak troponin (n = 7), peak B-type natriuretic peptide (n = 4), and composite cardiovascular complications (n = 2). Conclusions: OSA is highly prevalent in the cardiac inpatient population. The outcomes reported included mortality, cardiac function, cardiac biomarkers, and resource utilization. There are significant knowledge gaps regarding the effect of treatment and OSA severity on these outcomes. The findings from this review serve to inform further areas of research on the management of OSA among patients with CVD.

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