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Severe Obstructive Sleep Apnea Is Associated With Left Ventricular Diastolic Dysfunction^*

^* From the Divisions of Cardiology (Drs. Fung, Yip, and Sanderson) and Respiratory Medicine (Drs. Li, Choy, Ko, and Hui), Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.

Correspondence to: David S. C. Hui, MBBS, FCCP, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong; e-mail: dschui{at}cuhk.edu.hk

Introduction: Hypertension is common in patients with obstructive sleep apnea (OSA). However, the effect of OSA on ventricular function, especially diastolic function, is not clear. Therefore, we have assessed the prevalence of diastolic dysfunction in patients with OSA and the relationship between diastolic parameters and severity of OSA.

Methods: Sixty-eight consecutive patients with OSA confirmed by polysomnography underwent echocardiography. Diastolic function of the left ventricle was determined by transmitral valve pulse-wave Doppler echocardiography. Various baseline characteristics, severity of OSA, and echocardiographic parameters were compared between patients with and without diastolic dysfunction.

Results: There were 61 male and 7 female patients with a mean age of 48.1 ± 11.1 years, body mass index of 28.5 ± 4.3 kg/m², and apnea/hypopnea index (AHI) of 44.3 ± 23.2/h (mean ± SD). An abnormal relaxation pattern (ARP) in diastole was noted in 25 patients (36.8%). Older age (52.7 ± 8.9 years vs 45.1 ± 11.3 years, p = 0.005), hypertension (56% vs 20%, p = 0.002), and a lower minimum pulse oximetric saturation (SpO₂) during sleep (70.5 ± 17.9% vs 78.8 ± 12.9%, respectively; p = 0.049) were more common in patients with ARP. By multivariate analysis, minimum SpO₂ < 70% was an independent predictor of ARP (odds ratio, 4.34; 95% confidence interval, 1.23 to 15.25; p = 0.02) irrespective of age and hypertension. Patients with AHI 40/h had significantly longer isovolumic relaxation times than those with AHI < 40/h (106 ± 19 ms vs 93 ± 17 ms, respectively; p = 0.005).

Conclusion: Diastolic dysfunction with ARP was common in patients with OSA. More severe sleep apnea was associated with a higher degree of left ventricular diastolic dysfunction in this study.

Key Words: diastolic dysfunction • echocardiography • obstructive sleep apnea

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