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This Article Full Text (PDF) All Versions of this Article: chest.07-0966v1 132/6/1863    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Romero-Corral, A. Articles by Lopez-Jimenez, F. Search for Related Content PubMed PubMed Citation Articles by Romero-Corral, A. Articles by Lopez-Jimenez, F.

Decreased Right and Left Ventricular Myocardial Performance in Obstructive Sleep Apnea

Abel Romero-Corral, MD, MSc^*; Virend K. Somers, MD, PhD^*; Patricia A. Pellikka, MD^*; Eric J. Olson, MD; Kent R. Bailey, PhD^#; Josef Korinek, MD^*; Marek Orban, MD^*,**; Justo Sierra-Johnson, MD, MSc^*,; Masahiko Kato, MD, PhD^##; Raouf S. Amin, MD^*** and Francisco Lopez-Jimenez, MD, MSc^**

^*Division of Cardiovascular Diseases, Mayo Foundation Rochester, MN (Institution in which the study was performed) Division of Pulmonary and Critical Care Medicine, Mayo Foundation Rochester, MN (Institution in which the study was performed) ^#Department of Biostatistics, Mayo Clinic College of Medicine, Mayo Foundation Rochester, MN (Institution in which the study was performed) ^**ICRC, St. Anne's University Hospital Brno, Czech Republic. Department of Medicine, Atherosclerosis Research Unit, Karolinska Institute, Sweden ^##Department of Cardiovascular Medicine, Graduate School of Medical Science, Tottori University, Yonago, Japan ^***Aerodigestive and Sleep Center, Pediatric Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

lopez{at}mayo.edu

Abstract

BackgroundObstructive sleep apnea (OSA) may predispose to congestive heart failure (CHF), suggesting a deleterious effect of OSA on myocardial contractility.

MethodsA cross-sectional study of 85 subjects with suspected OSA who had their first overnight polysomnogram, accompanied by an echocardiographic study. Patients were divided according to the apnea hypopnea index: <5 (controls), 5-14 (mild OSA) and 15 (moderate-to-severe OSA). Right and left ventricular function was evaluated using the myocardial performance index (MPI) and other echocardiographic parameters. For the right ventricle analyses we excluded patients with a Doppler pulmonary systolic pressure 45 mmHg, while for the left ventricle we excluded patients with an ejection fraction 45 %.

ResultsAge was 60 ± 15 years and 83 % were men. Right and left ventricular function was altered in patient with OSA, especially in those with the moderate- to-severe OSA, even after adjustment for potential confounders. Right MPI was 0.23 ± 0.10 in controls, 0.26 ± 0.16 in mild OSA and 0.37 ± 0.11 in moderate-to-severe OSA (p for trend<0.01). Left MPI was 0.28 ± 0.05, 0.27 ± 0.07 and 0.41 ± 0.14, respectively (p for trend=0.04). Right and left MPI correlated positively and significantly with the apnea-hypopnea index (rho=0.40, p=0.002 and rho=0.27, p=0.02, respectively). Left atrial volume index was increased in patients with OSA (26.8 ± 11 in controls, 32.5 ± 15 in mild OSA and 30.4 ± 11 in moderate-to-severe OSA, p for trend=0.04).

ConclusionsOSA, particularly when moderate-to-severe, is associated with impaired right and left ventricular function and increased left atrial volume. These findings support the notion that OSA may contribute to the development of atrial fibrillation and CHF.

Key Words: obstructive sleep apnea • left atrium • ventricular function • right ventricle • left ventricle