Abstract P272: The Association Between Sleep Apnea and Left Ventricular Structure and Function: The ECHO-SOL Ancillary Study

Abstract

Background: Obstructive sleep apnea (OSA) initiates a range of pathophysiologic mechanisms which may promote cardiac disease, but few studies have examined the association of OSA with global longitudinal strain (GLS) and diastolic function, especially among middle aged and older Hispanics/Latinos in the United States. Methods: We examined cross-sectional data from adults aged 18-64 in the Hispanic Community Health Study/Study of Latinos ECHO-SOL Ancillary Study (2011-2014), a representative subsample of the parent study. OSA was assessed using an ARES Unicorder sleep apnea monitor for one night; the apnea-hypopnea index (AHI) was obtained. Echocardiographic measures evaluated left ventricular (LV) structure (LV mass index [LVMI], left atrial volume index), systolic function (ejection fraction, GLS) and diastolic function (E’ and E/e’ ratio). Potential confounders included age, sex, ethnicity, and body mass index. Multivariable linear regression was used to model the association between AHI and the echocardiographic outcomes. All analyses accounted for the complex survey design. Results: Among 1,506 participants (median age 55.0, interquartile range 49.0, 62.0, 58.3% female) with both sleep and echo data, 17.9% had an AHI ≥15 and 3.2% had an ejection fraction <50%. Each 10-unit higher AHI was associated with 1.4 (95% CI 0.3, 2.5) g/m2 greater LVMI, 0.1 (0.0, 0.3) worse GLS, 0.2 (0.1, 0.3) lower E’, and 0.3 (0.1, 0.5) greater E/E’ ratio. There were no associations between AHI and left atrial volume index or ejection fraction. Conclusion: OSA was associated with poorer LV GLS and diastolic function indices, but associations with structure and ejection fraction were less consistent. Subclinical LV dysfunction may precede the onset of symptomatic disease in this at-risk population. Further studies are needed to determine the longitudinal association of OSA and cardiac remodeling.