Association Between Intermittent Hypoxia and Left Ventricular Remodeling in Patients With Obstructive Sleep Apnea-Hypopnea Syndrome.

Ming Deng,Xiao Ke,Xiao-Shu Cheng,Yi-Fei Dong,Jian-Qing Xu,Yi-Teng Huang

doi:10.3389/fphys.2020.608347

Abstract

The present study was undertaken to examine the association between intermittent hypoxia and left ventricular (LV) remodeling and explore which parameter of intermittent hypoxia is most relevant to LV remodeling in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Two hundred eighty six patients underwent polysomnographic examination were enrolled. Based on apnea-hypoxia index (AHI), patients were divided into no, mild, moderate and severe OSAHS groups. Between-group differences in LV remodeling and the association between parameters of intermittent hypoxia and LV remodeling was evaluated. Patients with severe OSAHS were more likely to have hypertension, and higher values of LV mass (LVM) and LVM index (LVMI). In univariate regression analysis, male, body mass index (BMI), systolic and diastolic blood pressure (BP), statins, antihypertensive drugs, creatinine, and parameters of intermittent hypoxia (AHI, obstructive apnea index [OAI], lowest oxygen saturation [LSpO2], oxygen desaturation index [ODI], time spent below oxygen saturation of 90% [TS90%], and mean nocturnal oxygen saturation [MSpO2]) were associated with LVMI. After multivariate regression analyses, only male gender, BMI, systolic BP, creatinine, and ODI remained significantly associated with LVMI. Compared to those without LV hypertrophy (LVH), patients with LVH had higher ODI. Compared to patients with normal LV, concentric remodeling and eccentric LVH, those with concentric LVH had higher ODI. In conclusion, intermittent hypoxia was significantly associated with left ventricular remodeling; and among various parameters of intermittent hypoxia, ODI was the most relevant to LV remodeling.

Highlights

With the epidemic of overweight and obesity (Twig et al, 2016; Mouton et al, 2020), the incidence and prevalence of obstructive sleep apnea-hypopnea syndrome (OSAHS) is continuously increasing around the world including China (Cai et al, 2017; Osman et al, 2018)
OSAHS, obstructive sleep apnea-hypopnea syndrome; apnea-hypoxia index (AHI), apnea-hypopnea index; OAI, obstructive apnea index; MSpO2, mean nocturnal oxygen saturation; ODI, oxygen desaturation index; LSpO2, lowest oxygen saturation; TS90%, time spent below oxygen saturation of 90%. &P < 0.05 vs. no OSAHS, mild, and moderate OSAHS. #Presented as median
BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; HTN, hypertension; DM, diabetes mellitus; Af, atrial fibrillation; CCB, calcium channel blocker; ACEI/ARB, angiotensin converting enzyme inhibitor/angiotensin receptor blocker; MRA, mineralocorticoid receptor antagonist; FPG, fasting plasma glucose; TC, total cholesterol; TG, triglyceride; LDL-C, low density lipoprotein cholesterol; HDL-C, high density lipoprotein cholesterol; HCY, homocysteine; blood urea nitrogen (BUN), blood urine nitrogen; Estimated glomerular filtration rate (eGFR), estimated glomerular filtration rate; AHI, apnea-hypopnea index; OAI, obstructive apnea index; MSpO2, mean nocturnal oxygen saturation; ODI, oxygen desaturation index; LSpO2, lowest oxygen saturation; TS90%, time spent below oxygen saturation of 90%; CI, confidence interval; N/A, non-applicable; VIF, variance inflation factor

Summary

INTRODUCTION

With the epidemic of overweight and obesity (Twig et al, 2016; Mouton et al, 2020), the incidence and prevalence of obstructive sleep apnea-hypopnea syndrome (OSAHS) is continuously increasing around the world including China (Cai et al, 2017; Osman et al, 2018). Numerous studies have reported the adverse effects of intermittent hypoxia on cardiovascular system (Beaudin et al, 2017; Perrini et al, 2017; Bostanci et al, 2018), whether there is an independent association between intermittent hypoxia and LVH is unknown. Which parameter of intermittent hypoxia is the most clinically relevant to LVH development is unknown. This entity is important because if confirmed, intervention to intermittent hypoxia may help to retard LV remodeling progression and prevent LVH. The most relevant parameter of intermittent hypoxia identified can be used as a specific marker to quantify the risk of developing LVH. Leveraging data from our ongoing prospective cohort study, we conducted a cross-sectional analysis to evaluate that: (1) the association between intermittent hypoxia and LV remodeling; (2) which parameter of intermittent hypoxia is most relevant to LV remodeling in patients with OSAHS

Study Participants

RESULTS

DISCUSSION

CONCLUSION

DATA AVAILABILITY STATEMENT

ETHICS STATEMENT