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      Cardiac Structure and Apnea/Hypopnea Index in Patients with Arterial Hypertension and Excessive Weight


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          Background/Aims: Arterial hypertension is frequently associated with sleep apnea, excessive weight, and with changes in the echocardiographic characteristics of the left cardiac chambers. The present investigation was conducted in order to search for a possible relation between left cardiac structure and sleep apnea magnitude in patients with arterial hypertension and excessive weight. Methods: A group of 56 patients with arterial hypertension and mean body mass index of 30.6 ± 3.8 (weight in kilograms/height in meters squared) was studied by echocardiography, sleep study and electrocardiography. Results: A relatively high mean apnea-hypopnea index (AHI) was found (17.9 ± 17.2 episodes/h sleep), but this parameter was not found to be correlated with cardiac echocardiographic diameters. Patients with an AHI <5 episodes/h had smaller mean values for left atrial diameter, left ventricular mass index and left ventricular relative wall thickness, when compared to patients with an AHI value of ≧5. The mean corrected QT interval was found to be longer in female patients, whereas left ventricular end-diastolic diameter was smaller than in male patients. Conclusion: In patients with arterial hypertension and excessive weight, significant apnea seems to be very common. In such patients, left ventricle wall thickness, left ventricle mass index and the left atrium diameter may act as surrogate markers for significant sleep apnea. Thus, the hypothesis is raised that hypoxia may lead to changes in heart structure.

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          Most cited references8

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          Association of atrial fibrillation and obstructive sleep apnea.

          Obstructive sleep apnea (OSA) is associated with recurrent atrial fibrillation (AF) after electrocardioversion. OSA is highly prevalent in patients who are male, obese, and/or hypertensive, but its prevalence in patients with AF is unknown. We prospectively studied consecutive patients undergoing electrocardioversion for AF (n=151) and consecutive patients without past or current AF referred to a general cardiology practice (n=312). OSA was diagnosed with the Berlin questionnaire, which is validated to identify patients with OSA. We also assessed its accuracy compared with polysomnography in a sample of the study population. Groups were compared with the 2-tailed t, Wilcoxon, and chi2 tests. Logistic regression modeled the association of AF and OSA after adjustment for relevant covariates. Patients in each group had similar age, gender, body mass index, and rates of diabetes, hypertension, and congestive heart failure. The questionnaire performed with 0.86 sensitivity, 0.89 specificity, and 0.97 positive predictive value in our sample. The proportion of patients with OSA was significantly higher in the AF group than in the general cardiology group (49% versus 32%, P=0.0004). The adjusted odds ratio for the association between AF and OSA was 2.19 (95% CI 1.40 to 3.42, P=0.0006). The novel finding of this study is that a strong association exists between OSA and AF, such that OSA is strikingly more prevalent in patients with AF than in high-risk patients with multiple other cardiovascular diseases. The coinciding epidemics of obesity and AF underscore the clinical importance of these results.
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            ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography).

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              Diastolic dysfunction and left atrial volume: a population-based study.

              We examined the association between diastolic function and left atrial volume indexed to body surface area (LAVi) in a population-based study. Atrial enlargement has been suggested as a marker of the severity and duration of diastolic dysfunction (DD). However, the association between DD and atrial enlargement and their individual prognostic implications in the population is poorly defined. A cross-sectional sample of Olmsted County, Minnesota, residents > or =45 years of age (n=2,042) underwent comprehensive Doppler echocardiography and medical record review. The LAVi increased with worsening DD: 23 +/- 6 ml/m2 (normal), 25 +/- 8 ml/m2 (grade I DD), 31 +/- 8 ml/m2 (grade II DD), 48 +/- 12 ml/m2 (grades III to IV DD). In bivariate analyses, age, left ventricular mass index, and DD grade were positively associated, whereas female gender and ejection fraction (EF) were inversely associated with LAVi (p <0.001 for all). When controlling for age, gender, cardiovascular (CV) disease, EF, and left ventricular mass, grade II DD was associated with a 24%, and grade III to IV DD was associated with a 62% larger LA volume (p <0.0001 for both). The area under the receiver-operator characteristic curve for LAVi to detect grade I, grade II, or grade III to IV DD was 0.57, 0.81, and 0.98, respectively. Both DD and LAVi were predictive of all-cause mortality, but when controlling for DD, LAVi was not an independent predictor of mortality. These data suggest that DD contributes to LA remodeling. Indeed, DD is a stronger predictor of mortality; presumably it better reflects the impact of CV disease within the general population.

                Author and article information

                Kidney Blood Press Res
                Kidney and Blood Pressure Research
                S. Karger AG
                October 2006
                06 October 2006
                : 29
                : 3
                : 159-164
                aFaculdade de Medicina do Porto, and bHospital São João, Porto, Portugal
                95349 Kidney Blood Press Res 2006;29:159–164
                © 2006 S. Karger AG, Basel

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                : 27 December 2005
                : 07 July 2006
                Page count
                Tables: 5, References: 14, Pages: 6
                Original Paper

                Cardiovascular Medicine,Nephrology
                Left ventricular wall thickness,Obesity,Left atrium,Gender,Sleep apnea,Arterial hypertension


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