title: Obstructive sleep apnea is independently associated with worse diastolic function in coronary artery disease.
abstract: BACKGROUND
  Diastolic dysfunction is common in patients with coronary artery disease (CAD). We hypothesize that patients with CAD and preserved left ventricular ejection fraction (LVEF) and obstructive sleep apnea (OSA) will have worse diastolic function than similar patients without OSA.
  
  
  METHODS
  We analyzed sleep-study recordings and echocardiographic measurements obtained at baseline in a randomized controlled trial (RICCADSA) of revascularized patients with CAD who had LVEF of at least 50%. OSA was defined as an apnea-hypopnea-index (AHI) ≥15 events/h, and, no OSA, as an AHI <5. Worse diastolic function was defined as assumed elevated left ventricular filling pressure based on peak flow velocity in early diastole/Tissue Doppler of early diastolic ventricular filling (E/é) of >13 (or >9 in patients with an enlarged left atrial diameter [≥39 mm for women and ≥40 mm for men]).
  
  
  RESULTS
  Data from 431 patients were evaluated (mean age: 63.7 ± 8.8 y; men: 82.5%; OSA: n = 331). Worse diastolic function was more common among the patients with OSA than those without (54.4% vs 41.0%, p = 0.019). In multivariate analysis, OSA was associated with worse diastolic function (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.13; 3.18) adjusted for female sex (OR 2.28, 95% CI 1.28; 4.07), hypertension (OR 1.84, 95% CI 1.20; 2.82), and diabetes mellitus (OR 2.45, 95% CI 1.42; 4.23). Age ≥60 years, obesity, and current smoking were nonsignificant.
  
  
  CONCLUSIONS
  In this cohort with CAD and preserved LVEF, OSA was associated with worse diastolic function independent of the traditionally recognized risk indicators.
authors.affiliation: Department of Internal Medicine, Skaraborg Hospital, Lidköping, Sweden; Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Helena
authors.initials: H
authors.lastname: Glantz
authors.affiliation: Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Thunström
authors.affiliation: Department of Molecular and Clinical Medicine/Clinical Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Magnus C
authors.initials: MC
authors.lastname: Johansson
authors.affiliation: Department of Molecular and Clinical Medicine/Clinical Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Wallentin Guron
authors.affiliation: Department of Cardiology, Skaraborg Hospital, Skövde, Sweden.
authors.forename: Harun
authors.initials: H
authors.lastname: Uzel
authors.affiliation: Department of Cardiology, Skaraborg Hospital, Skövde, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Ejdebäck
authors.affiliation: Center for Research, Development and Education, Skaraborg Hospital, Skövde, Sweden.
authors.forename: Salmir
authors.initials: S
authors.lastname: Nasic
authors.affiliation: Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Sleep Medicine Unit, Skaraborg Hospital, Skövde, Sweden. Electronic address: yuksel.peker@lungall.gu.se.
authors.forename: Yüksel
authors.initials: Y
authors.lastname: Peker
mesh_terms: D000368:Aged; D045422:Continuous Positive Airway Pressure; D003324:Coronary Artery Disease / Q000150:complications* / Q000503:physiopathology* / Q000601:surgery; D003430:Cross-Sectional Studies; D003971:Diastole / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000503:physiopathology* / Q000628:therapy; D013318:Stroke Volume / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Coronary artery disease; Diastolic function; Doppler; Echocardiography; Sleep apnea