title: Severe obstructive sleep apnea increases left atrial volume independently of left ventricular diastolic impairment.
abstract: OBJECTIVE
  Severe obstructive sleep apnea (OSA) directly impairs left ventricular (LV) diastolic function. Left atrial volume index (LAVI), an independent predictor of future cardiovascular events, is also related to OSA severity. This study aimed to assess whether OSA is associated with an increase in LAVI independently of LV diastolic function.
  
  
  METHODS
  Two hundred six OSA patients (apnea hypopnea index, AHI ≥ 5/h) without cardiac disease, hypertension, and diabetes were enrolled. They underwent overnight fully attended polysomnography and 2-dimensional echocardiography in order to estimate LA volumes and LV diastolic function which was assessed by the ratio of transmitral early diastolic flow velocity to late diastolic flow velocity (E/A), deceleration time, and mitral annular velocity (e') which was derived from tissue Doppler imaging. Patients were divided into two groups based on AHI, namely, group M (5 ≤ AHI < 30/h) and group S (AHI ≥ 30/h).
  
  
  RESULTS
  The LAVI value in group S was significantly larger than that in group M (20 ± 5 vs. 23 ± 5 mL/m(2), P < 0.001). E/A in group S was significantly lower than that in group M (P < 0.001), whereas the ratio of E to e' (E/e') in group S was significantly higher than that in group M (P < 0.001). AHI showed a statistically significant correlation with LAVI (P < 0.001). On multivariate linear regression analysis, severe OSA was independently related with LAVI even after adjusting for age, sex, systolic blood pressure, body mass index, and measurements of LV diastolic function (P = 0.04).
  
  
  CONCLUSIONS
  Severe OSA itself might directly increase LAVI, independently of LV diastolic function.
authors.affiliation: Department of Cardiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Imai
authors.affiliation: Department of Cardiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Tanaka
authors.affiliation: Department of Cardiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Usui
authors.affiliation: Department of Cardiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
authors.forename: Nori
authors.initials: N
authors.lastname: Takahashi
authors.affiliation: Department of Cardiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
authors.forename: Saiko
authors.initials: S
authors.lastname: Kurohane
authors.affiliation: Department of Cardiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
authors.forename: Yasuyoshi
authors.initials: Y
authors.lastname: Takei
authors.affiliation: Department of Cardiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan. takatamd@gb3.so-net.ne.jp.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Takata
authors.affiliation: Department of Cardiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Yamashina
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity / Q000502:physiology; D002306:Cardiac Volume / Q000502:physiology*; D003971:Diastole / Q000502:physiology*; D015150:Echocardiography, Doppler; D005260:Female; D006325:Heart Atria / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000503:physiopathology*; D013223:Statistics as Topic; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000503:physiopathology*
keywords: Diastolic function; Echocardiography; Left atrial volume; Obstructive sleep apnea