TY - JOUR
T1 - Sleep-disordered breathing and left ventricular scar on cardiac magnetic resonance
T2 - Results of the multi-ethnic study of atherosclerosis
AU - Shah, Neomi A.
AU - Reid, Michelle
AU - Kizer, Jorge R.
AU - Sharma, Ravi K.
AU - Shah, Ravi V.
AU - Kundel, Vaishnavi
AU - Ambale-Venkatesh, Bharath
AU - Fayad, Zahi A.
AU - Shea, Steven J.
AU - Kaplan, Robert C.
AU - Lima, Joao A.C.
AU - Redline, Susan
N1 - Publisher Copyright:
Copyright © 2020 American Academy of Sleep Medicine. All rights reserved.
PY - 2020/6/15
Y1 - 2020/6/15
N2 - Study Objectives: The objectives of this study were to evaluate the independent association between sleep-disordered breathing (SDB) using overnight polysomnography and left ventricular (LV) scar using cardiac magnetic resonance (CMR) with late-gadolinium enhancement in a community-based cohort of the Multi-Ethnic Study of Atherosclerosis. Methods: Our analytical sample includes 934 participants from the fifth examination of the Multiethnic Study of Atherosclerosis who underwent both polysomnography and CMR. SDB was categorized as follows: no-SDB (apnea-hypopnea index [AHI] < 5 events/h), mild SDB (5 events/h ≤ AHI < 15 events/h), and moderate-severe SDB (AHI ≥ 15 events/h). LV scar was considered present if there was presence of scar on CMR (late-gadolinium enhancement > 0%). Logistic regression with multivariable adjustment for confounders (age, sex, race/ethnicity, body mass index, and cardiometabolic risk factors) was used to examine the independent association of SDB with LV scar. Confounders were identified using directed acyclic graphs. Results: The mean age of our sample was 67.0 ± 8.5 years (SD), with 49% (n = 461) females and a prevalence of SDB (AHI ≥ 5 events/h) of 63% (n = 590). LV scar was more prevalent in individuals with SDB (9.5%) versus those without SDB (3.8%; P <.01), and 88% of all LV scars were clinically unrecognized. After multivariable adjustment, both mild SDB and moderate-severe SDB were independently associated with LV scar (odds ratio, 2.53; 95% confidence interval, 1.13-5.64 and odds ratio, 2.31; 95% confidence interval, 1.01-5.24, respectively). Conclusions: In a community-based cohort, SDB (including mild) is independently associated with a more than 2-fold increase in the odds of LV scar presence measured using CMR with late-gadolinium enhancement. Most LV scars were clinically unrecognized. The impact of SDB treatment on subclinical myocardial infarction needs to be investigated in future studies.
AB - Study Objectives: The objectives of this study were to evaluate the independent association between sleep-disordered breathing (SDB) using overnight polysomnography and left ventricular (LV) scar using cardiac magnetic resonance (CMR) with late-gadolinium enhancement in a community-based cohort of the Multi-Ethnic Study of Atherosclerosis. Methods: Our analytical sample includes 934 participants from the fifth examination of the Multiethnic Study of Atherosclerosis who underwent both polysomnography and CMR. SDB was categorized as follows: no-SDB (apnea-hypopnea index [AHI] < 5 events/h), mild SDB (5 events/h ≤ AHI < 15 events/h), and moderate-severe SDB (AHI ≥ 15 events/h). LV scar was considered present if there was presence of scar on CMR (late-gadolinium enhancement > 0%). Logistic regression with multivariable adjustment for confounders (age, sex, race/ethnicity, body mass index, and cardiometabolic risk factors) was used to examine the independent association of SDB with LV scar. Confounders were identified using directed acyclic graphs. Results: The mean age of our sample was 67.0 ± 8.5 years (SD), with 49% (n = 461) females and a prevalence of SDB (AHI ≥ 5 events/h) of 63% (n = 590). LV scar was more prevalent in individuals with SDB (9.5%) versus those without SDB (3.8%; P <.01), and 88% of all LV scars were clinically unrecognized. After multivariable adjustment, both mild SDB and moderate-severe SDB were independently associated with LV scar (odds ratio, 2.53; 95% confidence interval, 1.13-5.64 and odds ratio, 2.31; 95% confidence interval, 1.01-5.24, respectively). Conclusions: In a community-based cohort, SDB (including mild) is independently associated with a more than 2-fold increase in the odds of LV scar presence measured using CMR with late-gadolinium enhancement. Most LV scars were clinically unrecognized. The impact of SDB treatment on subclinical myocardial infarction needs to be investigated in future studies.
KW - Cardiac magnetic resonance
KW - Late-gadolinium enhancement
KW - Left ventricular scar
KW - Myocardial injury
KW - Obstructive sleep apnea
KW - Sleep apnea
KW - Sleep-disordered breathing
UR - http://www.scopus.com/inward/record.url?scp=85086682728&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85086682728&partnerID=8YFLogxK
U2 - 10.5664/jcsm.8340
DO - 10.5664/jcsm.8340
M3 - Article
C2 - 32029066
AN - SCOPUS:85086682728
SN - 1550-9389
VL - 16
SP - 855
EP - 862
JO - Journal of Clinical Sleep Medicine
JF - Journal of Clinical Sleep Medicine
IS - 6
ER -