Al-Khadra Yasser, Darmoch Fahed, Alkhatib Mohammad, Baibars Motaz, Alraies M Chadi
Department of Internal Medicine, Cleveland Clinic, Cleveland, OH.
Department of Internal Medicine, St. Vincent Charity Medical Center, Cleveland, OH.
Ochsner J. 2018 Summer;18(2):136-140. doi: 10.31486/toj.17.0091.
Obstructive sleep apnea (OSA) is a known risk factor for atrial fibrillation (AF) that is principally driven by left atrial enlargement. The impact of hypoventilation caused by obesity-induced hypoventilation syndrome (OHS) on left atrial diameter has not been examined. We investigated the association between OHS and left atrial diameter in obese patients.
We performed a retrospective review of 210 consecutive medical records of patients diagnosed as obese (body mass index [BMI] >30 kg/m) and as having OHS and OSA for the period January 2010 through December 2016 at St. Vincent Charity Medical Center in Cleveland, OH. Logistic regression analysis was performed for left atrial diameter ≥4 cm in 2 groups of patients: those with OHS+OSA and those with OSA alone.
A total of 104 obese patients with OHS+OSA and 106 obese patients with OSA alone were identified. Statistically significant differences were found in 6 demographic and baseline characteristics: median BMI, median left atrial diameter, history of type 2 diabetes mellitus, history of stroke, history of coronary artery disease, and history of congestive heart failure. The median left atrial diameter for the OHS+OSA and OSA alone groups was 4.45 cm and 4.20 cm, respectively ( = 0.014). Left ventricular ejection fraction <50% was found in 22% of the patients with OHS+OSA and in 21% of the patients with OSA alone ( = 0.777). Multivariate logistic regression analysis showed that patients in the OHS+OSA group had 2 times higher odds (odds ratio 2.151, 95% confidence interval 1.016-4.550, = 0.045) of exhibiting a larger left atrial diameter vs patients in the OSA alone group.
The results of this study indicate that OHS may be an independent risk factor for left atrial enlargement and may possibly contribute to AF development irrespective of left ventricular function.
阻塞性睡眠呼吸暂停（OSA）是心房颤动（AF）的已知危险因素，主要由左心房扩大驱动。肥胖低通气综合征（OHS）引起的通气不足对左心房直径的影响尚未得到研究。我们调查了肥胖患者中OHS与左心房直径之间的关联。
我们对2010年1月至2016年12月期间在俄亥俄州克利夫兰市圣文森特慈善医疗中心连续诊断为肥胖（体重指数[BMI]>30 kg/m）且患有OHS和OSA的210例患者的病历进行了回顾性分析。对两组患者（OHS+OSA组和单纯OSA组）左心房直径≥4 cm进行逻辑回归分析。
共识别出104例肥胖合并OHS+OSA患者和106例单纯肥胖合并OSA患者。在6个人口统计学和基线特征方面发现了统计学上的显著差异：BMI中位数、左心房直径中位数、2型糖尿病病史、中风病史、冠状动脉疾病病史和充血性心力衰竭病史。OHS+OSA组和单纯OSA组的左心房直径中位数分别为4.45 cm和4.20 cm（P=0.014）。OHS+OSA组22%的患者和单纯OSA组21%的患者左心室射血分数<50%（P=0.777）。多变量逻辑回归分析显示，OHS+OSA组患者左心房直径较大的几率是单纯OSA组患者的2倍（优势比2.151，95%置信区间1.016-4.550，P=0.045）。
本研究结果表明，OHS可能是左心房扩大的独立危险因素，可能与房颤的发生有关，与左心室功能无关。
