Shah Neomi A, Reid Michelle, Kizer Jorge R, Sharma Ravi K, Shah Ravi V, Kundel Vaishnavi, Ambale-Venkatesh Bharath, Fayad Zahi A, Shea Steven J, Kaplan Robert C, Lima Joao A C, Redline Susan
Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.
J Clin Sleep Med. 2020 Jun 15;16(6):855-862. doi: 10.5664/jcsm.8340.
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.
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.
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).
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.
本研究的目的是在动脉粥样硬化多族裔研究的社区队列中，使用夜间多导睡眠监测评估睡眠呼吸紊乱（SDB）与使用延迟钆增强心脏磁共振成像（CMR）检测左心室（LV）瘢痕之间的独立关联。
我们的分析样本包括来自动脉粥样硬化多族裔研究第五次检查的934名参与者，他们同时接受了多导睡眠监测和CMR检查。SDB分类如下：无SDB（呼吸暂停低通气指数[AHI]<5次/小时）、轻度SDB（5次/小时≤AHI<15次/小时）和中度至重度SDB（AHI≥15次/小时）。如果CMR显示存在瘢痕（延迟钆增强>0%），则认为存在LV瘢痕。使用对混杂因素（年龄、性别、种族/族裔、体重指数和心脏代谢危险因素）进行多变量调整的逻辑回归来检验SDB与LV瘢痕的独立关联。使用有向无环图识别混杂因素。
我们样本的平均年龄为67.0±8.5岁（标准差），女性占49%（n = 461），SDB（AHI≥5次/小时）的患病率为63%（n = 590）。与无SDB者（3.8%）相比，SDB患者中LV瘢痕更常见（9.5%；P<.01），并且所有LV瘢痕中有88%在临床上未被识别。多变量调整后，轻度SDB和中度至重度SDB均与LV瘢痕独立相关（优势比分别为2.53；95%置信区间为1.13 - 5.64和优势比为2.31；95%置信区间为1.01 - 5.24）。
在社区队列中，SDB（包括轻度）与使用延迟钆增强CMR测量的LV瘢痕存在几率增加2倍以上独立相关。大多数LV瘢痕在临床上未被识别。SDB治疗对亚临床心肌梗死的影响需要在未来研究中进行调查。
