Sleep Disordered Breathing and Left Ventricular Scar on Cardiac Magnetic Resonance: Results of the Multi-Ethnic Study of Atherosclerosis (MESA)

PMID: 32029066 DOI: 10.5664/jcsm.8340

Abstract

Study objective: To evaluate the independent association between sleep disordered breathing (SDB) using overnight polysomnography (PSG) and left ventricular (LV) scar using cardiac magnetic resonance (CMR) with late-gadolinium enhancement (LGE) in a community based cohort of the Multi-ethnic Study of Atherosclerosis (MESA).

Methods: Our analytical sample includes 934 participants from the fifth examination of MESA who underwent both PSG and CMR. SDB was categorized as: no-SDB (apnea hypopnea index [AHI]<5), mild SDB (5≤AHI<15) and moderate-severe SDB (AHI≥15). LV scar was considered present if there was presence of scar on CMR (LGE>0%). Logistic regression with multivariable adjustment for confounders (age, sex, race/ethnicity, BMI, 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 years (SD 8.5), with 49% (n=461) females, and a prevalence of SDB (AHI≥5) of 63% (n=590). LV scar was more prevalent in individuals with SDB (9.5%) vs. those without SDB (3.8%) (p<0.01), 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, OR 2.53 (95% CI 1.13-5.64) and OR 2.31 (95% CI 1.01-5.24), respectively.

Conclusion: In a community based cohort, SDB (including mild) is independently associated with over a two-fold increase in the odds of LV scar presence measured using CMR with LGE. A majority of the LV scars were clinically unrecognized. The impact of SDB treatment on subclinical MI needs to be investigated in future studies.

© 2020 American Academy of Sleep Medicine.