Heterogeneity in Cardiac Structural Characteristics Among Patients with Preserved Left Ventricular Ejection Fraction Stratified by Sleep Apnea Subtypes_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

CAI Qinghao ^1,2 , YANG Yifan ¹ , OUYANG Lijun ¹ , CAO Haiming ¹ , MAI Runru ¹ , HUANG Jiayu ¹ , LIU Mi ¹ ,  ZHOU Yuanshen ¹ ,  XU Biyun ^1,2,3

1. Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, P.R. China;
2. State Key Laboratory of Traditional Chinese Medicine Syndrome/Department of Sleep Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510370, P.R. China;
3. Guangdong Provincial Academy of Chinese Medical Sciences, Zhuhai, Guangdong 510060, P.R. China;

Corresponding author：

ZHOU Yuanshen, Email: cloudxby@163.com; XU Biyun, Email: 13580347116@163.com

Keywords：

Cardiac structure; Cardiac function; Obstructive sleep apnea; Central sleep apnea; Cheyne-Stokes respiration

DOI：

10.7507/1671-6205.202503022

Video：

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Objective To explore the potential relationship between sleep apnea characterized by different Sleep Apnea subtype and cardiac structure and function.Methods Based on the composition of sleep respiratory events, this study aimed to analyze whether patients with different subtype of sleep apnea exhibit specific cardiac structural characteristics. A retrospective analysis was conducted on 223 patients admitted to Guangdong Provincial Hospital of Traditional Chinese Medicine between 2018 and 2024 who completed polysomnography (PSG) and echocardiography. Participants were categorized into four groups based on respiratory event: ① with Cheyne-Stokes respiration Events (CSB), ② with central sleep apnea events and without CSB Event (ICA), ③ with obstructive sleep apnea events mainly (IOA), ④ non-sleep apnea controls (NSA), and observed the correlation of PSG parameters and echocardiographic.Results Patients with sleep apnea accompanied by CSR were older (χ²=36.014, P<0.001) and exhibited significantly larger left atrial diameter (χ²=41.823, P<0.001) and left ventricular end-systolic diameter (χ²=20.397, P<0.001) compared to other groups. Other sleep apnea subtypes demonstrated varying degrees of increased interventricular septal thickness (χ²=25.272, P<0.001) and left ventricular wall thickness (χ²=21.650, P<0.001) relative to non-apneic controls.Conclusions All sleep apnea subtypes are associated with hypertension-related cardiac structural alterations. Notably, patients with CSR-complicated sleep apnea exhibit more severe cardiac remodeling, leading to impaired systolic and diastolic functions.

Citation： CAI Qinghao, YANG Yifan, OUYANG Lijun, CAO Haiming, MAI Runru, HUANG Jiayu, LIU Mi, ZHOU Yuanshen, XU Biyun. Heterogeneity in Cardiac Structural Characteristics Among Patients with Preserved Left Ventricular Ejection Fraction Stratified by Sleep Apnea Subtypes. Chinese Journal of Respiratory and Critical Care Medicine, 2025, 24(6): 383-388. doi: 10.7507/1671-6205.202503022 Copy

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2.	罗斌玉, 徐仕晗, 李逸雯, 等. 阻塞性睡眠呼吸暂停与心血管疾病的因果关系: 一项两样本孟德尔随机化研究. 中国循证医学杂志, 2023, 23(10): 1137-1142.
3.	杜家琦, 聂绍平, 于雪, 等. 阻塞性睡眠呼吸暂停在冠心病中作用的研究进展. 中国心血管杂志, 2024, 29(6): 574-578.
4.	Calvin AD, Somers VK, Johnson BD, et al. Left atrial size, chemosensitivity, and central sleep apnea in heart failure. Chest, 2014, 146(1): 96-103.
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9.	骆雷鸣, 任金霞. 高血压心脏形态、结构改变及危害. 中华保健医学杂志, 2021, 23(6): 555-560.
10.	Tadic M, Cuspidi C, Celic V, et al. Nocturnal hypertension and right heart remodeling. J Hypertens, 2018, 36(1): 136-142.
11.	Kim Y, Kim S, Ryu DR, et al. Factors Associated with Cheyne-Stokes Respiration in Acute Ischemic Stroke. J Clin Neurol, 2018, 14(4): 542-548.
12.	Zemrak F, Ambale-Venkatesh B, Captur G, et al. Left Atrial Structure in Relationship to Age, Sex, Ethnicity, and Cardiovascular Risk Factors: MESA (Multi-Ethnic Study of Atherosclerosis). Circ Cardiovasc Imaging, 2017, 10(2): e005379.
13.	Li H, Hastings MH, Rhee J, et al. Targeting Age-Related Pathways in Heart Failure. Circ Res, 2020, 126(4): 533-551.
14.	Silbiger JJ. Pathophysiology and Echocardiographic Diagnosis of Left Ventricular Diastolic Dysfunction. J Am Soc Echocardiogr, 2019, 32(2): 216-232.
15.	Baguet JP, Barone-Rochette G, Levy P, et al. Left ventricular diastolic dysfunction is linked to severity of obstructive sleep apnoea. Eur Respir J, 2010, 36(6): 1323-1329.
16.	Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr, 2016, 29(4): 277-314.
17.	胡静, 杨少玲. 超声技术评价心脏舒张功能的研究现状. 分子影像学杂志, 2020, 43(4): 593-596.
18.	Takada T, Nakata Y, Matsuura K, et al. Left Ventricular End-Systolic Diameter May Predict Persistent Heart Failure with Reduced Ejection Fraction. Int Heart J, 2023, 64(6): 1095-1104.
19.	Hachiro K. , Takashima N. , Suzuki T. Long-Term Outcomes After Aortic Valve Replacement for Aortic Valve Regurgitation - Importance of Left Ventricular End-Systolic Diameter. Circ J, 2024, 88(12): 1955-1961.
20.	Rana D, Torrilus C, Ahmad W, et al. Obstructive Sleep Apnea and Cardiovascular Morbidities: A Review Article. Cureus, 2020, 12(9): e10424.
21.	Mehra R. Sleep apnea and the heart. Cleve Clin J Med, 2019, 86(9 Suppl 1): 10-18.
22.	Rb B. Fundamentals of sleep medicine. Philadelphia PA: Elsevier/Saunders, 2012.
23.	Rha MS, Jeong Y, Kim CH, et al. Clinical Characteristics and Surgical Outcomes of Obstructive Sleep Apnea Patients With Mixed Apnea Components. Otolaryngol Head Neck Surg, 2023, 168(3): 521-527.
24.	Hernandez AB, Patil SP. Pathophysiology of central sleep apneas. Sleep Breath, 2016, 20(2): 467-482.

1. Parati G, Lombardi C, Castagna F, et al. Heart failure and sleep disorders. Nat Rev Cardiol, 2016, 13(7): 389-403.
2. 罗斌玉, 徐仕晗, 李逸雯, 等. 阻塞性睡眠呼吸暂停与心血管疾病的因果关系: 一项两样本孟德尔随机化研究. 中国循证医学杂志, 2023, 23(10): 1137-1142.
3. 杜家琦, 聂绍平, 于雪, 等. 阻塞性睡眠呼吸暂停在冠心病中作用的研究进展. 中国心血管杂志, 2024, 29(6): 574-578.
4. Calvin AD, Somers VK, Johnson BD, et al. Left atrial size, chemosensitivity, and central sleep apnea in heart failure. Chest, 2014, 146(1): 96-103.
5. Lanfranchi PA, Braghiroli A, Bosimini E, et al. Prognostic value of nocturnal Cheyne-Stokes respiration in chronic heart failure. Circulation, 1999, 99(11): 1435-1440.
6. 中国医师协会睡眠医学专业委员会, 中国医师协会神经内科医师分会睡眠学组. 中国成人失眠共病阻塞性睡眠呼吸暂停诊治指南(2024版). 中国全科医学, 2025, 28(11): 1289-1303.
7. 张岩. 心力衰竭患者三尖瓣环收缩期速度与中枢性睡眠呼吸暂停的相关性研究[D]. 中国医科大学, 2023.
8. 夏露, 谢治年, 廖芯艺, 等. 阻塞性睡眠呼吸暂停与高血压: 一项双向孟德尔随机化研究. 解放军医学杂志, 2024, 49(06): 636-642.
9. 骆雷鸣, 任金霞. 高血压心脏形态、结构改变及危害. 中华保健医学杂志, 2021, 23(6): 555-560.
10. Tadic M, Cuspidi C, Celic V, et al. Nocturnal hypertension and right heart remodeling. J Hypertens, 2018, 36(1): 136-142.
11. Kim Y, Kim S, Ryu DR, et al. Factors Associated with Cheyne-Stokes Respiration in Acute Ischemic Stroke. J Clin Neurol, 2018, 14(4): 542-548.
12. Zemrak F, Ambale-Venkatesh B, Captur G, et al. Left Atrial Structure in Relationship to Age, Sex, Ethnicity, and Cardiovascular Risk Factors: MESA (Multi-Ethnic Study of Atherosclerosis). Circ Cardiovasc Imaging, 2017, 10(2): e005379.
13. Li H, Hastings MH, Rhee J, et al. Targeting Age-Related Pathways in Heart Failure. Circ Res, 2020, 126(4): 533-551.
14. Silbiger JJ. Pathophysiology and Echocardiographic Diagnosis of Left Ventricular Diastolic Dysfunction. J Am Soc Echocardiogr, 2019, 32(2): 216-232.
15. Baguet JP, Barone-Rochette G, Levy P, et al. Left ventricular diastolic dysfunction is linked to severity of obstructive sleep apnoea. Eur Respir J, 2010, 36(6): 1323-1329.
16. Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr, 2016, 29(4): 277-314.
17. 胡静, 杨少玲. 超声技术评价心脏舒张功能的研究现状. 分子影像学杂志, 2020, 43(4): 593-596.
18. Takada T, Nakata Y, Matsuura K, et al. Left Ventricular End-Systolic Diameter May Predict Persistent Heart Failure with Reduced Ejection Fraction. Int Heart J, 2023, 64(6): 1095-1104.
19. Hachiro K. , Takashima N. , Suzuki T. Long-Term Outcomes After Aortic Valve Replacement for Aortic Valve Regurgitation - Importance of Left Ventricular End-Systolic Diameter. Circ J, 2024, 88(12): 1955-1961.
20. Rana D, Torrilus C, Ahmad W, et al. Obstructive Sleep Apnea and Cardiovascular Morbidities: A Review Article. Cureus, 2020, 12(9): e10424.
21. Mehra R. Sleep apnea and the heart. Cleve Clin J Med, 2019, 86(9 Suppl 1): 10-18.
22. Rb B. Fundamentals of sleep medicine. Philadelphia PA: Elsevier/Saunders, 2012.
23. Rha MS, Jeong Y, Kim CH, et al. Clinical Characteristics and Surgical Outcomes of Obstructive Sleep Apnea Patients With Mixed Apnea Components. Otolaryngol Head Neck Surg, 2023, 168(3): 521-527.
24. Hernandez AB, Patil SP. Pathophysiology of central sleep apneas. Sleep Breath, 2016, 20(2): 467-482.

Chinese Journal of Respiratory and Critical Care Medicine

Heterogeneity in Cardiac Structural Characteristics Among Patients with Preserved Left Ventricular Ejection Fraction Stratified by Sleep Apnea Subtypes

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