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

1.	Parati G, Lombardi C, Castagna F, et al. Heart failure and sleep disorders. Nat Rev Cardiol, 2016, 13(7): 389-403.
2.	羅斌玉, 徐仕晗, 李逸雯, 等. 阻塞性睡眠呼吸暫停與心血管疾病的因果關系: 一項兩樣本孟德爾隨機化研究. 中國循證醫學雜志, 2023, 23(10): 1137-1142.
3.	杜家琦, 聶紹平, 于雪, 等. 阻塞性睡眠呼吸暫停在冠心病中作用的研究進展. 中國心血管雜志, 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.	中國醫師協會睡眠醫學專業委員會, 中國醫師協會神經內科醫師分會睡眠學組. 中國成人失眠共病阻塞性睡眠呼吸暫停診治指南(2024版). 中國全科醫學, 2025, 28(11): 1289-1303.
7.	張巖. 心力衰竭患者三尖瓣環收縮期速度與中樞性睡眠呼吸暫停的相關性研究[D]. 中國醫科大學, 2023.
8.	夏露, 謝治年, 廖芯藝, 等. 阻塞性睡眠呼吸暫停與高血壓: 一項雙向孟德爾隨機化研究. 解放軍醫學雜志, 2024, 49(06): 636-642.
9.	駱雷鳴, 任金霞. 高血壓心臟形態、結構改變及危害. 中華保健醫學雜志, 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.	胡靜, 楊少玲. 超聲技術評價心臟舒張功能的研究現狀. 分子影像學雜志, 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. 羅斌玉, 徐仕晗, 李逸雯, 等. 阻塞性睡眠呼吸暫停與心血管疾病的因果關系: 一項兩樣本孟德爾隨機化研究. 中國循證醫學雜志, 2023, 23(10): 1137-1142.
3. 杜家琦, 聶紹平, 于雪, 等. 阻塞性睡眠呼吸暫停在冠心病中作用的研究進展. 中國心血管雜志, 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. 中國醫師協會睡眠醫學專業委員會, 中國醫師協會神經內科醫師分會睡眠學組. 中國成人失眠共病阻塞性睡眠呼吸暫停診治指南(2024版). 中國全科醫學, 2025, 28(11): 1289-1303.
7. 張巖. 心力衰竭患者三尖瓣環收縮期速度與中樞性睡眠呼吸暫停的相關性研究[D]. 中國醫科大學, 2023.
8. 夏露, 謝治年, 廖芯藝, 等. 阻塞性睡眠呼吸暫停與高血壓: 一項雙向孟德爾隨機化研究. 解放軍醫學雜志, 2024, 49(06): 636-642.
9. 駱雷鳴, 任金霞. 高血壓心臟形態、結構改變及危害. 中華保健醫學雜志, 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. 胡靜, 楊少玲. 超聲技術評價心臟舒張功能的研究現狀. 分子影像學雜志, 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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