Predictors of Atrial Remodeling in Patients with Sleep Apnea: Analysis of Electrocardiographic and Echocardiographic Variables

Abstract

Background: Obstructive sleep apnea (OSA) is an important risk factor for the development and recurrence of atrial fibrillation (AF). Atrial remodeling (AR) plays a critical role in the genesis of AF. We evaluated electrocardiographic and echocardiographic variables (electrical, anatomic, and functional) associated with AR in patients with OSA.

Methods: Two hundred and three consecutive patients undergoing polysomnography were screened, by which 80 patients were included and divided into groups according to apnea-hypopnea index in OSA- (AHI < 15) or OSA+ (AHI ≥ 15). Minimum oxyhemoglobin saturation (>90%, 80-90%, and <80%) and total time <90% saturation [T90] (60 min) were correlated to electrocardiographic (12-lead and signal-averaged electrocardiogram - SAECG) and echocardiographic (2D strain and 3D volumetric and functional) variables.

Results: Patients with OSA+ presented lower left atrial passive emptying fraction (LAPEF) compared to OSA- patients. MinSat <80% was associated with increased P-wave duration on SAECG and lower conduit strain compared to those with MinSat >90%. T90 > 60min was associated with increased P-wave duration on SAECG and increased P-maximum, P-mean, and P-DII on 12-lead ECG, as well as shorter Tonset-Tpeak interval compared to 60min was associated with increased P-wave duration in DII and increased P/PRi interval compared to