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Original Research: Sleep Disorders |

Left Atrial Size, Chemosensitivity, and Central Sleep Apnea in Heart FailureLeft Atrial Volume Index and Central Sleep ApneaLeft Atrial Volume Index and Central Sleep Apnea

Andrew D. Calvin, MD, MPH; Virend K. Somers, MD, PhD, FCCP; Bruce D. Johnson, PhD; Christopher G. Scott, MS; Lyle J. Olson, MD
Author and Funding Information

From the Division of Cardiovascular Diseases (Drs Calvin, Somers, Johnson, and Olson), and Department of Biomedical Statistics and Informatics (Mr Scott), Mayo Clinic, Rochester, MN.

CORRESPONDENCE TO: Lyle J. Olson, MD, Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905; e-mail: olson.lyle@mayo.edu


FUNDING/SUPPORT: This work was supported by the Mayo Clinic Clinician-Investigator Training Program (Dr Calvin); Mayo Foundation; American Heart Association [Grant 04-50103Z]; National Heart, Lung, and Blood Institute [Grants HL65176, HL70302, and HL73211]; and the National Center for Research Resources [Grant 1ULI RR024150], a component of the National Institutes of Health (NIH) and the NIH Roadmap for Medical Research.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(1):96-103. doi:10.1378/chest.13-0309
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BACKGROUND:  Central sleep apnea (CSA) is common among patients with heart failure (HF) and is promoted by elevated CO2 chemosensitivity. Left atrial size is a marker of the hemodynamic severity of HF. The aim of this study was to determine if left atrial size predicts chemosensitivity to CO2 and CSA in patients with HF.

METHODS:  Patients with HF with left ventricular ejection fraction ≤ 35% underwent polysomnography for detection of CSA, echocardiography, and measurement of CO2 chemosensitivity. CSA was defined as an apnea-hypopnea index (AHI) ≥ 15/h with ≥ 50% central apneic events. The relation of clinical and echocardiographic parameters to chemosensitivity and CSA were evaluated by linear regression, estimation of ORs, and receiver operator characteristics.

RESULTS:  Of 46 subjects without OSA who had complete data for analysis, 25 had CSA. The only parameter that significantly correlated with chemosensitivity was left atrial volume index (LAVI) (r = 0.40, P < .01). LAVI was greater in those with CSA than those without CSA (59.2 mL/m2 vs 36.4 mL/m2, P < .001) and significantly correlated with log-transformed AHI (r = 0.46, P = .001). LAVI was the best predictor of CSA (area under the curve = 0.83). A LAVI ≤ 33 mL/m2 was associated with 22% risk for CSA, while LAVI ≥ 53 mL/m2 was associated with 92% risk for CSA.

CONCLUSIONS:  Increased LAVI is associated with heightened CO2 chemosensitivity and greater frequency of CSA. LAVI may be useful to guide referral for polysomnography for detection of CSA in patients with HF.

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