Nocturnal hypoxemia, cardiac remodeling, and blood concentrations of fibrosis biomarkers in patients with atrial fibrillation and obstructive sleep apnea

Aim. To study cardiac remodeling, blood concentrations of fibrosis biomarkers depending on nocturnal hypoxemia (NH) in patients with atrial fibrillation (AF) and obstructive sleep apnea (OSA).

Material and methods. This case-control cross-sectional comparative study included 334 subjects as follows: 122 patients with AF(+)/OSA(+), 117 patients with AF(-)/OSA(+), 95 patients with AF(+)/OSA(-). The subjects underwent respiratory monitoring during sleep and transthoracic echocardiography. The blood concentrations of profibrogenic biomarkers were determined.

Results. The mean blood saturation level is lower, and the proportion of sleep time with saturation less than 90% is higher in patients with a combination of AF and OSA compared to patients without arrhythmia. The left atrial diameter, volumes and volume indices of both atria, pulmonary artery size, and pulmonary artery pressure in patients with AF combined with NH are greater than in patients with AF without NH. The blood levels of galectin-3 and growth differentiation factor-15 (GDF-15) are higher in patients with AF combined with NH than in patients with AF without NH and then in patients with NH without AF. In patients with AF in combination with OSA, an increased probability of NH is associated with a high blood concentration of GDF-15 (odds ratio =1,21, 95% confidence interval 1,001-1,34, p=0,002). NH increased the AF probability by 2,6 times (odds ratio =2,57, 95% confidence interval 1,47-4,46, p<0,001).

Conclusion. AF in patients with OSA in combination with NH is characterized by more significant cardiac remodeling (greater left and right atrial dilation), higher pulmonary hypertension and higher blood levels of profibrogenic factors (galectin-3 and GDF-15) than in patients without NH.

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