Sleep-disordered breathing and left ventricular scar on cardiac magnetic resonance: Results of the multi-ethnic study of atherosclerosis

Neomi A. Shah, Michelle Reid, Jorge R. Kizer, Ravi K. Sharma, Ravi V. Shah, Vaishnavi Kundel, Bharath Ambale-Venkatesh, Zahi A. Fayad, Steven J. Shea, Robert C. Kaplan, Joao A.C. Lima, Susan Redline

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Study Objectives: The objectives of this study were to evaluate the independent association between sleep-disordered breathing (SDB) using overnight polysomnography and left ventricular (LV) scar using cardiac magnetic resonance (CMR) with late-gadolinium enhancement in a community-based cohort of the Multi-Ethnic Study of Atherosclerosis. Methods: Our analytical sample includes 934 participants from the fifth examination of the Multiethnic Study of Atherosclerosis who underwent both polysomnography and CMR. SDB was categorized as follows: no-SDB (apnea-hypopnea index [AHI] < 5 events/h), mild SDB (5 events/h ≤ AHI < 15 events/h), and moderate-severe SDB (AHI ≥ 15 events/h). LV scar was considered present if there was presence of scar on CMR (late-gadolinium enhancement > 0%). Logistic regression with multivariable adjustment for confounders (age, sex, race/ethnicity, body mass index, and cardiometabolic risk factors) was used to examine the independent association of SDB with LV scar. Confounders were identified using directed acyclic graphs. Results: The mean age of our sample was 67.0 ± 8.5 years (SD), with 49% (n = 461) females and a prevalence of SDB (AHI ≥ 5 events/h) of 63% (n = 590). LV scar was more prevalent in individuals with SDB (9.5%) versus those without SDB (3.8%; P <.01), and 88% of all LV scars were clinically unrecognized. After multivariable adjustment, both mild SDB and moderate-severe SDB were independently associated with LV scar (odds ratio, 2.53; 95% confidence interval, 1.13-5.64 and odds ratio, 2.31; 95% confidence interval, 1.01-5.24, respectively). Conclusions: In a community-based cohort, SDB (including mild) is independently associated with a more than 2-fold increase in the odds of LV scar presence measured using CMR with late-gadolinium enhancement. Most LV scars were clinically unrecognized. The impact of SDB treatment on subclinical myocardial infarction needs to be investigated in future studies.

Original languageEnglish (US)
Pages (from-to)855-862
Number of pages8
JournalJournal of Clinical Sleep Medicine
Issue number6
StatePublished - Jun 15 2020


  • Cardiac magnetic resonance
  • Late-gadolinium enhancement
  • Left ventricular scar
  • Myocardial injury
  • Obstructive sleep apnea
  • Sleep apnea
  • Sleep-disordered breathing

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Neurology
  • Clinical Neurology


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