[17] Cardiovascular Pathology in Obstructive Sleep Apnea: A Retrospective Autopsy Study

Laura M Warmke, Margaret M Grimes. Virginia Commonwealth University Medical Center, Richmond, VA

Background: Obstructive sleep apnea (OSA) results in chronic intermittent hypoxia and is associated with cardiovascular disease (CVD). Imaging studies have demonstrated increased left ventricular mass and greater coronary atherosclerotic plaque burden in OSA compared to non-OSA patients. Only one previous autopsy study of CVD in OSA is identified in the literature. Since obesity is a risk factor for both OSA and CVD, we compared cardiovascular pathology at autopsy in obese patients with and without documented OSA.
Design: Autopsy records were searched for patients with a clinical history of OSA. Of 27 patients with OSA, 23 were obese (BMI≥31) and comprised the study group (n=23). The control group consisted of obese patients without documented OSA (n=25). Autopsy reports were reviewed for medical histories and gross descriptions of cardiovascular pathology. Recorded heart weights were compared to predicted heart weights for body weight and gender. Histologic sections of myocardium and arteries were reviewed in a blinded fashion.
Results: The two groups had no significant difference in age, gender, race, height or prevalence of ischemic heart disease, hypertension, diabetes, stroke, or history of smoking.

Table 1
 OSANo OSA 
 (n=23)(n=25)p value
BMI (lb/in²)48.0±15.950.2±13.70.60
Heart wt (g)665.1±204.0588.7±126.00.16
Heart wt >predicted (g)280.0±203.5 (n=20)186.6±113.8 (n=18)0.11
Heart wt >upper 95% CL* (g)256.3±157.0 (n=13)95.1±69.1 (n=12)0.005
RV wall thickness (cm)0.47±0.210.50±0.160.62
LV wall thickness (cm)1.83±0.581.59±0.430.16
    
*weight exceeding upper 95% confidence limit

No statistically significant difference was found in maximum coronary artery plaque thickness or per cent occlusion of coronary arteries. Plaque morphology, including extent of calcification, number of inflammatory cells, and lipid content, was similar in the two groups.
Conclusions: Heart weight tended to be greater in OSA than in non-OSA patients but the difference did not reach statistical significance. However, among those patients with heart weight exceeding the upper 95% confidence limit of predicted values, excess heart weight was significantly greater in OSA patients compared to patients without OSA. We found no significant difference in ventricular wall thickness, coronary plaque burden or plaque composition between the two groups.
Category: Autopsy

Wednesday, March 6, 2013 9:30 AM

Poster Session V # 10, Wednesday Morning

 

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