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Background:  Alterations of the autonomic nervous system (ANS) in the chronic stage of ischemic stroke (IS) are not well understood. Heart rate variability (HRV) provides a noninvasive approach to assess autonomic function., Objective:  To compare the HRV parameters during the sleep-wake cycle between patients with IS in the chronic stage and healthy subjects., Methods:  We conducted a retrospective transversal study based on clinical records and 24-hour electrocardiogram (EKG) monitoring registries of 179 patients with a confirmed IS diagnosis and 184 age- and sex-matched healthy subjects. Circadian variation was calculated according to the variation of the total autonomic activity (VTAI) and the parasympathetic activity (VPAI) indexes. Comparisons were performed using nonparametric tests. Multivariable analyses were performed with canonical discriminant analysis (CDA) and a three-way analysis of variance (ANOVA). Statistical significance was established with a confidence level of 95%., Results:  During waking hours, the healthy group exhibited higher variability in the time domain and frequency domain parameters: standard deviation of NN intervals (SDNN, p  < 0.001) and of the average NN intervals (SDANN, p  < 0.001), as well as low-frequency (LF) band ( p  < 0.001). During sleep, the difference was higher in the high-frequency (HF) band ( p  < 0.001), and lower in the low-/high-frequency ratio (LF/HF, p  < 0.001). Both VPAI and VTAI showed less significant difference in IS patients ( p  < 0.001)., Conclusion:  There was diminished heart vagal activity among IS patients, as measured through HRV. During sleep, this is likely caused by an imbalance in the sympathetic and parasympathetic systems shifting through the sleep phases. These imbalances could persist over time in patients with IS, lasting months after the initial injury., Competing Interests: The authors have no conflict of interest to declare., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/).)

Atrial fibrillation is the most common sustained arrhythmia in clinical practice, with a preference for older age groups. Considering population ageing, the projections for the next decades are alarming. In addition to its epidemiological importance, atrial fibrillation is evidenced by its clinical repercussions, including thromboembolic phenomena, hospitalizations, and a higher mortality rate. Its pathophysiological mechanism is complex and involves an association of hemodynamic, structural, electrophysiological, and autonomic factors. Since the 1990s, the Framingham study of multivariate analyses has demonstrated that hypertension, diabetes, heart failure, and valvular disease are independent predictors of this rhythm abnormality along with age. However, various other risk factors have been recently implicated in an increase of atrial fibrillation cases, such as sedentary behavior, obesity, sleep disorders, tobacco use, and excessive alcohol use. Moreover, changes in quality of life indicate a reduction in atrial fibrillation recurrence, thus representing a new strategy for excellence in the treatment of this cardiac arrhythmia. Therapeutic management involves a broad knowledge of the patient's health state and habits, comprehending 4 main pillars: lifestyle changes and rigorous treatment of risk factors; prevention of thromboembolic events; rate control; and rhythm control. Due to the dimension of factors involved in the care of patients with atrial fibrillation, integrated actions performed by interprofessional teams are associated with the best clinical results.

Objective: To develop and test a beat-to-beat blood pressure monitoring device during coronary angiography, and compare it with invasive blood pressure monitoring., Methods: Twenty-eight patients with an indication for hemodynamic study were selected for this investigation, and kept in supine position. Before starting the coronary angiography, they were instructed about the use of the left radial bracelet for beat-to-beat blood pressure monitoring., Results: There was a significant difference between the time required for the catheterization laboratory team to acquire the first invasive blood pressure reading and the time to obtain the first beat-to-beat reading (11.1±5.1 and 1.5±1.8, respectively; p<0.0001). The intraclass correlation coefficients (95%CI) of systolic and diastolic blood pressures were 0.897 (0.780-0.952) and 0.876 (0.734-0.942), indicating good reproducibility., Conclusion: This study showed the process to develop a beat-to-beat blood pressure monitoring device. When compared to invasive blood pressure monitoring, there were no significant differences between the two methods. This technique may play a promising coadjuvant role when combined with invasive monitoring during coronary angiography procedures.

Background: Exercise and CPAP improve OSA. This study examined the effects of exercise in patients with heart failure (HF) and OSA., Methods: Patients with HF and OSA were randomized to the following study groups: control, exercise, CPAP, and exercise + CPAP., Results: Sixty-five participants completed the protocol. Comparing baseline vs 3 months, the mean apnea-hypopnea index (AHI) did not change significantly (in events per hour) in the control group, decreased moderately in the exercise group (28 ± 17 to 18 ± 12; P < .03), and decreased significantly more in the CPAP group (32 ± 25 to 8 ± 11; P < .007) and in the exercise + CPAP group (25 ± 15 to 10 ± 16; P < .007). Peak oxygen consumption, muscle strength, and endurance improved only with exercise. Both exercise and CPAP improved subjective excessive daytime sleepiness, quality of life, and the New York Heart Association functional class. However, compared with the control group, changes in scores on the 36-item Medical Outcomes Study Short Form Survey and Minnesota Living with Heart Failure Questionnaire were only significant in the exercise groups., Conclusions: In patients with HF and OSA, our preliminary results showed that exercise alone attenuated OSA and improved quality of life more than CPAP. In the landscape treatment of OSA in patients with HF, this analysis is the only randomized trial showing any treatment (in this case, exercise) that improved all the studied parameters. The results highlight the important therapeutic benefits of exercise, particularly because adherence to CPAP is low., (Copyright © 2018. Published by Elsevier Inc.)

Background: Studies demonstrate an association between vitamin D (25(OH)D) deficiency and sleep disturbances, such as obstructive sleep apnea (OSA) and short sleep duration. However, to date, no studies have concurrently and objectively evaluated the effect of these factors on 25(OH)D., Objectives: To evaluate whether OSA and objective short sleep duration are independently associated with reduced 25(OH)D in an adult population sample., Methods: A cross-sectional study included 657 individuals from the city of Sao Paulo, Brazil, as part of the ERA project. Participants fulfilled questionnaires and underwent clinical evaluation, polysomnography and blood sample collection for 25(OH)D quantification. OSA was classified into three categories (mild, moderate and severe). The risk of 25(OH)D deficiency was considered as levels<30 ng/mL. Short sleep duration was defined as total sleep time<6 hours., Results: The risk of 25(OH)D deficiency was observed in 59.5% of the sample, affecting more individuals of the female gender, obese, with African American ethnicity, and those that were smokers, sedentary and presented hypertension and diabetes. In the final logistic model adjusted for age, gender, ethnicity, obesity, smoking, hypertension, diabetes, sedentary lifestyle, seasonality and creatinine serum levels, both OSA and short sleep duration showed significant independent associations with the risk of 25(OH)D deficiency (moderate OSA: OR for 25(OH)D<30 = 2.21, 95% CI: 1.35-3.64, p<0.01; severe OSA: OR for 25(OH)D<30 = 1.78, 95% CI: 1.06-3.00, p = 0.03; short sleep duration: OR for 25(OH)D<30 = 1.61, 95% CI: 1.15-2.26, p = 0.01). After a subgroup analysis, similar results were observed only in participants ≥50 years., Conclusion: OSA and short sleep duration are independently associated with the risk of 25(OH)D deficiency in an adult population. Age-related changes in vitamin D metabolism and the frequency of sleep disorders may be involved in these associations. Future studies exploring whether 25(OH)D levels may modulate OSA and sleep curtailment-related outcomes are needed.

Objective: Obstructive sleep apnea (OSA) has been linked to increased oxidative stress, lipid peroxidation and worsening atherosclerosis. This study investigated oxidized low-density lipoprotein (oxLDL) as a marker of lipid peroxidation, and total LDL cholesterol (direct LDL-C), as a marker of the lipid profile among individuals with OSA, and its association with hypertension (HYP) and dyslipidemia (DYS). The impact of one year of continuous positive airway pressure (CPAP) was also assessed., Methods: Blood was collected after 12 h of fasting from 99 consecutive patients who were diagnosed with OSA via polysomnography, and were also diagnosed with both HYP and DYS via clinical and laboratory studies. The patients were classified into the following three groups: GI [OSA with comorbidities (HYP or DYS)], GII [OSA without comorbidities], and GIII [control]. Thirty-five patients with an apnea/hypopnea index >20 per hour of sleep were randomized to groups that received either Sham-CPAP or CPAP treatments over 12 months., Results: In a binary regression controlled for sex, age, body mass index, and glycemia, model 1 which analyzed direct LDL-C, demonstrated significant levels of risk in the setting of DYS but not in the settings of HYP and OSA. In model 2, which analyzed oxLDL, DYS (p = 0.01), HYP (p = 0.032), and OSA (p = 0.039) were statistically significant. Significant alterations were observed in only the sleep parameters following one year of CPAP., Conclusions: Based on the statistical regression model, only the presence of DYS (p = 0.001) was associated with the levels of direct LDL-C. The remaining comorbidities (OSA and HYP) were not significantly related to the levels of direct LDL-C. Regarding oxLDL, OSA, HYP and DYS each added significant score values to the levels of oxLDL. These findings are suggestive of the importance of assessing oxLDL among patients presenting with OSA, both with and without comorbidities., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Introduction: The sleep of patients admitted to coronary care unit (CCU) may be compromised. A feasible and cost-effective tool to evaluate sleep in this scenario could provide important data. The aim of this study was to evaluate sleep with a questionnaire developed specifically for the CCU and to validate it with polysomnography (PSG)., Methods: Ninety-nine patients (68% male; 56 ± 10 years old) with acute coronary syndrome were included. PSG was performed within 36 h of admission. A specific 18-question questionnaire (CCU questionnaire) was developed and applied after the PSG. Cronbach's alpha test was used to validate the questionnaire. The Spearman test was used to analyze the correlation between the PSG variables and the questionnaire, and the Kruskal-Wallis test was used to compare the PSG variables among patients with good, regular, or poor sleep., Results: The total sleep time was 265 ± 81 min, sleep efficiency 62 ± 18%, REM sleep 10 ± 7%, apnea/hypopnea index 15 ± 23, and the arousal index 24 ± 15. Cronbach's alpha test was 0.69. The CCU questionnaire showed correlation with the sleep efficiency evaluated by PSG (r: 0.52; p < 0.001). Sleep quality was divided into three categories according to the CCU questionnaire: patients with good sleep had a sleep efficiency of 72 ± 9%, better than those with a regular or poor sleep (60 ± 16% and 53 ± 20%, respectively; p < 0.01)., Conclusion: The CCU questionnaire is a feasible and reliable tool to evaluate sleep in the CCU, showing correlation with the PSG sleep efficiency., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Purpose: This study aims to compare the effects of a mandibular advancement device (MAD) with continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA) on blood pressure (BP), oxidative stress, and heart rate variability (HRV) in a randomized, crossed-over, single-blind, and controlled trial., Methods: Twenty-nine moderate-to-severe adult OSA patients underwent MAD, CPAP, and placebo oral appliance treatment. Polysomnography, Epworth sleepiness scale, 24-h ambulatory BP monitoring, oxidative stress parameters (malondialdehyde, catalase, superoxide dismutase, vitamins C, E, B6, B12, folate, homocysteine, uric acid), and HRV were assessed at baseline and after 1 month of each treatment. Diaries were used to evaluate compliance for devices and a pressure-time meter for CPAP., Results: Both active treatments resulted in decreases in apnea and hypopnea index and Epworth sleepiness scale; CPAP showed a greater effect. Frequency of diastolic BP dipping was higher in the MAD group compared with the CPAP group. A significant drop from baseline levels for catalase activity was observed after MAD. For HRV, there was a significant decrease in total power at night with CPAP and MAD compared with POA, and a decrease in index of sleep autonomic variation with MAD compared with baseline levels. Compliance rates were higher with MAD rather than CPAP., Conclusions: Even though CPAP proved to be more effective at attenuating OSA, better compliance with MAD favored the reduction of one of the enzymes which participates in oxidative stress and better autonomic modulation during sleep.

Background: The mechanisms associated with the cardiovascular consequences of obstructive sleep apnea include abrupt changes in autonomic tone, which can trigger cardiac arrhythmias. The authors hypothesized that nocturnal cardiac arrhythmia occurs more frequently in patients with obstructive sleep apnea. Objective: To analyze the relationship between obstructive sleep apnea and abnormal heart rhythm during sleep in a population sample. Methods: Cross-sectional study with 1,101 volunteers, who form a representative sample of the city of São Paulo. The overnight polysomnography was performed using an EMBLA® S7000 digital system during the regular sleep schedule of the individual. The electrocardiogram channel was extracted, duplicated, and then analyzed using a Holter (Cardio Smart®) system. Results: A total of 767 participants (461 men) with a mean age of 42.00 ± 0.53 years, were included in the analysis. At least one type of nocturnal cardiac rhythm disturbance (atrial/ventricular arrhythmia or beat) was observed in 62.7% of the sample. The occurrence of nocturnal cardiac arrhythmias was more frequent with increased disease severity. Rhythm disturbance was observed in 53.3% of the sample without breathing sleep disorders, whereas 92.3% of patients with severe obstructive sleep apnea showed cardiac arrhythmia. Isolated atrial and ventricular ectopy was more frequent in patients with moderate/severe obstructive sleep apnea when compared to controls (p < 0.001). After controlling for potential confounding factors, age, sex and apnea-hypopnea index were associated with nocturnal cardiac arrhythmia. Conclusion: Nocturnal cardiac arrhythmia occurs more frequently in patients with obstructive sleep apnea and the prevalence increases with disease severity. Age, sex, and the Apnea-hypopnea index were predictors of arrhythmia in this sample.

Objective: To correlate arrhythmic symptoms with the presence of significant arrhythmias through the external event monitoring (web-loop)., Methods: Between January and December 2011, the web-loop was connected to 112 patients (46% of them were women, mean age 52±21 years old). Specific arrhythmic symptoms were defined as palpitations, pre-syncope and syncope observed during the monitoring. Supraventricular tachycardia, atrial flutter or fibrillation, ventricular tachycardia, pauses greater than 2 seconds or advanced atrioventricular block were classified as significant arrhythmia. The association between symptoms and significant arrhythmias were analyzed., Results: The web-loop recorded arrhythmic symptoms in 74 (66%) patients. Of these, in only 14 (19%) patients the association between symptoms and significant cardiac arrhythmia was detected. Moreover, significant arrhythmia was found in 11 (9.8%) asymptomatic patients. There was no association between presence of major symptoms and significant cardiac arrhythmia (OR=0.57, CI95%: 0.21-1.57; p=0.23)., Conclusion: We found no association between major symptoms and significant cardiac arrhythmia in patients submitted to event recorder monitoring. Event loop recorder was useful to elucidate cases of palpitations and syncope in symptomatic patients.

Background: Measurements of plasma and urinary catecholamine are susceptible to confounding factors that influence the results, complicating the interpretation of sympathetic nervous system (SNS) activity in the Obstructive sleep apnea (OSA) and arterial hypertension (HYP) conditions., Objective: In this study, we validated a test for platelet catecholamine and compared the catecholamine levels (adrenaline and noradrenaline) in urine, plasma and platelets in patients with OSA and HYP compared with controls., Methods: In the validation, 30 healthy, nonsmoking volunteers who were not currently undergoing treatment or medication were selected as the control group. One hundred fifty-four individuals (114 OSA, 40 non-OSA) were consecutively selected from the outpatient clinic of the Sleep Institute and underwent clinical, polysomnographic and laboratory evaluation, including the urinary, plasma and platelet levels of adrenaline (AD) and noradrenaline (NA). Patients were then allocated to groups according to the presence of OSA and/or hypertension., Results: A logistic regression model, controlled for age and BMI, showed that urinary AD and urinary NA were risk factors in the OSA+HYP group and the HYP group; however, the model showed higher levels of platelet NA for OSA without HYP. After 1 year of CPAP (continuous upper airway pressure) treatment, patients (n = 9) presented lower levels of urinary NA (p = 0.04) and platelet NA (p = 0.05)., Conclusion: Urinary NA and AD levels were significantly associated with the condition of hypertension with and without OSA, whereas platelet NA with OSA without comorbidity. These findings suggest that platelet catecholamine levels might reflect nocturnal sympathetic activation in OSA patients without hypertension.

Background: The few studies that examine the effect of nasal abnormalities on continuous positive airway pressure device (CPAP) adherence are controversial. The aim of this study was to evaluate the contribution of nasal abnormalities in CPAP adherence., Methods: We included patients with moderate to severe OSA. The patients were submitted to rhinoscopy, nasofibroscopy, nasal inspiratory peak flow, and acoustic rhinometry. The patients who used a CPAP for 4 h or more per night for at least 70 % of the nights over a 6-month period were considered to have good adherence., Results: Thirty-four patients finished the study. Eleven (33.4 %) were female and 23 (67.6 %) were male. Sixteen (47.1 %) patients had good adherence. The body mass index (p = 0.030), neck circumference (p = 0.006), and apnea-hypopnea index (p = 0.032) were higher, and the oxyhemoglobin saturation minimum was lower (p = 0.041) in the good adherence group. Nasal parameters showed no differences between good and poor adherence groups. In Spearman's correlation, surprisingly, there was a negative correlation between the highest number of hours of CPAP use with smaller values of nasal minimal cross-sectional areas in the supine position (r, 0.375; p = 0.029). In the linear regression model, the nasal findings that predicted increased of the CPAP use were the following: lower scores of nasal symptoms (p = 0.007) and lower nasal volume in supine position (p = 0.001)., Conclusions: The majority of the nasal parameters evaluated in this study did not influence CPAP adherence.

Background: There are innumerous indicators to assure the quality of a service. However, medical competence and the proper performance of a procedure determine its final quality. The Brazilian Society of Cardiac Arrhythmias recommends minimum parameters necessary to guarantee the excellence of ambulatory electrocardiographic monitoring services., Objective: To recommend minimum medical competences and the information required to issue a Holter monitoring report., Methods: This study was grounded in the concept of evidence-based medicine and, when evidence was not available, the opinion of a writing committee was used to formulate the recommendation. That committee consisted of professionals with experience on the difficulties of the method and management in providing services in that area., Results: The professional responsible for the Holter monitoring analysis should know cardiovascular pathologies and have consistent formation on electrocardiography, including cardiac arrhythmias and their differential diagnoses. The report should be written in a clear and objective way. The minimum parameters that comprise a Holter report should include statistics of the exam, as well as quantification and analysis of the rhythm disorders observed during monitoring., Conclusion: Ambulatory electrocardiographic monitoring should be performed by professionals knowledgeable about electrocardiographic analysis, whose report should comprise the minimum parameters mentioned in this document.

Purpose: Obstructive sleep apnea syndrome (OSAS) is associated with impaired cognition, especially executive functions. However, various of its comorbid conditions are also known to cause cognitive impairment, so it is unclear whether OSAS itself is responsible for cognitive deficits. Our aim was to determine the effects of OSAS on executive functions in otherwise healthy patients., Method: This was a parallel group design study, which involved 22 patients aged 36-65 years diagnosed with moderate to severe OSAS, whose body mass index was below 26, and who did not have diabetes, hypertension, or depression. Controls were 22 healthy individuals with similar age, gender, intelligence quotient, and schooling to those of the patients. Participants completed a test battery that included measures of 6 distinct executive domains (shifting, inhibition, updating, dual-task performance, planning, and access to long-term memory), of all subsystems of the multiple-component working memory model, attention, and mood., Results: OSAS and controls were equivalent in all demographic variables and test scores. The apnea-hypopnea index did not significantly correlate with executive performance, but mean oxygen saturation did so with measurements of executive shifting and access to long-term memory., Conclusions: OSAS without comorbidities did not lead to cognitive impairment.

Background: Obstructive Sleep Apnea (OSA) is a risk factor for several cardiovascular conditions including increased cardiovascular mortality. It is therefore essential to know the major cardiovascular effects of sleep-disordered breathing during a clinical evaluation., Objective: To analyze the cardiovascular characteristics of patients with OSA., Methods: Patients underwent baseline polysomnography and were consecutively selected from the database of the Sleep Institute between March 2007 and March 2009. All patients were instructed to attend the clinic for blood collection, physical examination, 12-lead electrocardiogram, spirometry, cardiopulmonary exercise testing on a treadmill and transthoracic echocardiography. The study was approved by the Research Ethics Committee and recorded at http://clinicaltrials.gov/ under number: NCT00768625., Results: We analyzed 261 patients and 108 controls. The main characteristics of patients with OSA were: obesity, hypertension, low plasma levels of high density lipoprotein (HDL) and increased left atrial diameter compared with controls (3.75 ± 0.42; 3.61 ± 0.41, p = 0.001), respectively. These associated characteristics correspond to a 16.6 increase in the likelihood of OSA regardless of reporting any symptoms of this disorder, such as sleepiness or snoring., Conclusion: In the sample studied, the mostly found cardiovascular profile of patients with OSA was: obesity, hypertension, low plasma levels of HDL and left atrial diameter increased.

Objective: To assess the prevalence of ventricular arrhythmias induced by exercise in a population with sleep disorders and to analyze the triggering factors., Methods: Patients were consecutively selected from the database of the Sleep Clinic of Universidade Federal de São Paulo. All subjects were submitted to basal polysomnography, blood sample collection, physical examination, 12-lead ECG, spirometry, cardiorespiratory exercise study on a treadmill, and echocardiogram. The Control Group was matched for age and gender., Results: A total of 312 patients were analyzed. Exercise-induced ventricular arrhythmia was observed in 7%. The aortic diameter was larger (3.44 ± 0.30, 3.16 ± 0.36, p = 0.04) and the minimal saturation was lower (92.75 ± 3.05, 95.50 ± 1.73, p=0.01) in the ventricular arrhythmia group when compared to controls, respectively. After correction of the aortic root to body surface, there was only a trend to a larger diameter being associated with the emergence of arrhythmia., Conclusions: Exercise-induced ventricular arrhythmia was observed in 7% of sample and it was associated with lower oxygen saturation during exercise.

Background: The angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism gene contributes to the genesis of hypertension (HTN) and may help explain the relationship between obstructive sleep apnea (OSA) and HTN. However, ACE is a pleiotropic gene that has several influences, including skeletal muscle and control of ventilation. We therefore tested the hypothesis that ACE polymorphism influences OSA severity., Methods: Male OSA patients (apnea-hypopnea index [AHI]>5 events/h) from 2 university sleep centers were evaluated by polysomnography and ACE I/D polymorphism genotyping., Results: We studied 266 males with OSA (age=48+/-13 y, body mass index=29+/-5 kg/m(2), AHI=34+/-25 events/h). HTN was present in 114 patients (43%) who were older (p<0.01), heavier (p<0.05) and had more severe OSA (p<0.01). The I allele was associated with HTN in patients with mild to moderate OSA (p<0.01), but not in those with severe OSA. ACE I/D polymorphism was not associated with apnea severity among normotensive patients. In contrast, the only variables independently associated with OSA severity among patients with hypertension in multivariate analysis were BMI (OR=1.12) and II genotype (OR=0.27)., Conclusions: Our results indicate reciprocal interactions between OSA and HTN with ACE I/D polymorphism, suggesting that among hypertensive OSA males, the homozygous ACE I allele protects from severe OSA.

Background: Studies have suggested that obstructive sleep apnea (OSA) contributes to the deterioration of left ventricular diastolic function. This may lead to atrial myocardial overstretching and enlargement, which could be associated with increased cardiovascular risk. The aim of this study was to evaluate left atrial (LA) volume and function in patients with OSA compared with controls without OSA and their associations with any left ventricular diastolic abnormalities using real-time 3-dimensional echocardiography (RT3DE)., Methods: Fifty-six patients with mild to severe OSA and 50 controls of similar age and with similar body mass indexes, blood pressure, and frequency of hypertension were analyzed. All subjects underwent polysomnography and RT3DE., Results: A larger 3-dimensional maximum LA volume indexed for body surface area, larger volume before atrial contraction, and higher active atrial ejection fraction were found in patients with OSA (P < .01 for all). Mitral annular early diastolic velocity (E') was reduced in patients with OSA (P = .03), whereas late diastolic velocity (A') and the ratio of mitral valve early diastolic velocity to mitral annular early diastolic velocity (E/E') were increased in the same group (P < .05 for both). In addition, a lower E'/A' ratio was also found in the OSA group (P = .02). An increase in 3-dimensional maximum LA volume indexed for body surface area was observed, depending on OSA severity. The apnea-hypopnea index and E/E' ratio were independent predictors of an increase in 3-dimensional maximum LA volume in a multiple regression model., Conclusion: Using RT3DE, this study demonstrates that OSA induces a functional burden on the left atrium, resulting in remodeling. These functional and structural changes are related to the impairment of diastolic function in this population.