Nocturnal hypoxemic burden is associated with epicardial fat volume in patients with acute myocardial infarction

  • Dominik Linz
  • Stefan Colling
  • Wolfgang Nußstein
  • Kurt Debl
  • Mathias Hohl
  • Claudia Fellner
  • Michael Böhm
  • Lars S. Maier
  • Okka W Hamer
  • Stefan Buchner
  • Michael Arzt
Sleep Breathing Physiology and Disorders • Original Article



Increased epicardial fat volume (EFV) is a common feature of patients with sleep-disordered breathing (SDB), is considered as an established marker of cardiovascular risk, and is associated with adverse cardiovascular events after myocardial infarction (MI).


To investigate the association between different measures of SDB severity and EFV after acute MI, we enrolled 105 patients with acute MI in this study. Unattended in-hospital polysomnography was performed to determine the number of apneas and hypopneas per hour during sleep (apnea-hypopnea index, AHI). To determine nocturnal hypoxemic burden, we used pulse oximetry and applied a novel parameter, the hypoxia load representing the integrated area of desaturation divided by total sleep time (HLTST). Of 105 patients, 56 underwent cardiovascular magnetic resonance to define EFV.


HLTST was significantly associated with EFV (r2 = 0.316, p = 0.025). Multivariate linear regression analysis accounting for age, sex, body mass index, smoking, and left ventricular mass demonstrated that the HLTST was an independent modulator of EFV (B-coefficient 0.435 (95% CI 0.021–0.591); p = 0.015). In contrast, AHI or established measures of hypoxemia did not correlate with EFV.


HLTST, a novel parameter to determine nocturnal hypoxemic burden, and not AHI as an event-based measure of SDB, was associated with EFV in patients with acute MI. Further studies are warranted to confirm the link between nocturnal hypoxemia and EFV and to determine the prognostic value of a more detailed characterization of nocturnal hypoxemic burden in patients with high cardiovascular risk.


Sleep apnea Hypoxia Epicardial fat Myocardial infarction Magnetic resonance imaging 



The authors are grateful for the excellent assistance provided by Astrid Brandl-Novak, Astrid Braune, Ruth Luigart, and Katja Ziczinski.

Authors’ contributions

Dominik Linz, Stefan Colling, Stefan Buchner, and Michael Arzt were responsible for the conception, the delineation of the hypotheses, and the design of the study, the acquisition of funding, data acquisition, the analysis and interpretation of such information, and writing the article, and in its revision prior to submission.

Wolfgang Nußstein, Kurt Debl, Okka W Hamer, and Claudia Fellner were involved in data acquisition, the analysis and interpretation of such information, and the critical revision of the article prior to submission.

Lars Maier, Mathias Hohl, and Michael Böhm were involved in data interpretation and in the critical revision of the article prior to submission.


The study was funded by ResMed (Martinsried, Germany), Philips Respironics (Murrysville, PA, USA), and the Faculty of Medicine of the University of Regensburg, Germany.

Compliance with ethical standards

Conflict of interest

Michael Arzt received grant support from ResMed (Martinsried, Germany), Philips Respironics (Murrysville, PA, USA). Michael Arzt and Dominik Linz previously received lecture fees from Philips Respironics (Murrysville, PA, USA) and ResMed (Martinsried, Germany). Stefan Buchner, Wolfgang Nußstein, Mathias Hohl, Michael Böhm, Stefan Colling, Kurt Debl, Okka W Hamer, Claudia Fellner, and Lars S. Maier have no conflicts of interest to disclose.

Ethical approval

All procedures performed in the study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol was reviewed and approved by the local institutional ethics committee.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

11325_2017_1616_MOESM1_ESM.docx (112 kb)
ESM 1 (DOCX 111 kb)


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Dominik Linz
    • 1
    • 2
  • Stefan Colling
    • 3
  • Wolfgang Nußstein
    • 3
  • Kurt Debl
    • 3
  • Mathias Hohl
    • 1
  • Claudia Fellner
    • 4
  • Michael Böhm
    • 1
  • Lars S. Maier
    • 3
  • Okka W Hamer
    • 4
  • Stefan Buchner
    • 3
    • 5
  • Michael Arzt
    • 3
    • 6
  1. 1.Department of Internal Medicine III, Universitätsklinikum des SaarlandesHomburg/SaarGermany
  2. 2.Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, Royal Adelaide HospitalUniversity of AdelaideAdelaideAustralia
  3. 3.Department of Internal Medicine IIUniversity Medical Center RegensburgRegensburgGermany
  4. 4.Institute for RadiologyUniversity Medical Center RegensburgRegensburgGermany
  5. 5.Innere Medizin II, Sana Klinken ChamChamGermany
  6. 6.Klinik und Poliklinik für Innere Medizin IIUniversitätsklinikum RegensburgRegensburgGermany

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