Objective:

To investigate the association of left atrial diameter (LAD) and epicardial adipose tissue (EAT) with heart failure with preserved ejection fraction (HFpEF) in patients with sleep apnea (SA) and evaluate their potential as markers for risk stratification.

Approach:

• Study Design: A total of 170 hospitalized patients with SA, diagnosed by polysomnography and who underwent cardiac CT between July 2022 and June 2023, were enrolled. Participants were divided into an HFpEF group (n = 96) and a non-HFpEF group (n = 74). Clinical data, including EAT relative volume and echocardiographic parameters, were collected and compared.
• Statistical Analysis: Logistic regression and ROC curve analyses were used to assess factors associated with HFpEF and their discriminatory ability, and Cox regression was performed for prognostic evaluation.

Key Findings:

• A combined model incorporating female sex, NT-proBNP level, LAD, and EAT relative volume yielded an area under the curve of 0.971 (95% CI: 0.942–1.000) for discriminating HFpEF.

Interpretation:

Both LAD and EAT relative volume are significantly associated with HFpEF in SA patients.

Limitations:

• The study was conducted in a single center, which may limit generalizability.
• Patients were not treated with continuous positive airway pressure (CPAP) during the study, which may affect outcomes.

Conclusion:

LAD and EAT relative volume may serve as markers for identifying high-risk individuals with HFpEF in the context of sleep apnea.