Nocturnal Hypoxemia Impacts Right Ventricle Diastolic Function in Obstructive Sleep Apnea: A Retrospective Observational Study

Abstract

Obstructive sleep apnea (OSA), although a growing healthcare problem and documented risk factor for cardiovascular diseases, is still under-diagnosed in cardiac patients. To investigate the correlation between OSA and echocardiographic parameters of right ventricle diastolic (RVD) dysfunction, in particular trans-tricuspid E-wave deceleration time (EDT), we retrospectively analyzed data of 103 pure (comorbidity-free) OSA patients with comprehensive echocardiographic examination (ETT). Apnea/hypopnea index (AHI), oxygen desaturation index (ODI), mean nighttime oxyhemoglobin saturation (SpO2), time elapsed with SpO2 < 90% (T90) and mean peak desaturation of nocturnal events (Mdes, graded as mild, medium or severe) were compared with echocardiographic parameters. We found RVD dysfunction present in 58.3% of patients. Altered EDT correlated significantly with mean SpO2, T90, and Mdes (p < 0.01, all). Nocturnal desaturators had a significantly worse EDT than non-desaturators (p = 0.027) and a higher risk of prolonged EDT (odds ratio, OR = 2.86). EDT differed significantly according to Mdes severity (p = 0.005) with a higher risk of prolonged EDT in medium/severe vs. mild Mdes (OR = 3.44). EDT detected the presence of RVD dysfunction in 58.3% of our pure OSA patients. It correlated poorly with AHI severity but strongly with nocturnal desaturation severity, independently of age. This ETT marker may be useful for deciding appropriate diagnostic and therapeutic strategies.

Effect of obstructive sleep apnea on right ventricular ejection fraction in patients with hypertrophic obstructive cardiomyopathy

“…Another study published recently also showed that nocturnal hypoxemia is associated with right ventricle diastolic function in OSA 19 . Furthermore, OSA is also an independent risk factor for subclinical right ventricular dysfunction in children 19 . In our study, we found that the diameter of the pulmonary artery and right ventricle significantly increased with the severity of OSA, which might underly the right ventricular dysfunction.…”

“…A previous study showed that right ventricular dysfunction reflected by RVEF is common in OSA, and it is reversible with the treatment of OSA 8 . Another study published recently also showed that nocturnal hypoxemia is associated with right ventricle diastolic function in OSA 19 . Furthermore, OSA is also an independent risk factor for subclinical right ventricular dysfunction in children 19 .…”

Obstructive sleep apnea and right ventricular function: A meta‐analysis of speckle tracking echocardiographic studies

“… 14 Studies targeting RV function in the OSA setting based on conventional echocardiographic parameters reported mixed results. Some authors pointed out that patients with OSA frequently present RV structural and functional alterations, 15 , 16 others, on the contrary, failed to reveal significant morpho‐functional alterations of this cardiac chamber. 17 , 18 …”

“…14 Studies targeting RV function in the OSA setting based on conventional echocardiographic parameters reported mixed results. Some authors pointed out that patients with OSA frequently present RV structural and functional alterations, 15,16 others, on the contrary, failed to reveal significant morpho-functional alterations of this cardiac chamber. 17,18 In the last decade, RV strain, a parameter measuring myocardial deformation, has been recognized to provide a better evaluation of RV dysfunction than conventional echocardiographic parameters and, for this reason, it has been incorporated into contemporary echocardiographic guidelines for the assessment of RV performance.…”