Assessment of right ventricular remodeling and dysfunction in obstructive sleep apnea syndrome: a prospective monocentric study.

Abstract

Obstructive sleep apnea (OSA) is a common sleep-related disorder that has been implicated in many serious cardiovascular diseases including cardiac remodeling and dysfunction. Since most investigations have focused on the left heart, little is known on right ventricular (RV) involvement in OSA. The role of theRV in the management of cardiovascular outcomes has become increasingly recognized. Early detection of subtle signs of RV dysfunction and remodeling in patients withOSA is crucial for optimal medical care. We aimed to investigate the effect of OSA and its severity on the RV structure and function using conventional echocardiography. We conducted a cross-sectional analytical study including patients withOSA who did not have heart failure or chronic pulmonary disease comparing them to controlswithout OSA. All patients underwent respiratory polygraphy at the Pneumology Department and standard echocardiography performed by the same blinded cardiologist at the Cardiology Department of Taher Sfar University Hospital. A total of 139 patients withOSA and 45 controls were enrolled in the study. Amonth the patients, there were 32% (n = 44) withmild, 20% (n = 28) withmoderate, and 48% (n = 67) withsevere OSA. Sixty-three percent of the study population were women. The mean age was 54.1 ± 11.0years. Early RV dilatation was present in the mild disease stage (RVID = 42.0 ± 7.7mm vs. 32.4 ± 5.5mm in controls; p < 0.0001) without obvious RVH. The systolic pulmonary artery pressure was significantly higher in patients withOSA (31.2 ± 8.2 vs. 20.9 ± 9.8; p < 0.0001). Tricuspid annular plane systolic excursion was borderline normal and significantly lower in patients withOSA (17.7 ± 4.7 vs. 26.0 ± 5.7, p < 0.0001). In multivariate analysis, an OSA was independently associated with RV remodeling (OR: 0.257, 95% CI [0.114-0.582], p = 0.001) but not with RV dysfunction. OSA was independently associated with structural alterations of RV early in the disease course, suggesting that the reversibility of these deleterious effects requires earlier detection and initiation of treatment.