Right Ventricular Remodeling and Dysfunction in Obstructive Sleep Apnea: A Systematic Review of the Literature and Meta-Analysis.

Abdirashit Maripov,Meerim Cholponbaeva,Kubatbek Muratali Uulu,Meerim Sartmyrzaeva,Akylbek Sydykov,Almaz Akunov,Argen Mamazhakypov,Akpay Sarybaev,Melis Duishobaev

doi:10.1155/2017/1587865

Abstract

Background Recent studies have reported that obstructive sleep apnea (OSA) patients present alterations in right ventricular (RV) structure and function. However, large randomized controlled trials evaluating the impact of OSA on the right ventricle are lacking. Methods A comprehensive electronic database (PubMed, Web of Science, and Google Scholar) and reference search up to October 30, 2016, was performed. A systematic review and meta-analysis were performed to assess RV structure and function in OSA patients based on conventional echocardiography and tissue Doppler imaging. Results Twenty-five studies with 1,503 OSA patients and 796 controls were included in this study. OSA patients exhibited an increase in RV internal diameter (weighted mean difference (WMD) (95% confidence intervals (CIs)) 2.49 (1.62 to 3.37); p = 0.000) and RV wall thickness (WMD (95% CIs) 0.82 (0.51 to 1.13); p = 0.000). Furthermore, OSA patients had a significantly elevated RV myocardial performance index (WMD (95% CI) 0.08 (0.06 to 0.10); p = 0.000), decreased RV S' (WMD (95% CI) −0.95 (−1.59 to −0.32); p = 0.003), tricuspid annular plane systolic excursion (WMD (95% CI) −1.76 (−2.73 to −0.78); p = 0.000), and RV fractional area change (WMD (95% CI) −3.16 (−5.60 to −0.73); p = 0.011). Conclusion OSA patients display RV dilatation, increased wall thickening, and altered RV function.

Highlights

Obstructive sleep apnea (OSA) is characterized by repetitive episodes of complete and/or partial interruption of the respiratory airflow during sleep, leading to oxygen desaturation and chronic intermittent hypoxia
OSA patients exhibited an increase in right ventricular (RV) internal diameter (weighted mean difference (WMD) (95% confidence intervals (CIs)) 2.49 (1.62 to 3.37); p = 0.000) and RV wall thickness (WMD 0.82 (0.51 to 1.13); p = 0.000)
Because large randomized controlled trials directly evaluating the impact of OSA on the structural and functional alterations of the right ventricle are lacking, we aimed to perform a systematic review of the literature and meta-analysis of studies based on the conventional echocardiographic assessment of RV structure and function in OSA patients

Summary

Introduction

Obstructive sleep apnea (OSA) is characterized by repetitive episodes of complete and/or partial interruption of the respiratory airflow during sleep, leading to oxygen desaturation and chronic intermittent hypoxia. Earlier reports have demonstrated increases in pulmonary artery pressure (PAP) during sleep, which suggested the development of sustained pulmonary hypertension in patients with OSA [4, 5]. Studies have shown that daytime pulmonary hypertension occurs in 20% to 40% of patients with OSA and concomitant pulmonary or heart disease [6,7,8]. Permanent pulmonary hypertension may develop in OSA patients in the absence of other known cardiopulmonary disorders [9, 10]. Pulmonary hypertension in OSA patients can lead to the development of right ventricular (RV) hypertrophy and dysfunction. Recent studies have reported that obstructive sleep apnea (OSA) patients present alterations in right ventricular (RV) structure and function. OSA patients display RV dilatation, increased wall thickening, and altered RV function

Objectives

Methods

Conclusion