Biventricular Myocardial Performance Is Impaired in Proportion to Severity of Obstructive Sleep Apnea

Akyol, Selahattin; Çörtük, Mustafa; Baykan, Ahmet Oytun; Kiraz, Kemal; Börekçi, Abdürrezzak; Şeker, Taner; Gür, Mustafa; Çaylı, Murat

doi:10.14503/thij-14-4868

Cited by 15 publications

(14 citation statements)

References 29 publications

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“…However, a study of 411 men, average age of 71 years old, showed that LV-EF is slightly lower in patients with moderate-to-severe OSA (61.0 ± 8.9%) than in subjects with AHI <15 (62.7 ± 6.3%; p =0.028) [8], and another recent report found that OSA severity is significantly correlated with a reduction in LV-EF ( p =0.005) [19] (Table 3). These results are confirmed by another study of 119 OSA patients monitored over 18 years, showing that, for every tenfold increase in AHI, the left ventricular ejection fraction showed a 1.3% independent decrease [18].…”

Section: Introductionsupporting

confidence: 56%

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Review of Echocardiographic Findings in Patients with Obstructive Sleep Apnea

Sascău

Zota

Stătescu

et al. 2018

Canadian Respiratory Journal

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Obstructive sleep apnea (OSA) causes recurrent apneas due to upper respiratory tract collapse, leading to sympathetic nervous system hyperactivation and increased cardiovascular risk. Moderate and severe forms of obstructive sleep apnea are associated with increased atrial volumes and affect left ventricular diastolic and then systolic function. Right ventricular ejection fraction can be accurately assessed via three-dimensional echocardiography, while bidimensional imaging can only provide a set of surrogate parameters to characterize systolic function (tricuspid annulus plane systolic excursion, right ventricular fractional area change, and lateral S'). Tissue Doppler imaging is a more sensitive tool in detecting functional ventricular impairment, but its use is limited by angle dependence and the unwanted influence of tethering forces. Two-dimensional speckle tracking echocardiography is considered more suitable for the assessment of ventricular function, as it is able to distinguish between active and passive wall motion. Abnormal strain values, a marker of subclinical myocardial dysfunction, can be detected even in patients with normal ejection fraction and chamber volumes. The left ventricular longitudinal strain is more affected by the presence of obstructive sleep apnea than circumferential strain values. Although the observed OSA-induced changes are subtle, the benefit of a detailed echocardiographic screening for subclinical heart failure in OSA patients on therapy adherence and outcome should be addressed by further studies.

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Section: Introductionsupporting

confidence: 56%

“…Left ventricular hypertrophy appears to be correlated to mean nocturnal oxygen saturation. The latter was an independent predictor of left ventricular mass and wall thickness (for every 1% decrease in saturation, the authors reported a mass gain of 4.38 g and an increase in wall thickness by 0.14 cm) [18].…”

Section: Introductionmentioning

confidence: 99%

Review of Echocardiographic Findings in Patients with Obstructive Sleep Apnea

Sascău

Zota

Stătescu

et al. 2018

Canadian Respiratory Journal

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“…Conventional parameters, however, such as Simpson biplane LV ejection fraction and S' m wave were comparable between the subgroups. Akyol et al [24] studied MPI in 116 patients with different degrees of OSA severity and compared findings according to OSA severity. The left MPI was significantly higher in the group with severe OSA (MPI = 0.5 ± 0.12) than in the groups with moderate OSA (MPI= 0.48 ± 0.09) and mild OSA (MPI= 0.45 ± 0.08) (p=0.018).…”

Section: Discussionmentioning

confidence: 99%

Assessment of Biventricular Function in Patients with Obstructive Sleep Apnea and Atrial Fibrillation: A Cross-sectional Study Using Two-dimensional Speckle Tracking Imaging

Fathia

Boudiche

Sammoud

et al. 2019

JAMMR

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Background: Obstructive sleep apnea syndrome (OSA) is a common but often under diagnosed condition. According to literature, OSA prevalence in atrial fibrillation (AF) patients varies from 21 to 85%. OSA is increasingly recognized as a risk factor for biventricular dysfunction. The present study aimed to compare left and right ventricular functions, assessed by conventional echocardiographic parameters and speckle tracking imaging, in non-valvular atrial fibrillation (NVAF) patients with and without severe OSA. Methods: A cross-sectional analytic study was conducted. Forty successive patients with NVAF were included. All of them had a clinical screening for symptoms suggestive of OSA and underwent polysomnographic study. Patients were divided into two groups (group 1: without severe OSA with an apnea-hypopnea index (AHI) < 30 events per hour (e/h), and group 2: having severe OSA with an AHI ≥ 30 e/h). Echocardiography was performed in all patients. Left and right ventricular function parameters were measured including global longitudinal strain (GLS) and myocardial performance index (MPI). Results: OSA was diagnosed in 90% of NVAF patients. The average AHI was 22.1 ± 13 e/h. Eleven patients (27.5%) had mild OSA, 9 patients (22.5%) had moderate OSA, and 16 patients (40%) had severe OSA. General clinical characteristics were comparable between groups. A statistically significant association was demonstrated between severe OSA and impairment of left ventricular GLS (-17.3 ± 4.5 vs. -14.9 ± 3%, in group 1 and 2 respectively, p = 0.02) and left ventricular MPI (0.37 ± 0.09 vs. 0.49 ± 0.13, in group 1 and 2 respectively, p = 0.01). Right ventricular lateral wall strain was non significantly lower in group 1 compared to group 2 (-22.5 ± 8.4 vs. -18.4 ± 5.8%, in group 1 and 2 respectively, p = 0.15). On multivariate logistic regression analysis, left ventricular GLS impairment (> -18%) and MPI > 0.37 were independent predictors of severe OSA. Conclusion: Severe OSA was diagnosed in 40% of NVAF patients. Impairment of left ventricular GLS and left MPI were statistically associated with severe OSA.

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“…Decreased right heart performance has been repeatedly described in OSA patients. [4][5][6][7] RV function seems to be impaired in proportion to the severity of OSA 4,5 and has been shown to be reversible by continuous positive airway pressure (CPAP) therapy. 6,7 In acute pulmonary embolism (PE), RV dysfunction is a critical determinant of outcome and is associated with a poor short-and long-term prognosis.…”

Section: Introductionmentioning

confidence: 99%

“…Decreased right heart performance has been repeatedly described in OSA patients. 4 - 7 RV function seems to be impaired in proportion to the severity of OSA 4 , 5 and has been shown to be reversible by continuous positive airway pressure (CPAP) therapy. 6 , 7 …”

Section: Introductionmentioning

confidence: 99%

Right-to-left Ventricular Diameter Ratio At Computed Tomographic Pulmonary Angiography in Patients with Acute Pulmonary Embolism and Obstructive Sleep Apnea

Berghaus

Konnerth

Probst

et al. 2020

Clin Med Insights Circ Respir Pulm Med

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Purpose: Right ventricular (RV) dysfunction in acute pulmonary embolism (PE) is a critical determinant of outcome. Obstructive sleep apnea (OSA) is a common comorbidity of PE and might also affect RV function. Therefore, we sought to investigate RV dysfunction in PE patients in proportion to the severity of OSA by evaluating the right-to-left ventricular (RV/LV) diameter ratio on computed tomographic pulmonary angiography (CTPA). Materials and Methods: 197 PE patients were evaluated for sleep-disordered breathing by portable monitoring and nocturnal polysomnography. RV dilatation was defined as an RV/LV diameter ratio of ⩾ 1.0. Results: RV dilatation was significantly more frequent in OSA patients compared to study participants without OSA (66.4% vs 49.1%, P = .036). Elevated troponin I values, indicating myocardial injury due to acute, PE-related RV strain, were significantly more frequent in OSA patients with an apnea-hypopnea index (AHI) ⩾ 15/h compared to those with an AHI < 15/h (62.1% vs 45.8%, P = .035). However, RV dysfunction documented by the RV/LV diameter ratio on CTPA was not significantly associated with the severity of OSA in multivariable regression analysis. Conclusion: Patients with moderate or severe OSA might compensate acute, PE-related RV strain better, as they are adapted to repetitive right heart pressure overloads during sleep.

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Biventricular Myocardial Performance Is Impaired in Proportion to Severity of Obstructive Sleep Apnea

Cited by 15 publications

References 29 publications

Review of Echocardiographic Findings in Patients with Obstructive Sleep Apnea

Review of Echocardiographic Findings in Patients with Obstructive Sleep Apnea

Assessment of Biventricular Function in Patients with Obstructive Sleep Apnea and Atrial Fibrillation: A Cross-sectional Study Using Two-dimensional Speckle Tracking Imaging

Right-to-left Ventricular Diameter Ratio At Computed Tomographic Pulmonary Angiography in Patients with Acute Pulmonary Embolism and Obstructive Sleep Apnea

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