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Canadian Journal of Cardiology

Assessment of Right Ventricular Function in Obstructive Sleep Apnea Syndrome and Effects of Continuous Positive Airway Pressure Therapy: A Pilot Study

Published:January 28, 2015DOI:https://doi.org/10.1016/j.cjca.2015.01.029

      Abstract

      Background

      It is known that obstructive sleep apnea syndrome (OSAS) can affect right ventricular (RV) performance even in the absence of systemic hypertension and other known cardiac or obstructive pulmonary disease. The purpose of the present study was to assess RV function in OSAS using 3-D echocardiography and speckle tracking echocardiography (STE) and evaluate changes after continuous positive airway pressure (CPAP) treatment.

      Methods

      Thirty-seven patients with OSAS without comorbidities and thirty control subjects were studied using 3-D echocardiography and STE. Fifteen patients underwent CPAP therapy and were studied before and after treatment. RV 3-D ejection fraction was calculated. Peak systolic strain was determined. RV dyssynchrony was defined as SD of the 6 time to peak systolic strain values.

      Results

      3-D RV ejection fraction was lower and RV dyssynchrony was greater in patients with moderate-severe OSAS compared with control subjects in the presence and absence of pulmonary hypertension. 3-D RV ejection fraction and RV dyssynchrony were independently associated with apnea-hypopnea index. Patients treated with CPAP had significant changes in RV parameters.

      Conclusions

      3-D RV ejection fraction and RV dyssynchrony were abnormal in OSAS patients compared with control subjects and associated with OSAS severity. RV 3-D STE abnormalities improved after chronic application of CPAP.

      Résumé

      Introduction

      On sait que le syndrome de l’apnée obstructive du sommeil (SAOS) peut affecter la performance du ventricule droit (VD) même en l’absence d’hypertension systémique et d’autres maladies cardiaques ou pulmonaires obstructives. Le but de la présente étude était d’évaluer la fonction du VD lors du SAOS à l’aide de l’échocardiographie 3D et de l’échocardiographie Speckle Tracking (suivi de pixel; EST) et les changements après le traitement par pression positive expiratoire continue (CPAP).

      Méthodes

      Trente-sept patients souffrant du SAOS sans comorbidités et 30 sujets témoins ont été étudiés à l’aide de l’échocardiographie 3D et de l’EST. Quinze patients ont subi la thérapie CPAP et ont été étudiés avant et après le traitement. La fraction d’éjection du VD en 3D a été calculée. La déformation systolique maximale a été déterminée. La dyssynchronie du VD a été définie comme étant suérieure de 6 fois l'ET des valeurs maximales de déformation systolique.

      Résultats

      La fraction d’éjection du VD en 3D était plus faible et la dyssynchronie du VD était plus grande chez les patients souffrant du SAOS modéré à grave que chez les sujets témoins en présence ou en l’absence d’hypertension pulmonaire. La fraction d’éjection du VD en 3D et la dyssynchronie du VD étaient indépendamment associées à l’index d’apnées-hypopnées. Les patients traités par CPAP montraient des changements significatifs dans les paramètres du VD.

      Conclusions

      La fraction d’éjection du VD en 3D et la dyssynchronie du VD étaient anormales chez les patients souffrant du SAOS comparativement aux sujets témoins et associées à la gravité du SAOS. Les anomalies du VD en 3D à l’EST s’amélioraient après l’application à long terme du CPAP.
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      References

      1. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The report of an American Academy of Sleep Medicine Task Force.
        Sleep. 1999; 22: 667-689
        • Fleetham J.
        • Ayas N.
        • Bradley D.
        • et al.
        Canadian Thoracic Society guidelines: diagnosis and treatment of sleep disordered breathing in adults.
        Can Respir J. 2006; 13: 387-392
        • Wang X.
        • Ouyang Y.
        • Wang Z.
        • et al.
        Obstructive sleep apnea and risk of cardiovascular disease and all-cause mortality: a meta-analysis of prospective cohort studies.
        Int J Cardiol. 2013; 169: 207-214
        • Kendzerska T.
        • Gershon A.S.
        • Hawker G.
        • Leung R.S.
        • Tomlinson G.
        Obstructive sleep apnea and risk of cardiovascular events and all-cause mortality: a decade-long historical cohort study.
        PLoS Med. 2014; 11: e1001599
        • Vanderveken O.M.
        • Boudewyns A.
        • Ni Q.
        • et al.
        Cardiovascular implications in the treatment of obstructive sleep apnea.
        J Cardiovasc Transl Res. 2011; 4: 53-60
        • Dursunoglu D.
        • Dursunoglu N.
        • Evrengul H.
        • et al.
        Impact of obstructive sleep apnoea on left ventricular mass and global function.
        Eur Respir J. 2005; 26: 283-288
        • Vitarelli A.
        • D’Orazio S.
        • Caranci F.
        • et al.
        Left ventricular torsion abnormalities in patients with obstructive sleep apnea syndrome: an early sign of subclinical dysfunction.
        Int J Cardiol. 2013; 165: 512-518
        • Tavil Y.
        • Kanbay A.
        • Sen N.
        • et al.
        Comparison of right ventricular functions by tissue Doppler imaging in patients with obstructive sleep apnea syndrome with or without hypertension.
        Int J Cardiovasc Imaging. 2007; 23: 469-477
        • Bayram N.A.
        • Ciftci B.
        • Bayram H.
        • et al.
        Effects of continuous positive airway pressure therapy on right ventricular function assessment by tissue Doppler imaging in patients with obstructive sleep apnea syndrome.
        Echocardiography. 2008; 25: 1071-1078
        • Tugcu A.
        • Guzel D.
        • Yildirimturk O.
        • Aytekin S.
        Evaluation of right ventricular systolic and diastolic function in patients with newly diagnosed obstructive sleep apnea syndrome without hypertension.
        Cardiology. 2009; 113: 184-192
        • Tanaka Y.
        • Hino M.
        • Mizuno K.
        • Gemma A.
        Assessment of the relationship between right ventricular function and the severity of obstructive sleep-disordered breathing.
        Clin Respir J. 2014; 8: 145-151
        • Hammerstingl C.
        • Schueler R.
        • Wiesen M.
        • et al.
        Impact of untreated obstructive sleep apnea on left and right ventricular myocardial function and effects of CPAP therapy.
        PLoS One. 2013; 8: e76352
        • Altekin R.E.
        • Karakas M.S.
        • Yanikoglu A.
        • et al.
        Determination of right ventricular dysfunction using the speckle tracking echocardiography method in patients with obstructive sleep apnea.
        Cardiol J. 2012; 19: 130-139
        • Oliveira W.
        • Poyares D.
        • Cintra F.
        • et al.
        Impact of continuous positive airway pressure treatment on right ventricle performance in patients with obstructive sleep apnoea, assessed by three-dimensional echocardiography.
        Sleep Med. 2012; 13: 510-516
        • Epstein L.J.
        • Kristo D.
        • Strollo Jr., P.J.
        • et al.
        Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults.
        J Clin Sleep Med. 2009; 5: 263-276
        • Lang R.M.
        • Bierig M.
        • Devereux R.B.
        • et al.
        Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology.
        J Am Soc Echocardiogr. 2005; 18: 1440-1463
        • Rudski L.G.
        • La W.W.
        • Afilalo J.
        • et al.
        Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography.
        J Am Soc Echocardiogr. 2010; 23: 685-713
        • Kaul S.
        • Tei C.
        • Hopkins J.M.
        • Shah P.M.
        Assessment of right ventricular function using two dimensional echocardiography.
        Am Heart J. 1984; 128: 301-307
        • Yeo T.C.
        • Dujardin K.S.
        • Tei C.
        • et al.
        Value of a Doppler-derived index combining systolic and diastolic time intervals in predicting outcome in primary pulmonary hypertension.
        Am J Cardiol. 1998; 81: 1157-1161
        • Berger M.
        • Haimowitz A.
        • VanTosh A.
        • Berdoff R.L.
        • Goldberg E.
        Quantitative assessment of pulmonary hypertension in patients with tricuspid regurgitation using continuous wave Doppler ultrasound.
        J Am Coll Cardiol. 1985; 6: 359-365
        • Yong G.
        • Khairy P.
        • DeGuise P.
        • et al.
        Pulmonary arterial hypertension in patients with transcatheter closure of secundum atrial septal defects: a longitudinal study.
        Circ Cardiovasc Interv. 2009; 2: 455-462
        • Beigel R.
        • Cercek B.
        • Luo H.
        • Siegel R.J.
        Noninvasive evaluation of right atrial pressure.
        J Am Soc Echocardiogr. 2013; 26: 1033-1042
        • Abbas A.E.
        • Fortuin F.D.
        • Schiller N.B.
        • et al.
        A simple method for noninvasive estimation of pulmonary vascular resistance.
        J Am Coll Cardiol. 2003; 4: 1021-1027
        • Pirat B.
        • McCulloch M.L.
        • Zoghbi W.A.
        Evaluation of global and regional right ventricular systolic function in patients with pulmonary hypertension using a novel speckle tracking method.
        Am J Cardiol. 2006; 98: 699-704
        • Teske A.J.
        • DeBoeck B.W.
        • Olimulder M.
        • et al.
        Echocardiographic assessment of regional right ventricular function: a head-to-head comparison between 2-dimensional and tissue Doppler-derived strain analysis.
        J Am Soc Echocardiogr. 2008; 21: 275-283
        • Vitarelli A.
        • Sardella G.
        • Roma A.D.
        • et al.
        Assessment of right ventricular function by three-dimensional echocardiography and myocardial strain imaging in adult atrial septal defect before and after percutaneous closure.
        Int J Cardiovasc Imaging. 2012; 28: 1905-1916
        • Vitarelli A.
        • Terzano C.
        Do we have two hearts? New insights in right ventricular function supported by myocardial imaging echocardiography.
        Heart Fail Rev. 2010; 15: 39-61
        • Vitarelli A.
        • Barillà F.
        • Capotosto L.
        • et al.
        Right ventricular function in acute pulmonary embolism: a combined assessment by three-dimensional and speckle tracking echocardiography.
        J Am Soc Echocardiogr. 2014; 27: 329-338
        • Kalogeropoulos A.P.
        • Georgiopoulou V.V.
        • Howell S.
        • et al.
        Evaluation of right intraventricular dyssynchrony by two-dimensional strain echocardiography in patients with pulmonary arterial hypertension.
        J Am Soc Echocardiogr. 2008; 21: 1028-1034
        • Punjabi N.M.
        • Newman A.B.
        • Young T.B.
        • Resnick H.E.
        • Sanders M.H.
        Sleep-disordered breathing and cardiovascular disease: an outcome-based definition of hypopneas.
        Am J Respir Crit Care Med. 2008; 177: 1150-1155
        • Barbé F.
        • Durán Cantolla J.
        • Capote F.
        • et al.
        Long-term effect of continuous positive airway pressure in hypertensive patients with sleep apnea.
        Am J Respir Crit Care Med. 2010; 181: 718-726
        • Romero-Corral A.
        • Somers V.K.
        • Pellikka P.A.
        • et al.
        Decreased right and left ventricular myocardial performance in obstructive sleep apnea.
        Chest. 2007; 132: 1863-1870
        • Shivalkar B.
        • Van de Heyning C.
        • Kerremans M.
        • et al.
        Obstructive sleep apnea syndrome: more insights on structural and functional cardiac alterations, and the effects of treatment with continuous positive airway pressure.
        J Am Coll Cardiol. 2006; 47: 1433-1439
        • Dursunoglu N.
        • Dursunoglu D.
        • Ozkurt S.
        • et al.
        Effects of CPAP on right ventricular myocardial performance index in obstructive sleep apnea patients without hypertension.
        Respir Res. 2006; 7: 22-30
        • Guidry U.C.
        • Mendes L.A.
        • Evans J.C.
        • et al.
        Echocardiographic features of the right heart in sleep-disordered breathing: the Framingham Heart Study.
        Am J Respir Crit Care Med. 2001; 164: 933-938
        • Arias M.A.
        • García Río F.
        • Alonso Fernández A.
        • Martínez I.
        • Villamor J.
        Pulmonary hypertension in obstructive sleep apnoea: effects of continuous positive airway pressure: a randomized, controlled cross-over study.
        Eur Heart J. 2006; 27: 1106-1113
        • Sajkov D.
        • McEvoy R.D.
        Obstructive sleep apnea and pulmonary hypertension.
        Prog Cardiovasc Dis. 2009; 51: 363-370
        • Minic M.
        • Granton J.T.
        • Ryan C.M.
        Sleep disordered breathing in group 1 pulmonary arterial hypertension.
        J Clin Sleep Med. 2014; 10: 277-283
        • Chung F.
        • Chau E.
        • Yang Y.
        • et al.
        Serum bicarbonate level improves specificity of STOP-Bang screening for obstructive sleep apnea.
        Chest. 2013; 143: 1284-1293
        • Kawata N.
        • Tatsumi K.
        • Terada J.
        • et al.
        Daytime hypercapnia in obstructive sleep apnea syndrome.
        Chest. 2007; 132: 1832-1838
        • Risum N.
        • Ali S.
        • Olsen N.T.
        • et al.
        Variability of global left ventricular deformation analysis using vendor dependent and independent two-dimensional speckle-tracking software in adults.
        J Am Soc Echocardiogr. 2012; 25: 1195-1203
        • Yamanaka Funabiki K.
        • Onishi K.
        • Tanabe M.
        • et al.
        Single beat determination of regional myocardial strain measurements in patients with atrial fibrillation.
        J Am Soc Echocardiogr. 2006; 19: 1332-1337
        • Ristow B.
        • Schiller N.B.
        Obtaining accurate hemodynamics from echocardiography: achieving independence from right heart catheterization.
        Curr Opin Cardiol. 2010; 25: 437-444