January 1, 2021Pan African Medical Journal5 citationsOpen Access

Predictive echocardiographic factors of severe obstructive sleep apnea

ITI. Touil HAHassen Ibn Hadj Amor MKM. Kéchida

Structured PICO

Does severe obstructive sleep apnea associate with worse echocardiographic parameters compared to mild to moderate obstructive sleep apnea in patients without cardiopulmonary comorbidities?

Population

93 patients aged over 18 years with polygraphy-proven obstructive sleep apnea (OSA), without any cardiovascular or pulmonary comorbidities (ischemic or valvular heart disease, hypertension, cardiomyopathy or chronic lung disease). Mean age 48.5±9.7 years, 62.2% female. Single-center study in Tunisia.

Intervention

Severe obstructive sleep apnea (AHI ≥ 30/H)

Comparator

Mild to moderate obstructive sleep apnea (5 ≤ AHI < 30/H)

Outcome

Echocardiographic abnormalities including left ventricular diastolic dysfunction, right ventricular internal diameter (RVID), and systolic pulmonary artery pressure (sPAP)surrogate

Severe obstructive sleep apnea is independently associated with right ventricular remodeling and higher systolic pulmonary artery pressure even in patients without known cardiopulmonary comorbidities.

Limitations

Assessment of echocardiographic parameters was performed by different practitioners
Lack of quantitative evaluation of some echocardiographic parameters, such as TAPSE, which were determined by eyeballing process
Use of standard bidimensional echography rather than advanced technologies like Speckle Tracking Echocardiography (STE) and real-time 3D echocardiography

Abstract

INTRODUCTION: obstructive sleep apnea (OSA) is a common chronic pulmonary disease, characterized by repetitive collapse of the upper respiratory airways, leading to oxygen desaturation. This condition is recognized to be associated with cardiovascular disease. Several studies have shown the effects of OSA on both geometry and cardiac function, with conflicting results. We aimed to investigate the relationship between echocardiographic abnormalities and the severity of OSA. METHODS: this is a cross-sectional single center study including patients, without any cardiovascular or pulmonary comorbidities, with polygraphy proven OSA. All participants underwent a detailed transthoracic echocardiography (TTE). RESULTS: a total of 93 patients were included in the study, with 62.2% (n=56) females. According to the apnea hypopnea index (AHI), patients were divided into two groups: mild to moderate OSA (5≤ AHI< 30/H) and severe OSA (AHI≥ 30/H). There were no differences in baseline characteristics between the two groups. The assessment of echocardiographic parameters demonstrated that severe OSA have a higher left ventricular end-systolic (LVES) (47.6±7.2 VS 46.2±4.7), left ventricular end-diastolic (LVED) (31.3±6.2 VS 28.9±4.5) diameters and interventricular septum (IVS) thickness (12.7±2.4 VS11.7±2.5) diameters rather than mild to moderate OSA without a significant difference between the two groups. Furthermore, severe OSA patients had lower mean value of left ventricular ejection fraction (LVEF) and fractional shortening (FS) equal to 62.1±9.7 and 32.5±6.3 respectively. The difference between the two groups was not statistically significant. However, a significant association was shown between severity of OSA and left ventricular (LV) diastolic dysfunction, right ventricular internal diameter (RVID) and systolic pulmonary artery pressure (sPAP), with p=0.05, p=0.05 and p= 0.03 respectively. The RVID was also independently associated to the severity of the OSA (aOR 1.33, 95%CI: 0.99-1.79; p=0.05). CONCLUSION: using bidimensional echocardiography showed a relationship between severe OSA and right ventricular parameters (diastolic dysfunction and RVID) and sPAP.

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