The Relationship Between Obstructive Sleep Apnea Severity and Right Heart Cavities Echocardiographic Features

Year 2025, Volume: 15 Issue: 2, 157 - 163, 31.08.2025

Ayça Arslan , Doğan İliş , İhsan Topaloğlu , İnanç Artaç , Muammer Karakayalı , Timor Omar , Mehmet Hakan Şahin , Muzaffer Karadeniz Yavuz Karabağ , İbrahim Rencüzoğulları

Abstract

Aim: Obstructive sleep apnea (OSA) has been attributed to an increased risk of cardiovascular disease and death from all causes. It has been demonstrated that OSA affects the right ventricle’s (RV) diastolic and systolic functioning, with diastolic dysfunction usually appearing before systolic failure. Delaying the progression of right ventricular failure may be clinically beneficial if RV diastolic insufficiency is accurately assessed and treated early. This study aimed to investigate right ventricular diastolic function in patients with OSA and its relationship with disease severity.
Material and Method: The study comprised 88 participants with an OSA diagnosis who had transthoracic echocardiography. Based on their apnea and hypopnea index, the individuals were split into two groups as mild-moderate OSA (mild; apnea and hypopnea index 5–14 events/hour, moderate; apnea and hypopnea index 15–29 events/hour) and severe OSA (apnea and hypopnea index ≥30 events/hour).
Results: The severe group consisted of forty-three people, whereas the mild-to-moderate group had forty-five. The right atrial volume index (RAVI) (13.26±4.81 mL/m² vs. 24.24±10.75 mL/ m2; p <0.001) and E/Em tricuspid ratio (5.70±2.32 vs. 7.21±3.83; p=0.046) of the severe group were substantially higher than those of the mild-moderate group.
Conclusion: The severity of OSA can be accurately predicted using the echocardiographic measures RAVI and tricuspid E/Em, which are practical, affordable, and easily available.

Keywords

obstructive sleep apnea , right ventricular diastolic dysfunction , right atrial volume index

References

• 1. Jordan AS, McSharry DG, Malhotra A. Adult obstructive sleep apnoea. Lancet. 2014;383:736–747.
• 2. Kendzerska T, Mollayeva T, Gershon AS, Leung RS, Hawker G, Tomlinson G. Untreated obstructive sleep apnea and the risk for serious long-term adverse outcomes: a systematic review. Sleep Med Rev. 2014. ;18(1):49–59.
• 3. Herod JW, Ambardekar AV. Right ventricular systolic and diastolic function as assessed by speckle-tracking echocardiography improve with prolonged isolated left ventricular assist device support. J Card Fail. 2014;20(7):498–505.
• 4. Sallach JA, Tang WH, Borowski AG, Tong W, Porter T, Martin MG, et al. Right atrial volume index in chronic systolic heart failure and prognosis. JACC Cardiovasc Imaging. 2009;2(5):527–34.
• 5. Güvenç TS, Hüseyinoğlu N, Özben S, Kul Ş, Çetin R, Özen K, 163 et al. Right ventricular geometry and mechanics in patients with obstructive sleep apnea living at high altitude. Sleep Breath. 2016;20(1):5–13.
• 6. Sascău R, Zota IM, Stătescu C, Boișteanu D, Roca M, Maștaleru A, et al. Review of Echocardiographic Findings in Patients with Obstructive Sleep Apnea. Can Respir J. 2018;2018:1206217.
• 7. American Academy of Sleep Medicine. https://aasm.org/ resources/factsheets/sleepapnea.pdf Accessed January 17, 2022.
• 8. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. (2015)Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 16(3):233–270.
• 9. Zakhama L, Herbegue B, Abouda M, Antit S, Slama I, Boussabah E, et al. Impact of obstructive sleep apnea on the right ventricle. Tunis Med. 2016;94(10):612–615.
• 10. Altekin RE, Karakas MS, Yanikoglu A, Ozel D, Ozbudak O, Demir I, et al. Determination of right ventricular dysfunction using the speckle tracking echocardiography method in patients with obstructive sleep apnea. Cardiol J. 2012;19(2):130–9.
• 11. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, 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(7):685–713; quiz 786–8.
• 12. Li J, Lin X, Li H, Lu C, Li R, Liu W, et al. Right ventricular diastolic dysfunction in patients with obstructive sleep apnea syndrome. Echocardiography. 2020;37(2):317–322.
• 13. Scotti C, Porta R, Olivares A, Comini L, Cinelli A, Scalvini S, et al. Nocturnal hypoxemia impacts right ventricle diastolic function in obstructive sleep apnea: a retrospective observational Study. J Clin Med. 2020;9(1):162.
• 14. Li J, Wang Z, Li Y, Meng Y, Li R, Wang W, et al. Assessment of regional right ventricular systolic function in patients with obstructive sleep apnea syndrome using velocity vector imaging. Medicine (Baltimore) . 2016;95(37):e4788.
• 15. Leite AR, Martinez DM, Garcia-Rosa ML, Macedo EA, Lagoeiro AJ, Martins WA, et al. Risk of Obstructive Sleep Apnea and Echocardiographic Parameters. Arq Bras Cardiol. 2019;113(6):1084–1089.
• 16. Tadic M, Cuspidi C, Grassi G, Mancia G. Obstructive sleep apnea and cardiac mechanics: how strain could help us. Heart Fail Rev. 2021;26(4):937–45.
• 17. Young T, Shahar E, Nieto FJ, Redline S, Newman AB, Gottlieb DJ, et al. Sleep Heart Health Study Research Group. Predictors of sleepdisordered breathing in community-dwelling adults: the Sleep Heart Health Study. Arch Intern Med. 2002;162(8):893–900.
• 18. Fattal D, Hester S, Wendt L. Body weight and obstructive sleep apnea: a mathematical relationship between body mass index and apnea-hypopnea index in veterans. J Clin Sleep Med. 2022;18(12):2723–2729.
• 19. Ming X, Yang M, Chen X. Metabolic bariatric surgery as a treatment for obstructive sleep apnea hypopnea syndrome: review of the literature and potential mechanisms. Surg Obes Relat Dis. 2021. ;17(1):215–220.