Impact of untreated obstructive sleep apnea on left and right ventricular myocardial function and effects of CPAP therapy

Christoph Hammerstingl, Robert Schueler, Martin Wiesen, Diana Momcilovic, Stefan Pabst, Georg Nickenig, Dirk Skowasch, Christoph Hammerstingl, Robert Schueler, Martin Wiesen, Diana Momcilovic, Stefan Pabst, Georg Nickenig, Dirk Skowasch

Abstract

Background: Obstructive sleep apnea (OSA) has deteriorating effect on LV function, whereas its impact on RV function is controversial. We aimed to determine the effect of OSA and continuous positive airway pressure (CPAP) treatment on left and right ventricular (LV, RV) function using transthoracic echocardiography (TTE) and 2 dimensional speckle tracking (2D ST) analysis of RV deformation capability.

Methods and results: 82 patients with OSA and need for CPAP therapy were prospectively enrolled and underwent TTE at study inclusion and after 6 months of follow up (FU). Multivariate regression analysis revealed an independent association between baseline apical right ventricular longitudinal strain (RV-Sl), BMI and the severity of OSA (apical RV-Sl: P = 0.0002, BMI: P = 0.02). After CPAP therapy, LV functional parameters (LVEF: P<0.0001, LV performance index: P = 0.03, stroke volume: P = 0.042), and apical RV-Sl (P = 0.001) improved significantly. The effect of CPAP therapy was related to severity of OSA (LVEF: AHI 5-14, 66.4 ± 8.8%, 68.5 ± 10.6% [P = ns]; AHI 15-30:59.8 ± 7.7%, 68.6 ± 9.3% [P = 0.002]; AHI>30:54.1 ± 12.4%, 68.2 ± 13.6%[P<0.0001]; apical RV-Sl: AHI 5-14: -17.3 ± 8.7%, -16.0 ± 10.8% [P = ns], AHI 15-30: -9.8 ± 6.0%, -15.4 ± 10.9% [P = 0.028], AHI>30: -6.3 ± 5.7%, -17.9 ± 11.2% [P<0.0001]).

Conclusions: OSA seems to have deteriorating effect on LV and RV function. We found a beneficial effect of CPAP on LV and RV functional parameters predominately in patients with severe OSA. 2D speckle tracking might be of value to determine early changes in global and regional right ventricular function.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Scatter plot - Correlation of…
Figure 1. Scatter plot - Correlation of AHI to baseline data.
(A) Correlation of AHI to BMI, (B) Correlation of AHI to LVEF, (C) Correlation of AHI global RV-Sl, (D) Correlation of AHI to apical RV-Sl. 2D RV-Sl, two dimensional right ventricular longitudinal strain; AHI, apnea hypopnea index; BMI, body mass index; LVEF, left ventricular ejection fraction.
Figure 2. Comparative receiver operating characteristic (ROC)…
Figure 2. Comparative receiver operating characteristic (ROC) curves analysis of BMI and apical 2D RV-Sl for the identification of patients with an AHI>30.
2D RV-Sl, two dimensional right ventricular strain; AHI, apnea hypopnea index; P, significance of difference between the two curves.
Figure 3. Boxplot - Development of left…
Figure 3. Boxplot - Development of left ventricular ejection fraction after CPAP according to AHI groups.
AHI, apnea hypopnea index; LVEF, left ventricular ejection fraction; ns, not significant.
Figure 4. Boxplot - Development of apical…
Figure 4. Boxplot - Development of apical RV-Sl after CPAP according to AHI groups.
2D RV-Sl, two dimensional right ventricular strain; AHI, apnea hypopnea index; ns, not significant.

References

    1. Park JG, Ramar K, Olson EJ (2011) Updates on definition, consequences, and management of obstructive sleep apnea. Mayo Clin Proc 86: 549–55.
    1. Somers VK, White DP, Amin R, Abraham WT, Costa F, et al. (2008) Sleep apnea and cardiovascular disease: an American Heart Association/american College Of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council On Cardiovascular Nursing. In collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health). Circulation 118: 1080–111.
    1. Masood A, Phillips B (2000) Sleep apnea. Curr Opin Pulm Med 6: 479–84.
    1. Bradley TD, Floras JS (2009) Obstructive sleep apnoea and its cardiovascular consequences. Lancet 373: 82–93.
    1. Lopez-Jimenez F, Sert Kuniyoshi FH, Gami A, Somers VK (2008) Obstructive sleep apnea: implications for cardiac and vascular disease. Chest 133: 793–804.
    1. Haruki N, Takeuchi M, Nakai H, Kanazawa Y, Tsubota N, et al. (2009) Overnight sleeping induced daily repetitive left ventricular systolic and diastolic dysfunction in obstructive sleep apnoea: quantitative assessment using tissue Doppler imaging. Eur J Echocardiogr 10: 769–75.
    1. Kim SH, Cho GY, Shin C, Lim HE, Kim YH, et al. (2008) Impact of obstructive sleep apnea on left ventricular diastolic function. Am J Cardiol 101: 1663–8.
    1. Jurcut R, Giusca S, La GA, Vasile S, Ginghina C, et al. (2010) The echocardiographic assessment of the right ventricle: what to do in 2010? Eur J Echocardiogr 11: 81–96.
    1. American Academy of Sleep Medicine (2005) International classification of sleep disorders, 2nd edition: Diagnostic and coding manual. 298 p.
    1. German Society of Sleep Research and Sleep medicine (DGSM) (2009) S3 guidelines on non restorative sleep/sleep disorders. Somnologie 13: 1–160.
    1. Douglas PS, Garcia MJ, Haines DE, Lai WW, Manning WJ, et al. (2011) Appropriate Use Criteria for Echocardiography. J Am Soc Echocardiogr 24: 229–67.
    1. Gottdiener JS, Bednarz J, Devereux R, Gardin J, Klein A, et al. (2004) American Society of Echocardiography recommendations for use of echocardiography in clinical trials. J Am Soc Echocardiogr 17: 1086–119.
    1. Tei C, Ling LH, Hodge DO, Bailey KR, Oh JK, et al. (1995) New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function–a study in normals and dilated cardiomyopathy. J Cardiol 26: 357–66.
    1. Tei C, Dujardin KS, Hodge DO, Bailey KR, McGoon MD, et al. (1996) Doppler echocardiographic index for assessment of global right ventricular function. J Am Soc Echocardiogr 9: 838–47.
    1. Rydman R, Soderberg M, Larsen F, Caidahl K, Alam M (2010) Echocardiographic evaluation of right ventricular function in patients with acute pulmonary embolism: a study using tricuspid annular motion. Echocardiography 27: 286–93.
    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 (1999) Sleep. 22: 667–89.
    1. Usui Y, Takata Y, Inoue Y, Tomiyama H, Kurohane S, et al. (2013) A. Severe obstructive sleep apnea impairs left ventricular diastolic function in non-obese men. Sleep Med 14: 155–9.
    1. Koshino Y, Villarraga HR, Orban M, Bruce CJ, Pressman GS, et al. (2010) Changes in left and right ventricular mechanics during the Mueller maneuver in healthy adults: a possible mechanism for abnormal cardiac function in patients with obstructive sleep apnea. Circ Cardiovasc Imaging 3: 282–9.
    1. Chami HA, Devereux RB, Gottdiener JS, Mehra R, Roman MJ, et al. (2008) Left ventricular morphology and systolic function in sleep-disordered breathing: the Sleep Heart Health Study. Circulation117: 2599–607.
    1. Kim SH, Cho GY, Shin C, Lim HE, Kim YH, et al. (2008) Impact of obstructive sleep apnea on left ventricular diastolic function. Am J Cardiol 101: 1663–8.
    1. Hammerstingl C, Schueler R, Wiesen M, Momcilovic D, Pabst S, et al. (2012) Effects of untreated obstructive sleep apnea on left and right ventricular myocardial function. Int J Cardiol 155: 465–9.
    1. Bradley TD (1992) Right and left ventricular functional impairment and sleep apnea. Clin Chest Med 13: 459–79.
    1. Berman EJ, DiBenedetto RJ, Causey DE, Mims T, Conneff M, et al. (1991) Right ventricular hypertrophy detected by echocardiography in patients with newly diagnosed obstructive sleep apnea. Chest 100: 347–50.
    1. Guidry UC, Mendes LA, Evans JC, Levy D, O’Connor GT, et al. (2001) Echocardiographic features of the right heart in sleep-disordered breathing: the Framingham Heart Study. Am J Respir Crit Care Med164: 933–8.
    1. Romero-Corral A, Somers VK, Pellikka PA, Olson EJ, Bailey KR, et al. (2007) Decreased right and left ventricular myocardial performance in obstructive sleep apnea. Chest 132: 1863–70.
    1. Sanner BM, Konermann M, Sturm A, Muller HJ, Zidek W (1997) Right ventricular dysfunction in patients with obstructive sleep apnoea syndrome. Eur Respir J 10: 2079–83.
    1. Colish J, Walker JR, Elmayergi N, Almutairi S, Alharbi F, et al. (2012) Obstructive sleep apnea: Effects of continuous positive airway pressure on vardiac biomarkers, echocardiography, and cardiac MRI. Chest 141: 674–81.
    1. Chan JY, Li AM, Au CT, Lo AF, Ng SK, et al. (2009) Cardiac remodelling and dysfunction in children with obstructive sleep apnoea: a community based study. Thorax 64: 233–9.
    1. Kim SH, Cho GY, Shin C, Lim HE, Kim YH, et al. (2008) Impact of obstructive sleep apnea on left ventricular diastolic function. Am J Cardiol 101: 1663–8.
    1. Shivalkar B, Van de HC, Kerremans M, Rinkevich D, Verbraecken J, et al. (2006) 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 47: 1433–9.
    1. Butt M, Dwivedi G, Shantsila A, Khair OA, Lip GY (2012) Left ventricular systolic and diastolic function in obstructive sleep apnea: impact of continuous positive airway pressure therapy. Circ Heart Fail 5: 226–33.
    1. (32) Altekin RE, Karakas MS, Yanikoglu A, Ozel D, Ozbudak O, et al (2012) Determination of right ventricular dysfunction using the speckle tracking echocardiography method in patients with obstructive sleep apnea. Cardiol J 19: 130–9.
    1. Jurcut R, Giusca S, La GA, Vasile S, Ginghina C, et al. (2010) The echocardiographic assessment of the right ventricle: what to do in 2010? Eur J Echocardiogr 11: 81–96.
    1. D’hooge J, Heimdal A, Jamal F, Kukulski T, Bijnens B, et al. (2000) Regional strain and strain rate measurements by cardiac ultrasound: principles, implementation and limitations. Eur J Echocardiogr 1: 154–70.
    1. Becker M, Bilke E, Kuhl H, Katoh M, Kramann R, et al. (2006) Analysis of myocardial deformation based on pixel tracking in two dimensional echocardiographic images enables quantitative assessment of regional left ventricular function. Heart 92: 1102–8.
    1. Langeland S, D’hooge J, Wouters PF, Leather HA, Claus P, et al. (2005) Experimental validation of a new ultrasound method for the simultaneous assessment of radial and longitudinal myocardial deformation independent of insonation angle. Circulation 112: 2157–62.
    1. Artis NJ, Oxborough DL, Williams G, Pepper CB, Tan LB (2008) Two-dimensional strain imaging: a new echocardiographic advance with research and clinical applications. Int J Cardiol 123: 240–8.
    1. Weidemann F, Kowalski M, D’hooge J, Bijnens B, Sutherland GR (2001) Doppler myocardial imaging. A new tool to assess regional inhomogeneity in cardiac function. Basic Res Cardiol 96: 595–605.
    1. Teske AJ, Cox MG, De Boeck BW, Doevendans PA, Hauer RN, et al. (2009) Echocardiographic tissue deformation imaging quantifies abnormal regional right ventricular function in arrhythmogenic right ventricular dysplasia/cardiomyopathy. J Am Soc Echocardiogr 22: 920–7.
    1. Dambrauskaite V, Delcroix M, Claus P, Herbots L, D’hooge J, et al. (2007) Regional right ventricular dysfunction in chronic pulmonary hypertension. J Am Soc Echocardiogr 20: 1172–80.
    1. Fernandez-Friera L, Garcia-Alvarez A, Guzman G, Bagheriannejad-Esfahani F, Malick W, et al. (2011) Apical right ventricular dysfunction in patients with pulmonary hypertension demonstrated with magnetic resonance. Heart 97: 1250–6.
    1. Lopez-Candales A, Rajagopalan N, Gulyasy B, Edelman K, Bazaz R (2009) Differential strain and velocity generation along the right ventricular free wall in pulmonary hypertension. Can J Cardiol 25: e73–e77.

Source: PubMed

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