Comparison of right ventricular functions by tissue Doppler imaging in patients with obstructive sleep apnea syndrome with or without hypertension.
OBJECTIVE
To evaluate the right ventricular function in patients with obstructive sleep apnea syndrome (OSAS) independent from systemic hypertension (HT) and to determine the association between OSAS severity and right ventricular dysfunction.


METHODS
The study population included 77 consecutive subjects; 20 of these patients had OSAS, 20 of them had HT, but did not have OSAS, 16 patients, who constituted the study group, had both disorders, and 21 subjects without any of these two disorders represented the control group. Right ventricular function was assessed by echocardiography: standard two-dimensional, M-Mode, and conventional Doppler as well as tissue Doppler imaging. None of the patients had a previous history of cardiac disease. The diagnosis of OSAS was based on an apnea- hipopnea index of 5 or higher in polysomnography.


RESULTS
Tricuspid inflow velocities and tissue Doppler derived tricuspid annular diastolic velocities were significantly different in the patient groups (OSAS, HT, OSAS + HT) compared to the control group. Tricuspid annular plane systolic excursion (TAPSE) (18.3 +/- 3.2, 18.4 +/- 2.5, 20.1 +/- 2.1, and 20.7 +/- 2.5 mm, respectively, P = 0.024) and peak systolic myocardial velocity at tricuspid lateral annulus (S-vel) (12.2 +/- 1.5, 10.9 +/- 0.9, 11.2 +/- 1.1, and 13.1 +/- 2.1 cm/s, respectively, P < 0.001) were significantly lower in patient groups compared to those of the study group. Tissue Doppler derived myocardial performance index (MPI) of the right ventricle was significantly impaired in the patient groups compared to the control group (0.34 +/- 0.06, 0.44 +/- 0.06, 0.45 +/- 0.07, and 0.41 +/- 0.06, respectively, P < 0.001). With regard to these right ventricular functional parameters, there was no significant difference between OSAS and the other patient groups (HT and OSAS + HT). There were significant correlations both between OSAS severity and the right ventricular functions, and between diastolic and systolic parameters of the right ventricle (r = -0.45, P < 0.05).


CONCLUSIONS
Both right ventricular systolic and diastolic functions are impaired in patients having OSAS with or without HT. Right ventricular MPI was found to be the parameter most closely related with OSAS severity and the right ventricular subclinical dysfunction.
Tavil
Yusuf
Y
Department of Cardiology, Gazi University Medical School, Erzurum m. Gul s. 5/23, Cebeci, Ankara, Turkey. yusuftavil@gmail.com
Kanbay
Asiye
A
Sen
Nihat
N
Ciftçi
Tansu Ulukavak
TU
Abaci
Adnan
A
Yalçin
M Ridvan
MR
Köktürk
Oğuz
O
Cengel
Atiye
A
D000328:Adult; D003971:Diastole; D018618:Echocardiography, Doppler, Color; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D012107:Research Design; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D013599:Systole; D014261:Tricuspid Valve / Q000000981:diagnostic imaging; D016278:Ventricular Function, Right