Obstructive sleep apnea and right ventricular function: A meta-analysis of speckle tracking echocardiographic studies

The authors investigated the association between obstructive sleep apnea (OSA) and right ventricular (RV) systolic dysfunction trough a meta-analysis of echocardiographic studies providing data on RV mechanics as assessed by longitudinal strain (LS). A systematic search was conducted using PubMed, OVID-MEDLINE, and Cochrane library databases to search English-language review papers published from inception to March 31, 2022. Only studies reporting data on RV free-wall or global LS in patients with OSA of different severity and non-OSA controls were reviewed. Data of interest were pooled to obtain standard means difference (SMD) with 95% confidence interval (CI). The meta-analysis included 628 participants (436 with OSA and 192 controls) from eight studies. Compared to controls, RV free wall LS was significantly reduced in the pooled OSA group (SMD 1.02 ± .33, CI:.17/1.24, P < .002); this was also the case for RV global LS (SMD: .72 ± .11, CI: .50/.93, P < .0001). Notably, compared to patients with mild-OSA those with moderate and severe OSA exhibited significantly lower RV free-wall LS and global LS values; this was not the case for tricuspid annular plane excursion. In conclusions, both RV free-wall and global LS are impaired in patients with OSA; deterioration of these indices, unlike TAPSE, was already evident in the early stages and was related to the severity of the syndrome. Thus, RV myocardial strain should be considered to be included in echocardiographic evaluation of OSA patients in order to detect subclinical cardiac damage in these patients regardless of its degree of severity.