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 echocardio- graphic 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 inter- val (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; dete- rioration 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 consid- ered 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.