Zakhama Lilia, Herbegue Besma, Abouda Maher, Antit Saoussen, Slama Iskander, Boussabah Elhem, Thameur Moez, Masmoudi Mourad, Abdelaali Nabil, Charfi Mohamed Ridha, Ben Youssef Soraya
Tunis Med. 2016 Oct;94(10):612-615.
Right ventricular (RV) involvement in obstructive sleep apnea syndrome (OAS) is controversial. The aim of this study was to determine a correlation between echocardiographic parameters of RV function and severity of OSA assessed by the apnea- hypopnea index (AHI).
Sixty patients with suspected OSA were enrolled. All patients had overnight polygraphy and an echocardiographic assessment of RV structure and function. Patients were divided into three groups: a control group (n=20) with an AHI<5/h, a group of mild to moderate OSA (n=18) with an AHI=5-30/h and a group of severe OSA (n=22) with AHI≥30/h.
There were no differences of age, body mass index and sex among the three groups. There was no difference in systolic pulmonary pressure. RV free wall thickness, end-diastolic surface and right atrium surface were statistically higher in OSA patients compared with controls. The peak systolic myocardial velocity at tricuspid lateral annulus S' were significantly lower in patients compared with controls (14.5±3 vs 12.2±2 cm / s, p<0.001; respectively). This decrease was greater in patients with severe OSA compared with mild to moderate OSA (11.4±3 vs 13.0±1 cm/s, p=0.05, respectively). Right ventricular myocardial performance index (MPI) was significantly higher in OSA compared with controls (0.55±0.12 vs 0.46±0.14, p=0.024, respectively) but it was not correlated with the severity of IAH.
In OSA patients, there was a significant RV dysfunction independently of pulmonary pressure, although the correlation with the severity of IAH was moderate.
右心室（RV）受累于阻塞性睡眠呼吸暂停综合征（OSA）存在争议。本研究的目的是确定右心室功能的超声心动图参数与通过呼吸暂停低通气指数（AHI）评估的阻塞性睡眠呼吸暂停严重程度之间的相关性。
纳入60例疑似阻塞性睡眠呼吸暂停患者。所有患者均进行了夜间多导睡眠监测及右心室结构和功能的超声心动图评估。患者分为三组：对照组（n = 20），AHI<5次/小时；轻度至中度阻塞性睡眠呼吸暂停组（n = 18），AHI = 5 - 30次/小时；重度阻塞性睡眠呼吸暂停组（n = 22），AHI≥30次/小时。
三组患者的年龄、体重指数和性别无差异。收缩期肺动脉压无差异。与对照组相比，阻塞性睡眠呼吸暂停患者的右心室游离壁厚度、舒张末期面积和右心房面积在统计学上更高。与对照组相比，患者三尖瓣侧环处的收缩期心肌峰值速度S'显著降低（分别为14.5±3对12.2±2 cm/s，p<0.001）。与轻度至中度阻塞性睡眠呼吸暂停患者相比，重度阻塞性睡眠呼吸暂停患者的这种降低更大（分别为11.4±3对13.0±1 cm/s，p = 0.05）。与对照组相比，阻塞性睡眠呼吸暂停患者的右心室心肌做功指数（MPI）显著更高（分别为0.55±0.12对0.46±0.14，p = 0.024），但它与IAH的严重程度无关。
在阻塞性睡眠呼吸暂停患者中，存在显著的右心室功能障碍，且与肺动脉压无关，尽管与IAH严重程度的相关性为中度。
