Assessment of Biventricular Function in Patients with Obstructive Sleep Apnea and Atrial Fibrillation: A Cross-sectional Study Using Two-dimensional Speckle Tracking Imaging

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Mghaieth Zghal Fathia
Boudiche Selim
Sammoud Kais
Ayari Jihen
Ben Ammar Jihen
Rekik Bassem
Farhati Abdeljelil
Ouali Sana
Larbi Noureddine
Ben Halima Manel
Mourali Mohamed Sami

Abstract

Background: Obstructive sleep apnea syndrome (OSA) is a common but often under diagnosed condition. According to literature, OSA prevalence in atrial fibrillation (AF) patients varies from 21 to 85%. OSA is increasingly recognized as a risk factor for biventricular dysfunction. The present study aimed to compare left and right ventricular functions, assessed by conventional echocardiographic parameters and speckle tracking imaging, in non-valvular atrial fibrillation (NVAF) patients with and without severe OSA.

Methods: A cross-sectional analytic study was conducted. Forty successive patients with NVAF were included. All of them had a clinical screening for symptoms suggestive of OSA and underwent polysomnographic study. Patients were divided into two groups (group 1: without severe OSA with an apnea-hypopnea index (AHI) < 30 events per hour (e/h), and group 2: having severe OSA with an AHI ≥ 30 e/h). Echocardiography was performed in all patients. Left and right ventricular function parameters were measured including global longitudinal strain (GLS) and myocardial performance index (MPI).

Results: OSA was diagnosed in 90% of NVAF patients. The average AHI was 22.1 ± 13 e/h. Eleven patients (27.5%) had mild OSA, 9 patients (22.5%) had moderate OSA, and 16 patients (40%) had severe OSA. General clinical characteristics were comparable between groups. A statistically significant association was demonstrated between severe OSA and impairment of left ventricular GLS (-17.3 ± 4.5 vs. -14.9 ± 3%, in group 1 and 2 respectively, p = 0.02) and left ventricular MPI (0.37 ± 0.09 vs. 0.49 ± 0.13, in group 1 and 2 respectively, p = 0.01). Right ventricular lateral wall strain was non significantly lower in group 1 compared to group 2 (-22.5 ± 8.4 vs. -18.4 ± 5.8%, in group 1 and 2 respectively, p = 0.15). On multivariate logistic regression analysis, left ventricular GLS impairment (> -18%) and MPI > 0.37 were independent predictors of severe OSA.

Conclusion: Severe OSA was diagnosed in 40% of NVAF patients. Impairment of left ventricular GLS and left MPI were statistically associated with severe OSA.

Keywords:
Obstructive sleep apnea, atrial fibrillation, left ventricle, right ventricle, echocardiography.

Article Details

How to Cite
Fathia, M. Z., Selim, B., Kais, S., Jihen, A., Jihen, B. A., Bassem, R., Abdeljelil, F., Sana, O., Noureddine, L., Manel, B. H., & Sami, M. M. (2019). Assessment of Biventricular Function in Patients with Obstructive Sleep Apnea and Atrial Fibrillation: A Cross-sectional Study Using Two-dimensional Speckle Tracking Imaging. Journal of Advances in Medicine and Medical Research, 30(10), 1-12. https://doi.org/10.9734/jammr/2019/v30i1030240
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Original Research Article