Right Ventricular Remodeling and Dysfunction in Obstructive Sleep Apnea: A Systematic Review of the Literature and Meta-Analysis

Table 1

Characteristics of the included studies. RVID: right ventricular basal diameter measured at end-diastole; RVWT: right ventricular wall thickness; RV MPI: right ventricular myocardial performance index; RV S’: tricuspid annular systolic velocity; TAPSE: tricuspid annular plane systolic excursion; RV FAC: right ventricular fractional area change; OSA: obstructive sleep apnea; ESS: Epworth Sleepiness Scale; PSG: polysomnography; AHI: apnea-hypopnea index; PAP: pulmonary artery pressure; N/A: not applicable.

Study	Year of publication	Country	Number of participants	Mean (SD) age (years)	BMI (kg/m^2)	OSA diagnosis (methods; criteria)/control group determination	Mean (SD) ESS score	Mean (SD) AHI	Mean (SD) PAP (mmHg)	RV remodeling and dysfunction measures
Hanly et al. [15]	1992	Canada	31 (OSA)	50 (12.3)	32.8 (7.2)	PSG; AHI < 5 events/h	N/A	49 (25.5)	N/A	RVID, RVWT
			20 (control)	48 (8.8)	26.2 (3.2)	PSG; AHI ≥ 5 events/h	N/A	2.7 (1.6)	N/A
Guidry et al. [16]	2001	USA	90 (OSA)	60 (9)	32 (5)	PSG; RDI > 90th percentile	N/A	42.0 (15.3) (RDI)	N/A	RV FAC, RVWT, RVID
			90 (control)	61 (9)	28 (4)	PSG; RDI < 50th percentile	N/A	4.6 (2.6) (RDI)	N/A
Verbraecken et al. [17]	2005	Belgium	43 (OSA)	55 (11)	31.6 (5.4)	PSG; AHI > 20 events/h	N/A	42 (24)	N/A	RVID, RV MPI, RV S’
			40 (control)	50 (16)	26.4 (2.3)	ESS score = 0 (all)	N/A	N/A	N/A
Dursunoğlu et al. [18]	2005	Turkey	11 (mild OSA)	46.0 (5.6)	30.4 (4.0)	PSG; AHI > 5–< 15 events/h	N/A	25.3 (2.6)	N/A	RVWT, RVID, RV MPI
			18 (moderate-to-severe OSA)	46.5 (4.9)	30.6 (4)	PSG; AHI ≥ 15 events/h	N/A	50.1 (11.6)	N/A
			20 (control)	43.5 (6)	29.3 (2.4)	PSG; AHI < 5 events/h	N/A	5.2 (2.8)	N/A
Shivalkar et al. [19]	2006	Belgium	43 (OSA)	55 (11)	31.6 (5.4)	PSG; AHI ≥ 5 events/h	N/A	N/A	32 (10)	RVID, RV MPI, RV S’
			40 (control)	50 (16)	26.4 (2.3)	ESS score = 0 (all)	N/A	N/A	22 (8)
Kasikcioglu et al. [20]	2007	Turkey	10 (OSA)	42 (6)	30.6 (3.2)	PSG: AHI > 30 events/h	N/A	43.8 (11.7)	N/A	RVID, RV S’
			10 (control)	45 (9)	27.7 (2.6)	Healthy males	N/A	2.1 (1.0)	N/A
Romero-Corral et al. [21]	2007	USA	15 (mild OSA).	59 (14)	33 (6)	PSG; AHI > 5–< 14 events/h	N/A	9.2 (2.9)	33.6 (12.7)	RV MPI, RV FAC
			36 (moderate-to-severe OSA)	63 (14)	33 (5)	PSG; AHI ≥ 15 events/h	N/A	34.9 (17.9)	33.9 (8.4)
			26 (control)	55 (15)	31 (6)	PSG; AHI < 5 events/h	N/A	1.7 (1.4)	34.0 (9.4)
Otto et al. [22]	2007	USA	23 (OSA)	45 (3)	33.7 (0.8)	PSG; AHI ≥ 5 events/h	N/A	50 (7)	N/A	RVID, RV S’
			18 (control)	45 (2)	32.3 (0.9)	PSG; AHI < 5 events/h	N/A	2 (0.4)	N/A
Tavil et al. [23]	2007	Turkey	20 (OSA)	50 (7)	30 (7)	PSG; AHI ≥ 5 events/h	N/A	31 (29)	N/A	TAPSE, RV S’, RV MPI
			21 (control)	49 (5)	29 (6)	PSG; AHI < 5 events/h	N/A	2 (2)	N/A
Bayram et al. [24]	2008	Turkey	28 (OSA)	44.8 (10.5)	29.7 (5.3)	PSG; AHI ≥ 15 events/h	N/A	62.3 (21.6)	N/A	RVID, RV S’,
			18 (control)	41.9 (11.5)	27.9 (2.7)	PSG; AHI < 5 events/h	N/A	2.6 (0.8)	N/A
Kepez et al. [25]	2009	Turkey	45 (mild-to-moderate OSA)	48.8 (8.2)	28.4 (3.4)	PSG; AHI > 5–< 30 events/h	N/A	15.0 (13.0)	N/A	RVID, RV S’
			40 (severe OSA)	48.6 (9.2)	31.5 (4.9)	PSG; AHI ≥ 30 events/h	N/A	46.0 (42.0)	N/A
			30 (control)	46.1 (8.7)	27.7 (4.0)	Absence of symptoms of sleep-related disorders	N/A	N/A	N/A
Tugcu et al. [26]	2009	Turkey	41 (OSA)	56 (12)	31.38 (4.97)	PSG; AHI ≥ 15 events/h, ESS score ≥ 10	19.37 (4.30)	38.84 (21.80)	28.20 (4.66)	RVWT, TAPSE, RV MPI, RV S’
			30 (control)	54 (10)	30.10 (3.65)	PSG; AHI < 5 events/h, ESS score < 10	2.60 (2.29)	1.46 (0.68)	24.73 (2.49)
Tugcu et al. [27]	2010	Turkey	27 (OSA)	54 (10)	31.1 (5.1)	PSG; AHI ≥ 15 events/h, ESS score ≥ 10	N/A	40 (22)	26.6 (3.1)	RVWT, RVID, TAPSE, RV S’
			26 (control)	54 (10)	29.6 (3.6)	PSG; AHI < 5 events/h, ESS score < 10	N/A	2 (1)	24.1 (2.3)
Yang et al. [28]	2012	China	77 (mild OSA)	58.4 (0.7)	27.39 (5.74)	PSG; AHI 5–15 events/h, SpO2 nadir 85–89%	N/A	20 (5.6)	28 (6)	RVID, RVWT, RV MPI,
			81 (moderate OSA)			PSG; AHI 15–30 events/h, SpO2 nadir 80–84%	N/A		38 (6)
			62 (severe OSA)			PSG; AHI > 30 events/h, SpO2 nadir <80%	N/A		55 (11)
			75 (control)	59.8 (1.1)	26.32 (4.57)	PSG; AHI < 5 events/h	N/A	2.9 (2)	22 (5)
Altekin et al. [29]	2012	Turkey	20 (mild OSA)	46.95 (6.4)	28.68 (3.44)	PSG; AHI > 5–< 15 events/h	N/A	10.73 (2.57)	27.62 (4.32)	RV MPI, TAPSE
			19 (moderate OSA)	46.79 (5)	29.05 (2.26)	PSG; AHI > 15–< 30 events/h	N/A	20.52 (2.60)	29.78 (4.24)
			19 (severe OSA)	46.68 (7.6)	29.80 (2.38)	PSG; AHI ≥ 30 events/h	N/A	58.1 (16.27)	32.06 (3.71)
			21 (control)	45.38 (4.5)	26.35 (4.14)	ESS score < 10	N/A	N/A	25.61 (5.43)
Hammerstingl et al. [30]	2012	Germany	154 (OSA)	61.7 (12.4)	31.1 (5.8)	PSG; AHI < 5 events/h	10.4 (5.2)	35.9 (28.4)	22.0 (12.6)	TAPSE, RV MPI
			29 (control)	55.7 (15.8)	30.1 (5.5)	PSG; AHI ≥ 5 events/h	7.9 (5.6)	2.3 (1.3)	17.3 (11.9)
Öztuna et al. [31]	2013	Turkey	23 (OSA)	53.6 (7.1)	34.8 (7.8)	PSG; AHI ≥ 15 events/h	9.17 (5.10)	N/A	21.8 (5.9)	RV MPI
			23 (control)	53.7 (6.5)	25.8 (1.7)	ESS score < 10	0.26 (0.54)	N/A	22.1 (4.4)
Araz et al. [32]	2014	Turkey	67 (OSA)	49.7 (12.7)	34.6 (8.3)	PSG; AHI ≥ 5 events/h	10 (4)	52 (6)	41.2 (12.9)	RVID
			31 (control)	49.8 (10.9)	29.5 (7.3)	PSG; AHI < 5 events/h	3 (2)	1.5 (1.4)	25.3 (7.5)
Vitarelli et al. [33]	2015	Italy	10 (mild OSA)	47.9 (10.3)	26.9 (5.8)	PSG; AHI > 5–< 15 events/h	N/A	7.1 (1.9)	25 (6)	TAPSE, RV MPI, RV FAC, RV S’
			8 (moderate OSA)	47.6 (9.1)	27.4 (5.5)	PSG; AHI > 15–< 30 events/h	N/A	19.8 (2.7)	35 (11)
			19 (severe OSA)	48.1 (10.2)	28.2 (6.3)	PSG; AHI ≥ 30 events/h	N/A	58.9 (9.1)	46 (11)
			30 (control)	46.2 (13.4)	26.4 (4.3)	PSG; AHI < 5 events/h	N/A	3.8 (1.4)	22 (3)
Ozkececi et al. [34]	2016	Turkey	30 (OSA)	49.6 (11.7)	31.6 (5.8)	PSG;AHI ≥ 5 events/h	N/A	24.5 (6–98)	22.4 (8.9)	RVID, RV MPI, RV S’, TAPSE
			60 (control)	46.4 (14)	29.3 (4.8)	PSG; AHI < 5 events/h	N/A	1 (1–4)	12.7 (7.5)
Altiparmak et al. [35]	2016	Turkey	52 (OSA)	49 (10)	26.5 (2.1)	PSG; AHI ≥ 5 events/h	N/A	N/A	32.4 (7)	RVID, RVWT, TAPSE, RV S’
			42 (control)	46(7)	25.8(3.3)	PSG; AHI < 5 events/h	N/A	N/A	21.6 (4.3)
Li et al. [36]	2016	China	24 (mild OSA)	47.3 (6.1)	26.40 (3.12)	PSG; AHI > 5–< 15 events/h	N/A	12.72 (2.03)	N/A	RVWT, RVID, TAPSE, RV FAC
			25 (moderate OSA)	47.9 (7.9)	26.83 (3.55)	PSG; AHI > 15–< 30 events/h	N/A	24.01 (3.56)	N/A
			20 (severe OSA)	48.5 (5.4)	27.97 (3.59)	PSG; AHI ≥ 30 events/h	N/A	40.78 (5.02)	N/A
			31 (control)	46.8 (5.4)	24.86 (2.78)	PSG; AHI < 5 events/h	N/A	1.72 (1.01)	N/A
Dobrowolski et al. [37]	2016	Poland	45 (mild OSA)	47.5 (10.5) All	N/A	PSG; AHI > 5–< 15 events/h	N/A	N/A	N/A	TAPSE, RV FAC, RV S’
			27 (moderate OSA)		N/A	PSG; AHI > 15–< 30 events/h	N/A	N/A	N/A
			40 (severe OSA)		N/A	PSG; AHI ≥ 30 events/h	N/A	N/A	N/A
			43 (control)		N/A	PSG; AHI < 5 events/h	N/A	N/A	N/A
Zhou et al. [38]	2016	China	21 (mild OSA)	52.8 (11.9)	29.6 (9.1)	PSG; AHI > 5–< 15 events/h	N/A	N/A	35.7 (6.1)	RV FAC, RV MPI
			19 (moderate OSA)	55.7 (12.4)	35.2 (10.1)	PSG; AHI > 15–< 30 events/h	N/A	N/A	33.4 (5.8)
			23 (severe OSA)	50.2 (12.1)	39.2 (9.8)	PSG; AHI ≥ 30 events/h	N/A	N/A	18.7 (6.9)
			19 (control)	52.0 (10.8)	24.2 (3.7)	PSG; AHI < 5 events/h	N/A	N/A	16.7 (6.2)
D’Andrea et al. [39]	2016	Italy	55 (OSA)	67.8 (11.2)	33.6 (6.6)	PSG; AHI ≥ 5 events/h	N/A	35.1 (15.4)	35.8 (14.4)	RVID, RVWT, TAPSE
			45 (control)	65.9 (12.3)	28.7 (3.6)	Absence of cardiovascular, structural, and functional abnormalities	N/A	N/A	24.8 (11.3)