Understanding the role of echocardiography in patients with obstructive sleep apnea and right ventricular subclinical myocardial dysfunction – comparison with other conditions affecting RV deformation

Despite efforts to treat obstructive sleep apnea syndrome (OSA), the condition remains an important risk factor in the development of cardiovascular disease. Early detection of RV dysfunction with novel echocardiographic techniques (speckle tracking echocardiography) may be useful in preventing progression to pulmonary hypertension, with subsequent heart failure and cardiovascular death. Echocardiography is the method of choice for the evaluation of OSA consequences on the heart. Although standard echocardiographic parameters are routinely used in these patients, there are several limitations in the early detection of RV dysfunction. The main concerns are the complex geometry of RV and the impact of pre- and afterload on RV myocardium, which cannot be assessed through standard measurements. The aim of this review is to highlight the utility of advanced echocardiographic parameters in the identification of OSA patients with subclinical myocardial dysfunction, which are at risk of developing heart failure and later adverse events. Speckle tracking echocardiography might provide higher sensitivity in unmasking alterations in RV function when conventional echocardiographic methods cannot detect them. Therefore, this method has a major role in the detection of early stages of RV dysfunction, along with better risk stratification and better timing in the initiation of therapy.