The Value Of Multiple Ultrasound Techniques In Evaluating Right Heart Function In Patients With Obstructive Sleep Apnea Syndrome

Objective: Obstructive sleep apnea hypopnea syndrome(OSAHS)is a common respiratory disease characterized by repeated hypoventilation and apnea during sleep.A large number of literatures mention that OSAHS patients suffer from hypoxemia due to the hypoventilation status of snoring at night and apnea.The chest movement of excessive forced breathing during snoring will cause the change of negative pressure in the chest cavity,leading to changes in the function and structure of the right heart.Early detection of abnormalities in right ventricular structure and function is crucial for screening high-risk patients with OSAHS and preventing disease progression.Blood sampling,myocardial zymography,electrocardiogram,cardiac ultrasound,magnetic resonance imaging,etc.can all be used to evaluate cardiac function.Among the above examination items,cardiac ultrasound has the advantages of non-invasive,radiation dose free,cost-effective,and good repeatability,high patient compliance,and is currently widely used in clinical practice.Two dimensional ultrasound can measure the size of the heart cavity,the thickness of the ventricular wall,and calculate cardiac volume indicators.Doppler ultrasound can measure blood flow velocity at the atrioventricular valve opening,myocardial motion velocity,and time.Spot tracking imaging can quantitatively analyze myocardial strain,myocardial work,and establish a three-dimensional heart model to obtain corresponding volume indicators.By combining the above technologies,cardiac ultrasound can not only understand the layered structure of the heart,It can also observe heart movement status in real-time,qualitatively and quantitatively analyze heart function,and detect cardiac abnormalities.This project analyzes the differences in various indicators of right heart function between OSAHS patients and healthy individuals,as well as the changes in right heart function indicators at different disease levels in OSAHS patients.It explores various echocardiographic techniques such as pulse Doppler,tissue Doppler,spot tracking imaging,and three-dimensional ultrasound to assess the sensitivity of right heart function in OSAHS patients and the clinical value of assessing the severity of OSAHS patients’ condition,Thus providing a reference basis for clinical diagnosis and treatment.Methods: 45 patients with OSAHS confirmed by sleep monitoring were selected from the respiratory department of our hospital from September 2021 to April 2023 as the OSAHS group/observation group.40 healthy target individuals were selected as the control group during the same period of physical examination,and echocardiography was performed on the right heart function of the OSAHS group and control group,including pulse Doppler,tissue Doppler,spot tracking imaging,and three-dimensional ultrasound measurements.Statistical analysis was conducted on various indicators,Comprehensive evaluation combined with multiple ultrasound techniques to assess right ventricular function in OSAHS patients.According to the difference of sleep apnea hypopnea index(AHI)and nocturnal minimum arterial oxygen saturation(Sa O2),patients with OSAHS were divided into three groups: mild OSAHS group(5≤ AHI<15 times/hour,nocturnal minimum Sa O2 85%-90%),a total of 12 patients;There were 13 cases in the moderate OSAHS group(15 ≤ AHI<30 times/hour,and the lowest Sa O2 at night was 80%-85%);A total of 20 patients with severe OSAHS(AHI≥ 30 times/hour,nighttime minimum Sa O2<80%)were analyzed for the differences in right heart function related indicators by echocardiography in different conditions,and the clinical value of echocardiography in evaluating the severity of OSAHS patients was explored.Result:1.Among the relevant indexes measured by conventional echocardiography,the right ventricular outflow tract diameter(RVOT),free wall tricuspid valve annular longitudinal displacement distance(TAPSE),right ventricular ejection fraction(RVEF),tricuspid valve early diastolic forward flow velocity(E),the ratio of tricuspid valve early diastolic forward flow velocity to tricuspid valve late diastolic forward flow velocity(E/A)The ratio(E/e ’)and Tei index of tricuspid valve orifice forward blood flow velocity and tricuspid valve annulus myocardial early diastolic velocity were significantly different between the two groups(P<0.05).Compared with the control group,in the mild OSAHS group,significant abnormalities were observed in RVLD,RVOT,E/A,E/e ’,Tei,etc.(P<0.05),but there was no significant difference between different disease groups(P>0.05);2.In the relevant indicators of two-dimensional spot tracking and quantitative analysis of pressure strain loops,the OSAHS group showed significant differences compared to the control group in terms of overall longitudinal strain of the right ventricle(RVGLS),free wall strain of the right ventricle(RVFWS),overall work efficiency of the right ventricle(RVGWE),overall work index of the right ventricle(RVGWI),and reactive work of the right ventricle(RVGWW)(P<0.05).In addition,RVFWS was significantly lower in the severe and moderate OSAHS groups than in the mild OSAHS group(P<0.05),and had a negative impact on the apnea index(AHI);3.Among the relevant indicators of three-dimensional ultrasound measurement,RVEDVI was significantly higher in the OSAHS group compared to the control group(P<0.05).In the mild and moderate groups,RVEDVI was significantly higher than the control group(P<0.05).Conclusion: Multiple ultrasound techniques have indicators to detect abnormalities in right ventricular function in OSAHS.Conventional echocardiography,three-dimensional echocardiography,and quantitative analysis of pressure strain loops can detect abnormalities in right ventricular structure or function in OSAHS patients,but they are not sensitive to changes in the right heart in patients with different degrees of OSAHS;Spot tracking quantitative analysis of strain can not only detect abnormalities in the right ventricular structure or function of OSAHS patients,but also detect abnormal indicators of different degrees of OSAHS patients,which has reference value for evaluating the progression of OSAHS patients.