Cardiometabolic Implications of Obstructive Sleep Apnea: Linking Insulin Resistance to Right Ventricular Dysfunction

Abstract

Abstract

Obstructive sleep apnea is an increasingly recognized sleep-related breathing disorder strongly associated with cardiometabolic dysfunction, including insulin resistance and right ventricular impairment. The present study aimed to investigate the association between insulin resistance and right ventricular dysfunction in patients with obstructive sleep apnea and to evaluate its cardiometabolic implications in a hospital-based population. A cross-sectional observational study was conducted on 280 adults aged 30–65 years diagnosed with polysomnography-confirmed obstructive sleep apnea. Insulin resistance was assessed using the Homeostatic Model Assessment for Insulin Resistance, while right ventricular function was evaluated through echocardiographic parameters including tricuspid annular plane systolic excursion and right ventricular fractional area change. Results demonstrated significantly higher HOMA-IR values in patients with moderate-to-severe obstructive sleep apnea compared to mild disease (p<0.001). Right ventricular systolic dysfunction was more prevalent in the insulin-resistant group, with a strong inverse correlation between HOMA-IR and tricuspid annular plane systolic excursion (r = -0.62, p<0.001). Multivariate regression identified insulin resistance and apnea–hypopnea index as independent predictors of right ventricular dysfunction. The findings indicate a strong pathophysiological link between intermittent hypoxia-induced metabolic dysfunction and subclinical right heart impairment. Early identification of insulin resistance may serve as a prognostic marker for cardiovascular risk stratification in obstructive sleep apnea patients, supporting integrated cardiometabolic screening in sleep medicine practice.