Electrocardiographic markers of obstructive sleep apnea: association of rSr' pattern with disease presence and severity in a hispanic cohort

Background: Obstructive sleep apnea (OSA) is a highly prevalent condition associated with significant cardiovascular morbidity. Early identification remains challenging, particularly in resource-limited settings. Electrocardiography (ECG) represents a widely available and low-cost tool, but its role in OSA detection remains incompletely defined. Purpose: To evaluate the association between ECG abnormalities and the presence and severity of OSA, with a focus on the rSr’ pattern in right precordial leads. Methods: We conducted a retrospective study of 670 adults who underwent overnight polysomnography and standard 12-lead ECG. Patients were categorized based on OSA diagnosis and Apnea-Hypopnea Index (AHI). ECG findings, including rSr’ pattern in V1–V2, deep S waves in V5–V6, QRS duration, and atrial fibrillation, were compared between groups. Multivariable logistic regression was performed to identify independent predictors of OSA. Results: Among 670 patients, those with OSA demonstrated a significantly higher prevalence of ECG abnormalities compared with non-OSA individuals. The rSr’ pattern in V1–V2 was significantly more frequent in patients with OSA (p