Association between sleep apnoea and pulmonary hypertension in Kyrgyz highlanders

Abstract

This case-control study evaluates a possible association between high altitude pulmonary hypertension (HAPH) and sleep apnoea in people living at high altitude.Ninety highlanders living at altitudes >2500 m without excessive erythrocytosis and with normal spirometry were studied at 3250 m (Aksay, Kyrgyzstan); 34 healthy lowlanders living below 800 m were studied at 760 m (Bishkek, Kyrgyzstan). Echocardiography, polysomnography and other outcomes were assessed. Thirty-six highlanders with elevated mean pulmonary artery pressure (mPAP) >30 mmHg (31-42 mmHg by echocardiography) were designated as HAPH+. Their data were compared to that of 54 healthy highlanders (HH, mPAP 13-28 mmHg) and 34 healthy lowlanders (LL, mPAP 8-24 mmHg).The HAPH+ group (median age 52 years (interquartile range 47-59) had a higher apnoea-hypopnoea index (AHI) of 33.8 events·h (26.9-54.6) and spent a greater percentage of the night-time with an oxygen saturation <90% (T<90; 78% (61-89)) than the HH group (median age 39 years (32-48), AHI 9.0 events·h (3.6-16), T<90 33% (10-69)) and the LL group (median age 40 years (30-47), AHI 4.3 events·h (1.4-12.6), T<90 0% (0-0)); p<0.007 for AHI and T<90, respectively, in HAPH+ versus others. In highlanders, multivariable regression analysis confirmed an independent association between mPAP and both AHI and T<90, when controlled for age, gender and body mass index.Pulmonary hypertension in highlanders is associated with sleep apnoea and hypoxaemia even when adjusted for age, gender and body mass index, suggesting pathophysiologic interactions between pulmonary haemodynamics and sleep apnoea.

Cross-Sectional Comparison of Sleep-Disordered Breathing in Native Peruvian Highlanders and Lowlanders

“…Nevertheless, prior studies describe substantial levels of periodic breathing and nocturnal hypoxemia in Asian and Andean highlanders (Lahiri et al, 1983a;Normand et al, 1992;Arai et al, 2002;Latshang et al, 2013). The effects of altitude cannot be clearly discerned, however, without suitable lowland control groups.…”

“…The effects of altitude cannot be clearly discerned, however, without suitable lowland control groups. Studies in native highlanders also suggest a high burden of SDB in those with chronic mountain sickness and pulmonary hypertension (Normand et al, 1992;Sun et al, 1996;Julian et al, 2013;Latshang et al, 2013). The PLATINO study characterized SDB in a somewhat larger community-based cohort and documented an *10% prevalence of moderate-to-severe sleep apnea in native highlanders at 2240 m elevation (Bouscoulet et al, 2008).…”

Sleep apnoea and pulmonary hypertension in high-altitude dwellers: more than an association?

“…LATSHANG et al [2] report PAP estimations by echocardiography using three different methods and overall the data appear concordant. Interestingly, however, the right-ventricular to right-atrial pressure gradient estimations in healthy Kyrgyz participants are markedly lower (i.e.…”

Präkapilläre pulmonale Hypertonie und schlafbezogene Atmungsstörungen: Gibt es einen Zusammenhang?

“…In einer aktuellen Studie zu Einwohnern des kirgisischen Hochlandes wurde bei Personen mit Höhen-PH (einer Sonderform der präkapillären PH bei Personen, die ihr ganzes Leben in Höhenlagen >2 500 m verbracht haben) eine hohe Prävalenz vor allem von OSA festgestellt. Diese Beobachtung legt nahe, dass die kombinierte Exposition gegenüber chronischer Hypoxämie durch das Leben in Höhenlagen einerseits und intermittierenden nächtlichen Hypoxämien infolge von Schlafapnoe andererseits das Risiko für das Auftreten einer PH im Vergleich zu Hochlandbewohnern ohne Schlafapnoe erhöhen könnte [57]. …”