Daytime Pulmonary Hypertension in Patients with Obstructive Sleep Apnea

Alchanatis, Manos; Tourkohoriti, Georgia; Kakouros, Stavros; Kosmas, Epaminondas; Podaras, Stylianos; Jordanoglou, J.

doi:10.1159/000050574

Cited by 140 publications

(35 citation statements)

References 15 publications

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“…Notwhitstanding, the prevalence for PH in the OSAS group (Group-3) was higher than that reported for other European populations with OSAS (17-27%) living at an altitude, on average, 150 m above sea level 4,7,8,13,14 and with mean BMI between 31 and 35, except for the report of Alchanatis et al 13 in which the BMI of the patients was in the lower limit of our sample (4177).…”

Section: Discussioncontrasting

confidence: 82%

“…For example, Sajkov et al 20 showed a correlation of r ¼ 0.96, Po0.001 between catheter-measured and Doppler estimates. More recently, Alchanatis et al 13 had shown similar correlation. The echocardiographic measurements were carried out by a single, experienced, trained specialist while the patient was awake, in left lateral decubitus position with a 201 upper body tilt, in the morning 30-60 min after the second night of polysomnography.…”

Section: Study Design and Polysomnography (Psg)mentioning

confidence: 67%

“…Others have reported that patients with PH had a high body mass index (BMI). 7,12,13 Bady et al 14 recently showed that severity of obesity and the associated changes in lung function play an important role in the pathogenesis of PH in patients with OSAS.…”

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confidence: 99%

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Prevalence of pulmonary hypertension and its association with respiratory disturbances in obese patients living at moderately high altitude

et al. 2004

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OBJECTIVE:To determine the point prevalence of pulmonary hypertension (PH) and its relationship with respiratory disturbances in obese patients living at moderate altitude. SUBJECTS: A total of 57 obese patients comprised the final sample and consisted of 34 women and 23 men, with a mean age of 42.7712.1 ys and a mean body mass index (BMI) 47.1710.6 kg/m 2 (range from 30.1 to 76.1). The mean living altitude was 2248.7 m, range 2100-2400 m above sea level. MEASUREMENTS: Doppler echocardiography, pulmonary function tests, arterial blood gas analysis, and polysomnography were performed. RESULTS: Data showed that 96.5% of the studied sample had daytime PH defined as calculated systolic pulmonary artery pressure (PSAP) 430 mmHg (mean PSAP ¼ 50, s.d. ¼ 13 mmHg). The severity of diurnal PH was found to be related to the presence of alveolar hypoventilation and BMI. The main risk factor for severity of diurnal PH was hypoventilation with a significant odds ratio (OR) 7.96, 95% CI 1.35-46.84, BMI was (OR 1.12, 95% CI 1.02-1.25) and apnea/hypopnea index was not a predictor of pulmonary hypertension severity (OR 0.99, 95% CI 0.97-1.02). CONCLUSION: We concluded that prevalence of diurnal PH is high in obese patients living at moderate altitude, and that hypoventilation is the main risk factor associated with the severity of pulmonary hypertension.

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Section: Discussioncontrasting

confidence: 82%

Section: Study Design and Polysomnography (Psg)mentioning

confidence: 67%

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Prevalence of pulmonary hypertension and its association with respiratory disturbances in obese patients living at moderately high altitude

et al. 2004

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“…Some authors [29]showed that OSAS was an independent risk factor leading to PH, whereas others [8]indicated that daytime hypoxemia was necessary to develop persistent PH. In our study nocturnal hypoxemia was observed in subjects with OSAS and not in mostly mild or moderate COPD.…”

Section: Discussionmentioning

confidence: 99%

There Is No Relationship between Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea Syndrome: A Population Study

Bednarek¹,

Pierpoint²,

Jończak³

et al. 2005

Respiration

154

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Background: Both chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea syndrome (OSAS) are common diseases. Some recent studies suggest an increased prevalence of COPD among subjects with OSAS. Objectives: The study objective was to evaluate whether there is an epidemiological relationship between COPD and OSAS in a random population sample. Materials and Methods: The study population, 356 males (53%) and 320 females, mean age 56.6 ± 8.2 years (range 41–72), was selected from a voting list for parliamentary election in Warsaw. The investigation included lung diseases and smoking history with polysomnography and spirometry. Results: OSAS was diagnosed in 76 subjects (11.3%), 59 males (8.8%) and 17 females (2.5%), mean apnea/hypopnea index (AHI) was 25.3 ± 16.1, mean overnight SaO₂ 92.1 ± 3.3%, minimum SaO₂ 76.9 ± 9.4%, and SaO₂ <90% = 18.9 ± 23.9% of total sleep time. COPD was diagnosed in 72 subjects (10.7%), 39 males and 33 females. Severity of airflow limitation was assessed according to European Respiratory Society (ERS) guidelines: mild in 70%, moderate in 22%, and severe in 8%. In 7 subjects (9.2% of OSAS population, 1% of total population) OSAS and COPD overlapped. Polysomnographic variables were compared between overlap (overlap syndrome, OS) and OSAS subjects. In the OS mean AHI was 19.0 versus 25.3 in OSAS (nonsignificant), mean SaO₂ 89.6 versus 92.3% in OSAS (p < 0.005), and time spent in SaO₂ <90% was 25.4 versus 18.2% in OSAS (p = 0.04). Conclusions: COPD in subjects with OSAS was as frequent as in the general population. In the OS group mean arterial blood saturation was lower and time spent in desaturation was longer than in OSAS. The presented data suggest a more severe course of sleep-disordered breathing in subjects with coexisting COPD.

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“…Most experts feel that OSA may modestly increase pulmonary arterial pressures, and evaluation for OSA should be part of the initial work-up in patients with pulmonary hypertension [84]. Therapy with CPAP has been shown to decrease pulmonary pressures in OSA patients with either high or normal pulmonary pressures [84, 85]. …”

Section: Right Ventricle Pulmonary Hypertension and Osamentioning

confidence: 99%

Deleterious Effects of Sleep-Disordered Breathing on the Heart and Vascular System

Dincer

O’Neill

2006

Respiration

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Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing, affecting 5–15% of the population. It is characterized by intermittent episodes of partial or complete obstruction of the upper airway during sleep that disrupts normal ventilation and sleep architecture, and is typically associated with excessive daytime sleepiness, snoring, and witnessed apneas. Patients with obstructive sleep apnea present risk to the general public safety by causing 8-fold increase in vehicle accidents, and they may themselves also suffer from the physiologic consequences of OSA; these include hypertension, coronary artery disease, stroke, congestive heart failure, pulmonary hypertension, and cardiac arrhythmias. Of these possible cardiovascular consequences, the association between OSA and hypertension has been found to be the most convincing. Although the exact mechanism has not been understood, there is some evidence that OSA is associated with frequent apneas causing mechanical effects on intrathoracic pressure, cardiac function, and intermittent hypoxemia, which may in turn cause endothelial dysfunction and increase in sympathetic drive. Therapy with continuous positive airway pressure has been demonstrated to improve cardiopulmonary hemodynamics in patients with OSA and may reverse the endothelial cell dysfunction. Despite the availability of diagnostic measures and effective treatment, many patients with sleep-disordered breathing remain undiagnosed. Therefore, OSA continues to be a significant health risk both for affected individuals and for thegeneral public. Awareness and timely initiation of an effective treatment may prevent potential deleterious cardiovascular effects of OSA.

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Daytime Pulmonary Hypertension in Patients with Obstructive Sleep Apnea

Cited by 140 publications

References 15 publications

Prevalence of pulmonary hypertension and its association with respiratory disturbances in obese patients living at moderately high altitude

Prevalence of pulmonary hypertension and its association with respiratory disturbances in obese patients living at moderately high altitude

There Is No Relationship between Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea Syndrome: A Population Study

Deleterious Effects of Sleep-Disordered Breathing on the Heart and Vascular System

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