Frequency and Impact of Pulmonary Hypertension in Patients With Obstructive Sleep Apnea Syndrome

Minai, Omar A.; Ricaurte, Basma; Kaw, Roop; Hammel, Jeff; Mansour, Mary; McCarthy, Kevin; Golish, Joseph A.; Stoller, James K.

doi:10.1016/j.amjcard.2009.06.048

Cited by 138 publications

(119 citation statements)

References 27 publications

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“…44 Elevated pulmonary artery pressure appears to correlate with severity of sleep apnea and resting daytime hypoxemia, and may sometimes improve with CPAP treatment. 45 However, whether OSA causes pulmonary hypertension remains unclear.…”

Section: -Pathway For Intermittent Hypoxemia (Ih) and Osa Comorbiditimentioning

confidence: 99%

Intermittent Hypoxemia and OSA

Dewan

Nieto

Somers

2015

Chest

493

188

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OSA is a common chronic disorder that is associated with signifi cant morbidity and mortality including cardiovascular, metabolic, and neurocognitive disease and increased cancer-related deaths. OSA is characterized by recurrent episodes of apneas and hypopneas associated with repetitive episodes of intermittent hypoxemia, intrathoracic pressure changes, and arousals.Intermittent hypoxemia (IH) is now being recognized as a potential major factor contributing to the pathogenesis of OSA-related comorbidities. OSA-related high-frequency IH is characterized by cycles of hypoxemia with reoxygenation that is distinctly diff erent than sustained low-frequency hypoxia and contributes to ischemia-reperfusion injury. Data from both animal and human studies support mechanistic links between IH and its adverse impact at the tissue level. IH promotes oxidative stress by increased production of reactive oxygen species and angiogenesis, increased sympathetic activation with BP elevation, and systemic and vascular infl ammation with endothelial dysfunction that contributes to diverse multiorgan chronic morbidity and mortality aff ecting cardiovascular disease, metabolic dysfunction, cognitive decline, and progression of cancer. Data from observational studies in large population groups also support the role for hypoxia in the pathogenesis of OSA comorbidity. Treatment with CPAP to reverse OSA-related symptoms and comorbidities has been shown to provide variable benefi t in some but not all patient groups. Early treatment with CPAP makes intuitive sense to promote maximal functional recovery and minimize residual injury. More studies are needed to determine the interacting eff ects of IH and obesity, diff erential eff ects of both short-term and longterm hypoxemia, and the eff ect of CPAP treatment.CHEST 2015; 147 ( 1 ): 266 -274 ABBREVIATIONS : AF 5 atrial fi brillation ; AHI 5 apnea-hypopnea index ; HIF 5 hypoxia-inducible factor ; IH 5 intermittent hypoxemia ; NADPH 5 reduced nicotinamide adenine dinucleotide phosphate ; NO 5 nitric oxide ; ROS 5 reactive oxygen species ; Sp o 2 5 pulse oximetry blood oxygen saturation ; VEGF 5 vascular endothelial growth factor[ Contemporary Reviews in Sleep Medicine ]

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Section: -Pathway For Intermittent Hypoxemia (Ih) and Osa Comorbiditimentioning

confidence: 99%

Intermittent Hypoxemia and OSA

Dewan

Nieto

Somers

2015

Chest

493

188

View full text Add to dashboard Cite

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“…A retrospective analysis of 83 patients with OSA who underwent right heart catheterisation showed PH in 58 (70%) patients [40]. Among these, 18 patients had pulmonary arterial hypertension (PAH).…”

Section: Sleep Apnoea and Phmentioning

confidence: 99%

Idiopathic pulmonary fibrosis and sleep disorders: no longer strangers in the night

et al. 2015

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The prevalence of obstructive sleep apnoea (OSA) is continuously increasing in patients with idiopathic pulmonary fibrosis (IPF) and, for the first time, the recent IPF guidelines recognise OSA as an important associated comorbidity that can affect patient's survival. Thus, it becomes conceivable that clinicians should refer patients with newly diagnosed IPF to sleep centres for the diagnosis and treatment of OSA as well as for addressing issues regarding the reduced compliance of patients with continuous positive airway pressure therapy. The discovery of biomarkers common to both disorders may help early diagnosis, institution of the most appropriate treatment and follow-up of patients. Better understanding of epigenetic changes may provide useful information about pathogenesis and, possibly, development of new drugs for a dismal disease like IPF. @ERSpublications It is now believed that IPF and sleep disorders can coexist in the same patient

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“…This suggests that OSA and its severity might accelerate the pre-existing RV and LV dilatation, thus leading to the progression of HF. Although PH in OSAS is generally of mild to moderate degree [16], it can cause functional limitations and increase the mortality [6]. However, opposite findings, with no correlation of OSAS with haemodynamic impairment, were reported by some authors [11].…”

Section: Discussionmentioning

confidence: 73%

“…Although a correlation between RV hypertrophy observed in pulmonary hypertension (PH) and the severity of OSA has been documented, its clinical role is still unclear [5]. The relationship between the severity of PH and mortality in patients with OSA was reported [6]. It is important to identify the clinical indicators of poor prognosis and treatable conditions that might contribute to the progression of HF and PH in the group of DCM patients with concomitant OSA.…”

Section: Introductionmentioning

confidence: 99%

The influence of obstructive sleep breathing disturbances on echocardiographic and pulmonary haemodynamic parameters in patients with dilated cardiomyopathy

et al. 2016

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A b s t r a c t Background:It is important to identify the clinical indicators of poor prognosis and treatable conditions that might contribute to the progression of heart failure (HF) and pulmonary hypertension (PH) in the group of patients with dilated cardiomyopathy (DCM) and concomitant obstructive sleep apnoea (OSA). Aim:To evaluate the influence of OSA on echocardiographic and haemodynamic parameters in patients with DCM, and the outcome in long-term follow-up. Methods:We enrolled patients with DCM and severely impaired ejection fraction (EF < 30%). Each patient underwent polygraphy, echocardiography, and right heart catheterisation. Subjects were divided into groups based on the apnoea-hypopnoea index (AHI): > 0 and < 5 (group I), ≥ 5 and ≤ 15 (group II), > 15 and ≤ 30 (group III), and > 30 (group IV). We compared the OSA-free (AHI < 5) subjects with those with OSA (AHI ≥ 5). The evaluated clinical end-points were death and orthotropic heart transplant. Results:The study population comprised 51 patients. Mean EF was 22%; 59% of patients were suffering from OSA. The increased severity of OSA correlated with worse pulmonary haemodynamics. Patients with OSA had higher mean pulmonary arterial pressure and pulmonary vascular resistance than individuals without OSA (p = 0.044, p = 0.032, respectively). The highest chamber diameters assessed in echocardiography were found in group IV (p < 0.05). A total of 10 end-points occurred during follow-up (8.9 ± 5.1 months), with significant differences observed between groups I-IV and the highest rate in group IV (p < 0.001). Conclusions:The increasing severity of OSA worsens the prognosis of DCM patients, independently of severe HF and coexistent PH. Systematic OSA screening in patients with HF might facilitate identification of individuals at high risk of progression of pulmonary haemodynamic impairment and end-point rate.

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Frequency and Impact of Pulmonary Hypertension in Patients With Obstructive Sleep Apnea Syndrome

Cited by 138 publications

References 27 publications

Intermittent Hypoxemia and OSA

Intermittent Hypoxemia and OSA

Idiopathic pulmonary fibrosis and sleep disorders: no longer strangers in the night

The influence of obstructive sleep breathing disturbances on echocardiographic and pulmonary haemodynamic parameters in patients with dilated cardiomyopathy

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