Narrative review of sleep and pulmonary hypertension

Abstract

Pulmonary hypertension (PH) is a condition of raised pulmonary artery pressure (PAP), which may be secondary to a number of causes, one of which is sleep disordered breathing (SDB). When PH complicates SDB, it carries a significant burden of morbidity and mortality due to the risk of progression to right ventricular failure over time. This narrative review will cover the definition and classification of PH, and explore the epidemiology of PH in SDB. The mechanisms by which the two conditions are linked will be reviewed. Repetitive hypoxia with or without hypercapnia alongside frequent arousals can result in important metabolic and pulmonary vascular consequences for the left and right heart. MEDLINE was used to search for all relevant articles and abstracts published from January 1960 to October 2019 inclusive (in all languages). Current best practice in the investigation and management of PH complicating SDB will be reviewed. Important diagnostic investigations and when to consider and screen further for PH in patients with SDB will be discussed. Optimal disease management must include control of SDB with therapy.Additional treatment options will be reviewed. Areas for further research will be highlighted.

Cardiac Implications of Adenotonsillar Hypertrophy and Obstructive Sleep Apnea in Pediatric Patients: A Comprehensive Systematic Review

“…However, the biological underpinnings of PH in pediatric SDB are still under investigation. Inflammation can damage the vessel walls, making them more prone to constriction and increased pressure [42]. Hypoxia can damage the pulmonary blood vessels, causing them to constrict and increase pressure [42,43].…”

“…Inflammation can damage the vessel walls, making them more prone to constriction and increased pressure [42]. Hypoxia can damage the pulmonary blood vessels, causing them to constrict and increase pressure [42,43]. Endothelial dysfunction induced by OSA [42], specifically, the impairment of the layer of cells lining the inner walls of blood vessels, makes them less capable of regulating blood pressure.…”

“…Hypoxia can damage the pulmonary blood vessels, causing them to constrict and increase pressure [42,43]. Endothelial dysfunction induced by OSA [42], specifically, the impairment of the layer of cells lining the inner walls of blood vessels, makes them less capable of regulating blood pressure. Dysregulation mechanisms associated with hypoxic episodes observed in SDB contribute to the onset of PH [41].…”