Pulmonary artery dilation indicates severe obstructive sleep apnea in patients with resistant hypertension: the Resist-POL Study

Dobrowolski, Piotr; Florczak, Elżbieta; Klisiewicz, Anna; Prejbisz, Aleksander; Rybicka, Justyna; Śliwiński, Paweł; Januszewicz, Andrzej; Hoffmań, Piotr

doi:10.20452/pamw.3388

Cited by 14 publications

(15 citation statements)

References 3 publications

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“…Several studies exploiting conventional echocardiography and tissue Doppler imaging have reported that OSA patients frequently present structural and functional alterations of the right ventricle [16–21, 23, 24, 26, 29, 31–36, 38]. In contrast, other studies did not reveal any changes in RV morphology and function in OSA patients by the application of conventional echocardiography and TDI [15, 22, 25, 27, 30, 37, 39]. Importantly, novel techniques, including 2D and 3D speckle-tracking echocardiography, are very sensitive and can reveal alterations in RV morphology and performance in early disease stages when changes in the conventional echocardiographic parameters are not yet present [25, 27, 36, 39].…”

Section: Discussionmentioning

confidence: 99%

Right Ventricular Remodeling and Dysfunction in Obstructive Sleep Apnea: A Systematic Review of the Literature and Meta-Analysis

Maripov

Mamazhakypov

Sartmyrzaeva

et al. 2017

Canadian Respiratory Journal

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Background Recent studies have reported that obstructive sleep apnea (OSA) patients present alterations in right ventricular (RV) structure and function. However, large randomized controlled trials evaluating the impact of OSA on the right ventricle are lacking. Methods A comprehensive electronic database (PubMed, Web of Science, and Google Scholar) and reference search up to October 30, 2016, was performed. A systematic review and meta-analysis were performed to assess RV structure and function in OSA patients based on conventional echocardiography and tissue Doppler imaging. Results Twenty-five studies with 1,503 OSA patients and 796 controls were included in this study. OSA patients exhibited an increase in RV internal diameter (weighted mean difference (WMD) (95% confidence intervals (CIs)) 2.49 (1.62 to 3.37); p = 0.000) and RV wall thickness (WMD (95% CIs) 0.82 (0.51 to 1.13); p = 0.000). Furthermore, OSA patients had a significantly elevated RV myocardial performance index (WMD (95% CI) 0.08 (0.06 to 0.10); p = 0.000), decreased RV S' (WMD (95% CI) −0.95 (−1.59 to −0.32); p = 0.003), tricuspid annular plane systolic excursion (WMD (95% CI) −1.76 (−2.73 to −0.78); p = 0.000), and RV fractional area change (WMD (95% CI) −3.16 (−5.60 to −0.73); p = 0.011). Conclusion OSA patients display RV dilatation, increased wall thickening, and altered RV function.

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Section: Discussionmentioning

confidence: 99%

Right Ventricular Remodeling and Dysfunction in Obstructive Sleep Apnea: A Systematic Review of the Literature and Meta-Analysis

Maripov

Mamazhakypov

Sartmyrzaeva

et al. 2017

Canadian Respiratory Journal

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“…Previous reports from sleep clinic cohorts have suggested that nocturnal hypoxemia in moderate-to-severe OSA may contribute to vascular remodeling in pulmonary artery architecture, which may elevate pulmonary vascular resistance [30,31]. In one previous study, evaluating 155 patients with resistant pulmonary hypertension patients who underwent sleep study, there was a significant association between OSA severity and mPAD [32].…”

Section: Discussionmentioning

confidence: 99%

Impact of concomitant obstructive sleep apnea on pulmonary involvement and main pulmonary artery diameter in adults with scleroderma

et al. 2020

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Purpose Pulmonary involvement is common in adults with scleroderma. The effect of concomitant obstructive sleep apnea (OSA) on risk for pulmonary hypertension in scleroderma is unknown. An enlarged main pulmonary artery diameter (mPAD) derived from chest computer tomography (CT) is a useful predictor of pulmonary hypertension. We addressed the effect of OSA on pulmonary involvement and enlarged mPAD in adults with scleroderma. Methods All participants underwent pulmonary function testing, carbon monoxide diffusion capacity, chest CT, and overnight sleep recording with home sleep apnea testing. OSA diagnosis was based on an apnea-hypopnea index (AHI) ≥ 15/h. Oxygen desaturation index (ODI) was also recorded. Scleroderma involvement of the lungs was defined as the Warrick score ≥ 7 based on the CT findings. Enlarged mPAD was defined as an mPAD ≥ 29 mm in men and ≥ 27 mm in women. Results After exclusions, 62 patients (58 women) were included. OSA was found among 20 (32%), 17/42 (38%) in the limited cutaneous type, and 3/20 (15%) in the diffuse cutaneous type (p = 0.08). Scleroderma involvement of the lungs was observed in 40 participants (65% in OSA vs 64% in no-OSA; n.s.). Enlarged mPAD was measured in 16 participants, 10 of 20 (50%) in the OSA group and 6 of 17 (14%) in the no-OSA group (p = 0.003). OSA was associated with enlarged mPAD (odds ratio 4.7, 95% confidence interval 1.1-20.9; p = 0.042) independent of age, body mass index, and pulmonary involvement. There was a linear relationship between mPAD and AHI (r = 0.37; p = 0.003) as well as ODI (r = 0.41; p < 0.001). Conclusions In this cohort, OSA was associated with risk for pulmonary hypertension independent of pulmonary involvement. These findings suggest that assessing the effect of therapy for concomitant OSA in patients with scleroderma is warranted. Trial registration NCT 02740569

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“…In all patients, an AHI of less than 5/h was achieved. The CPAP treatment also resulted in a reduction in daytime sleepiness (median [IQR] ESS score, 13 [8][9][10][11][12][13][14][15][16][17][18][19][20] Baseline serum melatonin concentrations In the majority of the study population, the highest serum melatonin levels were noted at 2 AM (FIGURE 2). This finding was reported for all controls and for 53 of the 71 patients (74.6%) with OSA.…”

Section: Methodsmentioning

confidence: 99%

“…16,17 It is currently regarded as one of the most frequent causes of arterial hypertension and is the most common comorbidity in patients with arterial hypertension resistant to treatment. 18,19 Recurrent fits of apnea/hypopnea and awakenings, which are typical for OSA, result in sleep fragmentation and a reduction in sleep duration and quality. It is likely that sleep disorders in these patients may cause disturbances in melatonin secretion.…”

mentioning

confidence: 99%

Treatment with continuous positive airway pressure and diurnal and nocturnal serum melatonin concentration in patients with obstructive sleep apnea

Barnaś¹,

Maskey-Warzęchowska²,

Bielicki³

et al. 2017

Polish Archives of Internal Medicine

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ORIGINAL ARTICLE CPAP treatment and serum melatonin in OSA 589 models and humans have shown that melatonin secretion is strongly related to sleep, and individuals with decreased melatonin levels suffer from sleep disturbances and insomnia. This refers to elderly patients (as melatonin concentrations tend to fall with age), night-shift workers with an exogenously disrupted sleep-wake rhythm, individuals who had undergone pinealectomy, and others.1,2,10 In patients with primary insomnia, exogenous melatonin decreases sleep onset latency, increases total sleep time, and improves sleep quality. 11,12 Melatonin also effectively reduces jet INTRODUCTION Melatonin is a serotonin-derived hormone secreted by the pineal gland in a cyclic manner. 1 It has diverse activities and regulates numerous physiological processes in mammals, including the sleep-wake rhythm, sexual maturation, reproduction, and aging. It also has antioxidant, oncostatic, and immunomodulative properties.1-3 Its release responds to the light-dark cycle.4-6 The peak melatonin secretion occurs during the night hours; during the day, its concentrations are low. Exposure to light acutely suppresses nocturnal melatonin release. OBJECTIVES The aim of the study was to evaluate the profile of circadian melatonin secretion in patients with obstructive sleep apnea (OSA) and to assess the impact of 2-day and 3-month treatment with continuous airway pressure (CPAP) on diurnal and nocturnal serum melatonin levels.PATIENTS AND METHODS Serum melatonin levels were evaluated in 71 untreated patients with OSA and 18 healthy controls at 6 time points: 10 AM, 2 PM, 6 PM, 10 PM, 2 AM, and 6 AM. The measurements were repeated after 2 days and 3 months of CPAP treatment. RESULTSMelatonin secretion rhythm was altered in 25.4% of the patients with OSA. In patients with preserved secretion rhythm, the serum melatonin level was significantly lower at 2 AM and 6 AM, compared with healthy controls: 68.2 pg/ml (interquartile range [IQR], 30.1-109.8 pg/ml) vs 109.1 pg/ml (IQR, 63-167.9 pg/ml), P = 0.02 and 40.8 pg/ml (IQR,.2 pg/ml) vs 67.7 pg/ml (IQR, 32.7-131.7 pg/ml), P = 0.04, respectively. Melatonin levels did not change significantly after the 2-day and 3-month CPAP treatment. However, at 3 months, a shift of the peak melatonin concentration to 2 AM was observed in patients with an altered secretion rhythm.CONCLUSIONS OSA has a significant effect on serum melatonin levels. Neither short-term nor long-term CPAP treatment significantly changes melatonin concentrations; however, our results seem to indicate that a 3-month CPAP treatment may be helpful in restoring the physiological rhythm of melatonin secretion in patients with OSA.

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Pulmonary artery dilation indicates severe obstructive sleep apnea in patients with resistant hypertension: the Resist-POL Study

Cited by 14 publications

References 3 publications

Right Ventricular Remodeling and Dysfunction in Obstructive Sleep Apnea: A Systematic Review of the Literature and Meta-Analysis

Right Ventricular Remodeling and Dysfunction in Obstructive Sleep Apnea: A Systematic Review of the Literature and Meta-Analysis

Impact of concomitant obstructive sleep apnea on pulmonary involvement and main pulmonary artery diameter in adults with scleroderma

Treatment with continuous positive airway pressure and diurnal and nocturnal serum melatonin concentration in patients with obstructive sleep apnea

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