Pulmonary hypertension in the obstructive sleep apnoea syndrome: prevalence, causes and therapeutic consequences

Kessler, Romain; Chaouat, Ari; Weitzenblum, E; Oswald, M.; Ehrhart, M; Apprill, M; Krieger, J

doi:10.1183/09031936.96.09040787

Cited by 188 publications

(130 citation statements)

References 43 publications

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“…Whether permanent pulmonary arterial hypertension could result solely from apnoea-induced nocturnal repeated hypoxaemias still remains a much-debated question. It is usually stated that the development of pulmonary arterial hypertension is often associated with daytime hypoxaemia that is principally related to an associated COPD [10,18]. The present data suggest that SAS may be complicated by pulmonary arterial hypertension in the absence of associated COPD.…”

Section: Discussionmentioning

confidence: 48%

Cardiorespiratory consequences of sleep apnoea syndrome in patients with massive obesity

Laaban¹,

Cassuto²,

Orvoen-Frija³

et al. 1998

Eur Respir J

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aaSleep apnoea syndrome (SAS) has been reported to be associated with excess mortality [1,2] and a wide range of cardiac and respiratory sequelae [3][4][5]: daytime alveolar hypoventilation, pulmonary arterial hypertension, systemic arterial hypertension, left ventricular hypertrophy and dysfunction, cardiac arrhythmias and ischaemic heart disease. However, conflicting data have been published on the cardiorespiratory consequences of SAS. This might be due to the fact that most studies did not take sufficient account of the potential effects of confounding variables, such as age, smoking, and obesity [6]. Obesity is a major confounding factor as it is strongly associated with SAS [7,8], and may yield the same cardiorespiratory complications as SAS. Therefore, observing cardiac and respiratory abnormalities in an obese patient with SAS does not necessarily imply a causal association between nocturnal apnoeas and cardiorespiratory morbidity.Another confounding factor is the association of chronic obstructive pulmonary disease (COPD), which may explain certain conflicting results on the role of SAS in the development of daytime alveolar hypoventilation and pulmonary arterial hypertension [9][10][11].The aim of the present study was to assess the cardiorespiratory consequences of SAS by comparing the results of a comprehensive cardiorespiratory evaluation in apnoeic and nonapnoeic patients with a similar degree of obesity, i.e. massive obesity and without COPD. This study investigated the role of SAS in the development of daytime alveolar hypoventilation, pulmonary arterial hypertension, systemic arterial hypertension, left ventricular dysfunction, left ventricular hypertrophy and dilatation, cardiac arrhythmias and coronary artery disease. Patients and methods Study populationThe study population included morbidly obese patients admitted consecutively over a 3 yr period to the Nutrition department of Hôtel-Dieu Hospital for an extensive Nocturnal apnoeas in massive obesity may thus be associated with moderate daytime hypoxaemia, mild pulmonary arterial hypertension and moderate left ventricular hypertrophy, but not with severe cardiorespiratory complications.

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Section: Discussionmentioning

confidence: 48%

Cardiorespiratory consequences of sleep apnoea syndrome in patients with massive obesity

Laaban¹,

Cassuto²,

Orvoen-Frija³

et al. 1998

Eur Respir J

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“…[16]. В нескольких исследованиях показано, что индекс массы тела (ИМТ) и тяжесть ночных эпизодов десатурации у больных с СОАС имеют более сильную связь с ЛГ, чем ИАГ.…”

Section: терапевтический архив 01 2017unclassified

“…Возможно, это связано с тем, что в большинстве проведенных исследований из группы больных СОАС не исключали пациентов с сопутствующими за-болеваниями, которые сами могут служить независимыми при-чинами ЛГ, -прежде всего ХОБЛ и синдромом ожирения-ги-повентиляции (СОГ). В исследовании Страсбургской группы [16] проведено сравнение показателей гемодинамики у больных с СОАС и СОГ. У больных с «чистым» тяжелым СОАС (средний ИАГ 73 эпизода в час) Рра составило 15±5 мм рт.ст., и лишь у 9% пациентов оно превышало 20 мм рт.ст.…”

Section: терапевтический архив 01 2017unclassified

Obstructive sleep apnea at high altitude

Myrzaakhmatova

2017

Terapevticheskii arkhiv

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Синдром обструктивного апноэ во сне в условиях высокогорья А.К. МЫРЗААХМАТОВАНациональный центр кардиологии и терапии им. акад. М. Миррахимова, Бишкек, Киргизская Республика Аннотация Синдром обструктивного апноэ во сне (СОАС) -важная и социально значимая проблема современной медицины, отно-сящаяся к числу наиболее распространенных патологических состояний. Проблема СОАС особенно актуальна для жите-лей высокогорных регионов, так как сочетание климатических, социальных и культурных факторов может оказывать зна-чительное влияние на течение болезни как у коренных горцев, так и у лиц, временно пребывающих на больших высотах. В статье представлен обзор современной литературы, освещающий проблему СОАС в условиях высокогорья. Приведены данные отечественной и зарубежной литературы, затрагивающие особенности патогенеза и клинической картины СОАС. Проанализированы современные данные о влиянии высокогорья на течение СОАС у коренных жителей высокогорья и у лиц, временно пребывающих на больших высотах. Подчеркнута роль гипобарической гипокапнии как важнейшего фак-тора развития центральных апноэ во сне на фоне обструктивных и усугубляющих течение болезни. Obstructive sleep apnea (OSA) is an important and socially relevant problem of modern medicine, which is referred to as a most common pathological condition. The problem of OSA is especially urgent for inhabitants of high mountainous regions, as a combination of climatic, social, and cultural factors can significantly affect the course of the disease in both indigenous highlanders and people temporarily residing at high altitude. The paper reviews the current literature covering the problem of OSA at high altitude. It gives the data of Russian and foreign literature on the pathogenesis and clinical presentation of OSA. The author also analyzes an update on the impact of high altitude on the course of OSA in indigenous highlanders and people temporarily living at high altitude. She emphasizes the role of hypobaric hypocapnia as the most important factor for the development of central sleep apnea in the presence of conditions that are obstructive and aggravating the course of the disease.

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“…KOAH hastalarında nCPAP tedavisi geceleyin oluşan hipoksileri düzeltmede yetersiz olabilmektedir. 77,78 Bu hastalarda özellikle REM döneminde devam eden hipoksemiler görülmektedir. Sonuç olarak nCPAP tedavisi altında SaO 2 değeri %90'ın altında olduğu zaman, nCPAP tedavisine 1.5-3 L/dak oksijen tedavisi eklemek gerekmektedir.…”

Section: Copd and Sleepunclassified

Chronic Obstructive Pulmonary Disease and Sleep

Öztürk¹

2011

Solunum

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ÖZETUykunun hava yolu direnci, solunum kaslarının kasılımı ve solunum kontrolü dahil olmak üzere solunum sistemi üzerine etkileri bulunmaktadır. Kişinin solunum sorunları yoksa bu deği-şiklikler fizyolojik sınırlar içinde kalmaktadır. Ancak solunum sorunu olan olgularda ve özellikle kronik obstrüktif akciğer hastalarında (KOAH) uyku ciddi sorun yaratmaktadır. KOAH'ta solunumun kontrolü, uyku ve uyanıklıkta sağlıklı bireylerle aynı temel özelliklere sahip olmasına karşın, solunum ve gaz değişi-mi olumsuz etkilenmekte ve hızlı göz hareketleri (REM) sırasın-da solunum kaslarında görülen atoni hiperkapni ve hipoksiyi derinleştirmektedir. Hipoksi arousalları (uyanayazma), uyku bölünmelerini, pulmoner hipertansiyonu ve mortalite riskini artırmaktadır. KOAH'lı olgularda diğer kronik hastalıklarda olduğu gibi hipoksi olmaksızın uyku kalitesi bozulmakta ve tedavide kullanılan ilaçlar da uyku bölünmelerine ve uykusuzluğa neden olabilmektedir. Bu derlemede KOAH ile uyku bozukluklarının birlikteliğini, fizyolojik mekanizmaları ve kliniğe yansımalarını incelemek istedik.Anahtar sözcükler: hipoventilasyon, Kronik Obstrüktif Akciğer Hastalığı (KOAH), pozitif hava yolu basıncı, uyku bozuklukları ABSTRACTSleep affects the respirotory system by causing changes in airway resistance, respiratory muscle contractility, and central respiratory control. In an individual who has no respiratory problems, these changes remain within physiological limits. However, in patients with respiratory problems, especially chronic obstructive pulmonary disease (COPD), sleep creates a serious problem.Although the control of breathing in patients with COPD follows the same basic principles as it does in normal subjects, both awake and asleep, the respiratory and gas exchange is adversely affected and the atonia of respiratory muscles during rapid eye movement (REM) sleep deepens the hypoxia and hypercapnia. The hypoxia leads to increased arousals, sleep disruptions, pulmonary hypertension, and higher mortality. As with other chronic diseases, the quality of sleep among patients with COPD deteriorates without hypoxia and the drugs used in therapy cause sleep deprivations and insomnia. This review presents an examination of the association of COPD and sleep disorders, including the physiologic mechanisms and their clinical implications. Tablo I). [3][4][5] Bu makalede KOAH hastalarında görülen uyku bozukluklarının mekanizmaları ve tedavi yöntemleri, güncel literatür yardımıyla tartışılmaktadır. Keywords Solunum Dergisi t Önder Öztürk 67 GİRİŞ

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Pulmonary hypertension in the obstructive sleep apnoea syndrome: prevalence, causes and therapeutic consequences

Cited by 188 publications

References 43 publications

Cardiorespiratory consequences of sleep apnoea syndrome in patients with massive obesity

Cardiorespiratory consequences of sleep apnoea syndrome in patients with massive obesity

Obstructive sleep apnea at high altitude

Chronic Obstructive Pulmonary Disease and Sleep

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