Sleep apnea and pulmonary hypertension: A riddle waiting to be solved

Sharma, Sunil; Stansbury, Robert; Hackett, B.; Fox, Henrik

doi:10.1016/j.pharmthera.2021.107935

Cited by 19 publications

(12 citation statements)

References 68 publications

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“…Our study confirms that the burden of malignant ventricular arrhythmia is high in patients with heart failure and SDB [ 22 ]. Serizawa et al reported that the presence of SDB was an independent predictor for the occurrence of life-threatening ventricular arrhythmia, and their rate of ICD therapy was higher during sleeping time [ 23 ].…”

Section: Discussionsupporting

confidence: 88%

Impact of Sleep-Disordered Breathing Treatment on Ventricular Tachycardia in Patients with Heart Failure

Gerçek

Gerçek²,

Alzein

et al. 2022

JCM

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Background: Sleep-disordered breathing (SDB) is a highly common comorbidity in patients with heart failure (HF), and a known risk factor for ventricular tachycardia (VT) development. However, little is known about the impact of SDB treatment on VT burden in HF patients to date. Therefore, this study investigated VT burden, as well as implantable cardioverter-defibrillator (ICD) therapies in HF patients with SDB treatment, in comparison to untreated SDB HF patients. Methods: This retrospective study analyzed VT burden, rate of antitachycardia pacing (ATP), and the number of shocks delivered in a propensity score-matched patient cohort of patients with SDB treatment or control. Patients had moderate or severe SDB (n = 73 per each group; standardized mean difference of 0.08) and were followed for a minimum of one year. In addition, survival over 4 years was assessed. Results: Mean patient age was 67.67 ± 10.78 and 67.2 ± 10.10, respectively, with 15.06% and 10.95% of the patients, respectively, being female. Regarding SDB subtypes in the control and SDB treatment group, central sleep apnea was present in 42.46% and 41.09% of the patients, respectively, and obstructive sleep apnea was present in 26.02% and 31.50% of the patients, respectively. Mixed type sleep disorder was present in 31.50% and 27.40% of cases. Among the SDB treatment group, a significantly lower number of VTs (28.8% vs. 68.5%; p = 0.01), ATP (21.9% vs. 50.7%; p = 0.02), as well as a lower shock rate (5.5% vs. 31.5%; p < 0.01), was observed compared to the control group. Furthermore, the VT burden was significantly lower in the SDB treatment group when compared to the time prior to SDB treatment (p = 0.02). Event-free survival was significantly higher in the SDB treatment group (Log-rank p < 0.01). Conclusion: SDB treatment in HF patients with ICD leads to significant improvements in VT burden, ATP and shock therapy, and may even affect survival. Thus, HF patients should be generously screened for SDB and treated appropriately.

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Section: Discussionsupporting

confidence: 88%

Impact of Sleep-Disordered Breathing Treatment on Ventricular Tachycardia in Patients with Heart Failure

Gerçek

Gerçek²,

Alzein

et al. 2022

JCM

Self Cite

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“…Whilst clinically relevant pulmonary hypertension is rare in pure OSAS, it may occur much more frequently in the so-called overlap syndrome, i.e., the combined occurrence of OSAS and chronic obstructive pulmonary disease (COPD) ( 30 ). Although there still remain gaps in our understanding of the pathophysiology of this relationship ( 67 ), one relevant observation helping us to understand the association of OSAS with vascular disease in both, the pulmonary and systemic circulation, is the presence of endothelial dysfunction, i.e., the inability of the vascular endothelium to generate physiological amounts of NO as required to maintain vasodilator tone ( 68 ).…”

Section: Clinical Relevance Of Hypoxic Pulmonary Vasoconstrictionmentioning

confidence: 99%

Dysregulation of the Nitric Oxide/Dimethylarginine Pathway in Hypoxic Pulmonary Vasoconstriction—Molecular Mechanisms and Clinical Significance

Hannemann

Böger

2022

Front. Med.

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The pulmonary circulation responds to hypoxia with vasoconstriction, a mechanism that helps to adapt to short-lived hypoxic episodes. When sustained, hypoxic pulmonary vasoconstriction (HPV) may become deleterious, causing right ventricular hypertrophy and failure, and contributing to morbidity and mortality in the late stages of several chronic pulmonary diseases. Nitric oxide (NO) is an important endothelial vasodilator. Its release is regulated, amongst other mechanisms, by the presence of endogenous inhibitors like asymmetric dimethylarginine (ADMA). Evidence has accumulated in recent years that elevated ADMA may be implicated in the pathogenesis of HPV and in its clinical sequelae, like pulmonary arterial hypertension (PAH). PAH is one phenotypic trait in experimental models with disrupted ADMA metabolism. In high altitude, elevation of ADMA occurs during long-term exposure to chronic or chronic intermittent hypobaric hypoxia; ADMA is significantly associated with high altitude pulmonary hypertension. High ADMA concentration was also reported in patients with chronic obstructive lung disease, obstructive sleep apnoea syndrome, and overlap syndrome, suggesting a pathophysiological role for ADMA-mediated impairment of endothelium-dependent, NO-mediated pulmonary vasodilation in these clinically relevant conditions. Improved understanding of the molecular (dys-)regulation of pathways controlling ADMA concentration may help to dissect the pathophysiology and find novel therapeutic options for these diseases.

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“…Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a clinically universal and potentially fatal disease [1][2][3]. Its main manifestations are collapsed or partial obstruction of the upper airway during sleep, resulting in increased resistance during breathing, poor ventilation, and even apnea.…”

Section: Introductionmentioning

confidence: 99%

X-Ray Cephalometric Analysis of the Effects of Angle Class II and III Malocclusion on the Upper Airway Width and Hyoid Position between Parents and Children of Uygur Nationality

Cheng

Jiang

Man

et al. 2022

Computational and Mathematical Methods in Medicine

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Objective. The objective of this paper is to analyze the effect of angle class II and III malocclusion on the sagittal diameter of the upper airway between parents and children of Uygur nationality and to compare the degree of influence. Methods. 29 Uygur adolescents with malocclusion and their fathers (mothers) were selected as our subjects via X-ray cephalometric radiograph to analyze the difference between the upper airway sagittal dimension and normal occlusion and compare the influence of malocclusion on the upper airway between parents and children. Results. Compared with normal group, the vertical distance from the hyoid point to orbital-ear plane (H-FH) and vertical distance from hyoid point to the mandibular plane (H-MP) in angle class II malocclusion elevated signally, while the vertical distance from hyoid point to anterior cervical plane (H-VL), PNS-UPW, H-FH, and H-MP decreased significantly; compared with normal group: the distance between the posterior nasal spine and the upper pharynx wall (PNS-UPW), H-FH, and H-MP in angle class III malocclusion visually reduced, while PAS, and horizontal distance from the hyoid point and center point of sella turcica to orbital-ear foot (H-S), increased markedly. The impact of class II malocclusion on parents’ U-MPM was greater than their children. Conclusion. The oropharyngeal space of upper airway becomes smaller and hyoid shifts downwards due to class II malocclusion. Class III malocclusion results in decreased nasopharyngeal gap with hyoid to shift upward. The influence of class II malocclusion on the upper pharyngeal tract of parents was greater than their children.

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Sleep apnea and pulmonary hypertension: A riddle waiting to be solved

Cited by 19 publications

References 68 publications

Impact of Sleep-Disordered Breathing Treatment on Ventricular Tachycardia in Patients with Heart Failure

Impact of Sleep-Disordered Breathing Treatment on Ventricular Tachycardia in Patients with Heart Failure

Dysregulation of the Nitric Oxide/Dimethylarginine Pathway in Hypoxic Pulmonary Vasoconstriction—Molecular Mechanisms and Clinical Significance

X-Ray Cephalometric Analysis of the Effects of Angle Class II and III Malocclusion on the Upper Airway Width and Hyoid Position between Parents and Children of Uygur Nationality

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