The association between sleep-related breathing disorders and pre-capillary pulmonary hypertension: A chicken and egg question

Abstract Introduction There are some evidences of sleep-related breathing disorders (SRBD) association with pulmonary hypertension (PH). Only limited information regarding the SRBD prevalence in pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) patients, is available. Purpose To estimate the features of SRBD and the asymmetric dimethylarginine (ADMA) level in PAH and CTEPH patients and their relationship with the severity of PH. Methods There were included 31 patients (45% male; 55% female) with a verified diagnosis of precapillary PH: 22.6% – with PAH; 9,7% with PAH associated with adult congenital heart disease; 64.5% – with CTEPH; 3.2% with PAH associated with connective tissue disease. Patients underwent a general clinical examination, questionnaires, a comprehensive assessment of respiratory function, a complete polysomnographic study, ECG and ECHO studies, assessment of clinical and biochemical blood tests, including an assessment of ADMA and NT-proBNP levels. Results SRBD of a predominantly obstructive nature were found in 74.2% of the examined: 38.7% were mild, 22.6% were moderate, 12.9% were severe. In 35% of patients, episodes of periodic breathing during sleep were recorded. There was no association SRBD with PH functional class and hemodynamic parameters. Moderate correlation was observed between the apnea-hypopnea index and remodeling indices of the heart chambers according to ECHO: for the end-diastolic size of the left ventricle (ρ=0.54; p=0.005); for an indicator of the ratio of the size of the ventricles (RV/LV) (ρ=−0.41, p=0.05). The presence of SRBD wasn't associated with the level of peripheral blood saturation according to pulse oximetry in sleep and during wakefulness. Negative moderate correlation was observed between NT-proBNP level and the average peripheral blood saturation at night in the entire examined group (ρ=−0.40; p=0.035). All patients showed an increase in ADMA, with no association between ADMA and SRBD severity. Conclusions The incidence of SRBD is extremely high in PAH and CTEPH patients. However, there no association between presence and severity of PH, including with right heart remodeling. But the severity of nocturnal hypoxemia is associated with an increase in NT-proBNP level, a proven marker of poor prognosis in PAH and CTEPH groups of patients. SRBD severity indices (apnea-hypopnea index and desaturation index) are associated with ECHO parameters characterizing remodeling of left heart chambers. Increasing ADMA level as a marker of endothelial dysfunction was related with PH severity, but not with SRBD. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Almazov National Medical Research Centre

Download Full-text

Sleep-related breathing disorders and pulmonary hypertension

European Respiratory Journal ◽

10.1183/13993003.02258-2020 ◽

2020 ◽

Vol 57 (1) ◽

pp. 2002258

Author(s):

Yochai Adir ◽

Marc Humbert ◽

Ari Chaouat

Keyword(s):

Pulmonary Hypertension ◽

Sleep Apnoea ◽

Sleep Related Breathing Disorders ◽

Breathing Disorders ◽

Respiratory Events ◽

Obstructive Sleep ◽

Pulmonary Haemodynamics ◽

Pulmonary Arterial ◽

Central Apnoea

Sleep-related breathing disorders (SBDs) include obstructive apnoea, central apnoea and sleep-related hypoventilation. These nocturnal events have the potential to increase pulmonary arterial pressure (PAP) during sleep but also in the waking state. “Pure” obstructive sleep apnoea syndrome (OSAS) is responsible for a small increase in PAP whose clinical impact has not been demonstrated. By contrast, in obesity hypoventilation syndrome (OHS) or overlap syndrome (the association of chronic obstructive pulmonary disease (COPD) with obstructive sleep apnoea (OSA)), nocturnal respiratory events contribute to the development of pulmonary hypertension (PH), which is often severe. In the latter circumstances, treatment of SBDs is essential in order to improve pulmonary haemodynamics.Patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) are at risk of developing SBDs. Obstructive and central apnoea, as well as a worsening of ventilation–perfusion mismatch, can be observed during sleep. There should be a strong suspicion of SBDs in such a patient population; however, the precise indications for sleep studies and the type of recording remain to be specified. The diagnosis of OSAS in patients with PAH or CTEPH should encourage treatment with continuous positive airway pressure (CPAP). The presence of isolated nocturnal hypoxaemia should also prompt the initiation of long-term oxygen therapy. These treatments are likely to avoid worsening of PH; however, it is prudent not to treat central apnoea and Cheyne–Stokes respiration (CSR) with adaptive servo-ventilation in patients with chronic right-heart failure because of a potential risk of serious adverse effects from such treatment.In this review we will consider the current knowledge of the consequences of SBDs on pulmonary haemodynamics in patients with and without chronic respiratory disease (group 3 of the clinical classification of PH) and the effect of treatments of respiratory events during sleep on PH. The prevalence and consequences of SBDs in PAH and CTEPH (groups 1 and 4 of the clinical classification of PH, respectively), as well as therapeutic options, will also be discussed.

Download Full-text

Pulmonary Arterial Hypertension

Sleep Disorders ◽

10.1093/med/9780190671099.003.0052 ◽

2019 ◽

pp. 884-896

Author(s):

Hugo Paz y Mar ◽

Neal F. Chaisson

Keyword(s):

Pulmonary Hypertension ◽

Sleep Apnea ◽

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Central Sleep Apnea ◽

Chronic Obstructive ◽

Sleep Related Breathing Disorders ◽

Obstructive Pulmonary Disease ◽

Breathing Disorders ◽

Pulmonary Arterial

The high prevalence of pulmonary arterial hypertension (PAH) in patients with obstructive sleep apnea (OSA) and the putative pathophysiologic connections have been extensively documented. Conversely, patients with established PAH are at risk for sleep-related ventilatory instability, including OSA, central sleep apnea, and nocturnal desaturations. This chapter reviews the prevalence and pathophysiologic interactions of these conditions, the interplay with associated disorders, and the effects of continuous positive airway pressure therapy on pulmonary hemodynamics. In patients with OSA, chronic effects of repetitive hypoxia as well as comorbidities, including chronic obstructive pulmonary disease and left-sided heart dysfunction, play a role in promoting pulmonary hypertension. Sleep disordered breathing, representing a spectrum of sleep-related breathing disorders inclusive of OSA, is highly prevalent among patients with established pulmonary hypertension. Obstructive events, central sleep apnea, and nocturnal hypoxia are within the spectrum of sleep-related breathing disorders in pulmonary hypertension. The mechanisms for these associations remain speculative.

Download Full-text

Sleep-related breathing disorders in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension

Arterial’naya Gipertenziya (Arterial Hypertension) ◽

10.18705/1607-419x-2020-26-1-85-93 ◽

2020 ◽

Vol 26 (1) ◽

pp. 85-93

Author(s):

M. A. Dyachenko ◽

M. A. Simakova ◽

L. S. Korostovtseva ◽

M. V. Bochkarev ◽

N. S. Goncharova ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Left Ventricular ◽

Sleep Related Breathing Disorders ◽

Nocturnal Hypoxemia ◽

Breathing Disorders ◽

Thromboembolic Pulmonary Hypertension ◽

Pulmonary Arterial

Background. The data evidence that in patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) nocturnal hypoxemia is associated with poor prognosis. Although, data regarding sleep-related breathing disorders (SRBD) prevalence and their association with pulmonary hypertension (PH) severity are scarce.Objective. To evaluate the prevalence and the structure of SRBD in patients with PAH and CTEPH and the relationship of SRBD with PH severity. Design and methods. In a prospective, single-center study we examined 31 patients (45 % male (n = 14)) with a verified diagnosis of precapillary PH: 22,6 % with IPAH; 9,7 % with PAH associated with congenital heart disease; 64,5 % with CTEPH; 3,2 % with PAH associated with connective tissue disease. Patients underwent a general clinical examination, questionnaires, respiratory tests, full videopolysomnography, electrocardiogram, and heart ultrasound (ECHO) examination, clinical and biochemical blood tests, including the assessment of ADMA and NT-proBNP levels.Results. No differences in SRBD pattern in patients with PAH and CTEPH were observed as well as with the severity of PH. A positive correlation was found between the apnea-hypopnea index (AHI) and the end-diastolic left ventricular dimension (ρ = 0,54; p = 0,005); the ventricular diameter ratio (RV/LV) negatively correlated with AHI (ρ = –0,41; p = 0,05). Low peripheral blood oxygen saturation negatively correlated with NT-proBNP level (ρ = –0,40; p = 0.035). ADMA level was increased in all patients, nevertheless no association between ADMA and SRBD severity was found (χ2 = 2,97; p = 0,085).Conclusions. SRBD often occurs among patients with PAH and CTEPH, while the presence of SRBD is not associated with the severity of PH. The severity of SRBD is associated with left heart remodeling. The severity of nocturnal hypoxemia in our group is associated with the increased NT-proBNP level, which is consistent with the idea of a negative prognostic value of nocturnal hypoxemia in patients with PAH and CTEPH.

Download Full-text

Etiopathogenetic Mechanisms of Pulmonary Hypertension in Sleep-Related Breathing Disorders

Pulmonary Medicine ◽

10.1155/2012/273591 ◽

2012 ◽

Vol 2012 ◽

pp. 1-10 ◽

Cited By ~ 11

Author(s):

Ayodeji Adegunsoye ◽

Siva Ramachandran

Keyword(s):

Obstructive Sleep Apnea ◽

Pulmonary Hypertension ◽

Sleep Apnea ◽

Sleep Disordered Breathing ◽

Sleep Apnea Syndrome ◽

Sleep Related Breathing Disorders ◽

Breathing Disorders ◽

Obstructive Sleep ◽

Significant Health ◽

Disordered Breathing

Obstructive sleep apnea syndrome is a common disorder with significant health consequences and is on the rise in consonance with the obesity pandemic. In view of the association between sleep-disordered breathing and pulmonary hypertension as depicted by multiple studies, current clinical practice guidelines categorize obstructive sleep apnea as a risk factor for pulmonary hypertension and recommend an assessment for sleep disordered breathing in evaluating patients with pulmonary hypertension. The dysregulatory mechanisms associated with hypoxemic episodes observed in sleep related breathing disorders contribute to the onset of pulmonary hypertension and identification of these potentially treatable factors might help in the reduction of overall cardiovascular mortality.

Download Full-text

Sleep quality and sleep related breathing disorders among nursing staff working in a tertiary care teaching hospital

MedPulse International Journal of Medicine ◽

10.26611/10111425 ◽

2020 ◽

Vol 14 (2) ◽

pp. 33-38

Author(s):

Amarnath R L C ◽

Keyword(s):

Sleep Quality ◽

Teaching Hospital ◽

Nursing Staff ◽

Tertiary Care ◽

Sleep Related Breathing Disorders ◽

Tertiary Care Teaching Hospital ◽

Care Teaching ◽

Breathing Disorders

Download Full-text

EXPRESS: Hypoxemia during Sleep and Overnight Rostral Fluid Shift in Pulmonary Arterial Hypertension: a pilot study

Pulmonary Circulation ◽

10.1177/2045894021996930 ◽

2021 ◽

pp. 204589402199693

Author(s):

Etienne-Marie Jutant ◽

David Montani ◽

Caroline Sattler ◽

Sven GÃ¼nther ◽

Olivier Sitbon ◽

...

Keyword(s):

Sleep Apnea ◽

Pilot Study ◽

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Central Sleep Apnea ◽

The Body ◽

Fluid Shift ◽

Sleep Related Breathing Disorders ◽

Breathing Disorders ◽

Pulmonary Arterial

Introduction. Sleep-related breathing disorders, including sleep apnea and hypoxemia during sleep, are common in pulmonary arterial hypertension (PAH), but the underlying mechanisms remain unknown. Overnight fluid shift from the legs to the upper airway and to the lungs promotes obstructive and central sleep apnea, respectively, in fluid retaining states. The main objective was to evaluate if overnight rostral fluid shift from the legs to the upper part of the body is associated with sleep-related breathing disorders in PAH. Methods. In a prospective study, a group of stable patients with idiopathic, heritable, related to drugs, toxins, or treated congenital heart disease PAH underwent a polysomnography and overnight fluid shift measurement by bioelectrical impedance in the month preceding or following a one-day hospitalization according to regular PAH follow-up schedule with a right heart catheterization. Results. Among 15 patients with PAH (women: 87%; median [25th;75th percentiles] age: 40 [32;61] years; mean pulmonary arterial pressure 56 [46;68] mmHg; pulmonary vascular resistance 8.8 [6.4;10.1] Wood units), 2 patients had sleep apnea and 8 (53%) had hypoxemia during sleep without apnea. The overnight rostral fluid shift was 168 [118;263] mL per leg. Patients with hypoxemia during sleep had a greater fluid shift (221 [141; 361] mL) than those without hypoxemia (118 [44; 178] mL, p = 0.045). Conclusion. This pilot study suggests that hypoxemia during sleep is associated with overnight rostral fluid shift in PAH.

Download Full-text

Comparison of Frequency and Severity of Sleep-Related Breathing Disorders in Children with Simple Obesity and Paediatric Patients with Prader–Willi Syndrome

Journal of Personalized Medicine ◽

10.3390/jpm11020141 ◽

2021 ◽

Vol 11 (2) ◽

pp. 141

Author(s):

Agnieszka Lecka-Ambroziak ◽

Marta Wysocka-Mincewicz ◽

Anna Świercz ◽

Małgorzata Jędrzejczak ◽

Mieczysław Szalecki

Keyword(s):

Insulin Resistance ◽

Apnea Hypopnea Index ◽

Oral Glucose ◽

Prader Willi Syndrome ◽

Model Assessment ◽

Sleep Related Breathing Disorders ◽

Breathing Disorders ◽

Simple Obesity ◽

Rhgh Treatment ◽

Group 1

Sleep-related breathing disorders (SRBDs) can be present in children with simple obesity and with Prader–Willi syndrome (PWS) and influence an individual diagnostic and treatment approach. We compared frequency and severity of SRBDs in children with simple obesity and with PWS, both without and on recombinant human growth hormone (rhGH) treatment, and correlation of SRBDs with insulin resistance tests. A screening polysomnography-polygraphy (PSG), the oral glucose tolerance test (OGTT) and homeostasis model assessment of insulin resistance (HOMA-IR) were analysed in three groups of patients—with simple obesity (group 1, n = 30, mean age 14.2 years), patients with PWS without the rhGH therapy (group 2, n = 8, mean age 13.0 years) and during the rhGH treatment (group 3, n = 17, mean age 8.9 years). The oxygen desaturation index (ODI) was significantly higher in groups 2 and 3, compared to group 1 (p = 0.00), and hypopnea index (HI) was higher in group 1 (p = 0.03). Apnea–hypopnea index (AHI) and apnea index (AI) results positively correlated with the insulin resistance parameters in groups 1 and 3. The PSG values worsened along with the increasing insulin resistance in children with simple obesity and patients with PWS treated with rhGH that may lead to a change in the patients’ care.

Download Full-text