Sleep-related breathing disorders and pulmonary hypertension

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.

Day-case tonsillectomy for children in Glasgow: the impact of changing indications and deprivation

2013 ◽  
Vol 127 (4) ◽  
pp. 392-398 ◽  
Author(s):  
W A Clement
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Day Surgery ◽  
Sleep Apnoea ◽  
Day Case ◽  
Sleep Related Breathing Disorders ◽  
Number Of Children ◽  
Breathing Disorders ◽  
Obstructive Sleep ◽  
Same Day Discharge ◽  
The Impact

AbstractObjective:To determine the number of children undergoing tonsillectomy that could have this performed as a day surgery procedure.Methods:This paper reports a prospective cohort study, which entailed a comparison of children's eligibility for day-case surgery between 2001 and 2011 and an assessment of the Scottish Index of Multiple Deprivation scores.Results:In total, 148 children were enrolled. In 2011, 60 children (42 per cent) were eligible for surgery with same day discharge compared with 27 per cent in 2001. The percentage of children undergoing tonsillectomy for sleep-related breathing disorders or obstructive sleep apnoea hypopnoea syndrome increased from 26 per cent to 55 per cent.Conclusion:Eligibility for tonsillectomy with same day discharge has increased. This appears to be related to an increase in the number of children who are able to fulfil the social criteria for same day discharge. The results indicate an association between deprivation and tonsillectomy, particularly surgery carried out for the symptoms of sleep-related breathing disorders or obstructive sleep apnoea hypopnoea syndrome. There has been a significant increase in the percentage of children undergoing tonsillectomy for the indication of sleep-related breathing disorders or obstructive sleep apnoea hypopnoea syndrome.

scholarly journals Pulmonary Arterial Hypertension

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.

scholarly journals The nose, snoring and obstructive sleep apnoea

2011 ◽  
Vol 49 (3) ◽  
pp. 259-263
Author(s):  
B. Kotecha
Keyword(s):  
Nasal Obstruction ◽  
Obstructive Sleep Apnoea ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Nasal Surgery ◽  
Sleep Related Breathing Disorders ◽  
Breathing Disorders ◽  
Obstructive Sleep ◽  
Nasal Pathology

Snoring and obstructive sleep apnoea are both due to multilevel anatomical obstruction, and the nose and nasal pathology both contribute in many cases. This paper addresses some of the issues surrounding the problem and briefly discusses the role of medication and nasal dilators and in more detail the implication of nasal surgery in various aspects of sleep related breathing disorders (SRBD). Nasal obstruction leads to mouth breathing, which destabilises the upper airway and aggravates SRBD.

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

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.

Sleep-related breathing disorders: classification and diagnosis

ESC CardioMed ◽  
2018 ◽  
pp. 1062-1065
Author(s):  
Melissa C. Lipford ◽  
Virend K. Somers
Keyword(s):  
Risk Factors ◽  
Clinical Practice ◽  
Sleep Apnoea ◽  
Screening Tools ◽  
Cardiac Patients ◽  
Separate Entity ◽  
Sleep Related Breathing Disorders ◽  
Clinical Screening ◽  
Breathing Disorders ◽  
Obstructive Sleep

Sleep-related breathing disorders encapsulate multiple respiratory abnormalities which occur during sleep. The most common disorders within this category are obstructive sleep apnoea, central sleep apnoea, and sleep-related hypoventilation. This chapter defines each of these conditions as a separate entity; however, in clinical practice there is overlap between the disorders and patients may have combinations of disease. Untreated sleep-related breathing disorders serve as risk factors for cardiovascular and cerebrovascular disease, and these diseases are commonly co-morbid in cardiac patients. Identification and treatment in the cardiac patient population is extremely important; yet many patients remain undiagnosed. This chapter discusses clinical screening tools as well as definitive diagnostic studies for these respiratory disorders. The definitions in this chapter will pertain only to adult patients.

Sleep disorders

2018 ◽  
Author(s):  
Lawrence J. Epstein
Keyword(s):  
Sleep Disorders ◽  
Sleep Apnoea ◽  
Behaviour Disorder ◽  
Sleep Wake Disorders ◽  
Sleep Related Breathing Disorders ◽  
Breathing Disorders ◽  
Sleep Behaviour ◽  
Obstructive Sleep ◽  
Broad Array ◽  
The Individual

Over 70 described sleep disorders disrupt the sleep of an estimated 50–70 million Americans. The disorders present with a broad array of symptoms but result in the individual not getting the health, cognitive, and restorative benefits of a good night’s sleep. The disorders have been categorized into the following categories: insomnia, sleep-related breathing disorders, central disorders of hypersomnolence, circadian rhythm sleep–wake disorders, parasomnias, and sleep-related movement disorders. This chapter reviews each category and provides details on the symptoms, pathophysiology, and treatment of the most common disorder in each category, including insomnia, obstructive sleep apnoea, narcolepsy, restless legs syndrome, and REM sleep behaviour disorder. The presenting complaint is the key to diagnosis, directing subsequent evaluation.

scholarly journals Pulmonary haemodynamics in patients with OSAS or an overlap syndrome

2004 ◽  
Vol 61 (3) ◽  
Author(s):  
I. Hawrylkiewicz ◽  
P. Sliwinski ◽  
D. Górecka ◽  
R. Plywaczewski ◽  
J. Zielinski
Keyword(s):  
Pulmonary Hypertension ◽  
Distinct Group ◽  
Overlap Syndrome ◽  
Obstructive Sleep Apnoea Syndrome ◽  
Sleep Study ◽  
Obstructive Sleep ◽  
Study Results ◽  
Pulmonary Haemodynamics ◽  
Alveolar Hypoxia ◽  
Pulmonary Arterial

Background. Alveolar hypoxia is the most important mechanism leading to pulmonary arterial vasoconstriction, remodelling and pulmonary hypertension. Patients with Obstructive Sleep Apnoea Syndrome (OSAS) experience multiple short periods of alveolar hypoxia during apnoeic episodes. However, the question as to whether these hypoxic episodes are responsible for the development of permanent pulmonary hypertension is still debatable. We aimed to investigate the relationship between the episodes of nocturnal desaturation and pulmonary haemodynamics in two distinct group patients: with pure OSAS or an overlap syndrome. Methods: We studied 67 patients with severe OSAS (means: age 45±8 years, AHI 62±22, FEV1 3.6±0.8 L = 97±16% of predicted PaO2 72±10 mmHg, PaCO2 40±4 mmHg) and 17 patients with an overlap syndrome (OS), means: age 51±5 years, AHI 64±19, FEV1 1.5±0.7 = 43±16% of predicted PaO2 57±9 mmHg). All subjects underwent pulmonary artery catheterisation with pressure and flow recordings and an overnight full sleep study. Results. On average patients with OSAS had nocturnal desaturation (mean overnight SaO2 = 87±5%) and normal PPA (15.8±4.6 mmHg). Only 11 out of 67 subjects (16%) presented with pulmonary hypertension. Patients with OS had nocturnal desaturation (mean overnight SaO2 = 80.2±8.5%) and mild pulmonary hypertension (PPA 24.2±7.4 mmHg). Only three out of 17 patients had normal pulmonary arterial pressure. Conclusions. In patients with severe OSAS, pulmonary hypertension is rare (16%) and is related best to the severity of the disease and to obesity. In OS patients diurnal pulmonary hypertension is frequent but does not correlate with the severity of nocturnal desaturation.

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