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- Title
Sleep-Disordered Breathing and Nocturnal Hypoxemia in Precapillary Pulmonary Hypertension: Prevalence, Pathophysiological Determinants, and Clinical Consequences.
- Authors
Spiesshoefer, Jens; Herkenrath, Simon; Harre, Katharina; Kahles, Florian; Florian, Anca; Yilmaz, Ali; Mohr, Michael; Naughton, Matthew; Randerath, Winfried; Emdin, Michele; Passino, Claudio; Regmi, Binaya; Dreher, Michael; Boentert, Matthias; Giannoni, Alberto
- Abstract
Background and objective: The clinical relevance and interrelation of sleep-disordered breathing and nocturnal hypoxemia in patients with precapillary pulmonary hypertension (PH) is not fully understood. Methods: Seventy-one patients with PH (age 63 ± 15 years, 41% male) and 35 matched controls were enrolled. Patients with PH underwent clinical examination with assessment of sleep quality, daytime sleepiness, 6-minute walk distance (6MWD), overnight cardiorespiratory polygraphy, lung function, hypercapnic ventilatory response (HCVR; by rebreathing technique), amino-terminal pro-brain natriuretic peptide (NT-proBNP) levels, and cardiac MRI (n = 34). Results: Prevalence of obstructive sleep apnea (OSA) was 68% in patients with PH (34% mild, apnea-hypopnea index [AHI] ≥5 to <15/h; 34% moderate to severe, AHI ≥15/h) versus 5% in controls (p < 0.01). Only 1 patient with PH showed predominant central sleep apnea (CSA). Nocturnal hypoxemia (mean oxygen saturation [SpO2] <90%) was present in 48% of patients with PH, independent of the presence of OSA. There were no significant differences in mean nocturnal SpO2, self-reported sleep quality, 6MWD, HCVR, and lung and cardiac function between patients with moderate to severe OSA and those with mild or no OSA (all p > 0.05). Right ventricular (RV) end-diastolic (r = −0.39; p = 0.03) and end-systolic (r = −0.36; p = 0.04) volumes were inversely correlated with mean nocturnal SpO2 but not with measures of OSA severity or daytime clinical variables. Conclusion: OSA, but not CSA, is highly prevalent in patients with PH, and OSA severity is not associated with nighttime SpO2, clinical and functional status. Nocturnal hypoxemia is a frequent finding and (in contrast to OSA) relates to structural RV remodeling in PH.
- Subjects
PULMONARY hypertension; FUNCTIONAL status; CASE-control method; MAGNETIC resonance imaging; OXYGEN saturation; SLEEP; SLEEP apnea syndromes; DISEASE prevalence; DESCRIPTIVE statistics; PULMONARY function tests; PEPTIDE hormones; HYPOXEMIA; DROWSINESS; DISEASE risk factors
- Publication
Respiration, 2021, Vol 100, Issue 9, p865
- ISSN
0025-7931
- Publication type
Article
- DOI
10.1159/000515602