Pulmonary hypertension and hypoxemia in obstructive sleep apnea syndrome.

Sajkov, Dimitar; Cowie, R. J.; Thornton, Andrew; Espinoza, Hugo; Rd, McEvoy

doi:10.1164/ajrccm.149.2.8306039

Cited by 208 publications

(132 citation statements)

References 21 publications

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“…Nonetheless, it is known that patients with OSAS can have low values of Pa,O 2 related to the development of pulmonary hypertension. The development of pulmonary hypertension cannot be predicted by OSAS severity, FEV1 values, BMI or smoking habit [14].…”

Section: Discussionmentioning

confidence: 99%

Obstructive sleep apnoea syndrome: is the "half-night polysomnography" an adequate method for evaluating sleep profile and respiratory events?

Fanfulla¹,

Patruno²,

Bruschi³

et al. 1997

Eur Respir J

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Recently, to reduce the costs of polysomnography, split-night studies have been introduced into routine practice: the first part of the night is used to make the diagnosis of obstructive sleep apnoea syndrome (OSAS) and the second part to achieve an appropriate level of continuous positive airway pressure. Since this split-night protocol has not yet been validated by the comparison of polysomnographic pictures obtained in the first and second parts of the night, the aim of this study was to evaluate sleep profile and respiratory disturbances in the first part (PSG1) and second (PSG2) portion of a standard full-night polysomnographic examination (PSGtot) in a group of OSAS patients.Twenty nine consecutive OSAS patients, aged 54±10 yrs; body mass index (BMI) 40±6 kg·m -2 (mean±SD values), were studied by separate analyses of PSG1, PSG2 and PSGtot.PSG1 was found to have a low sensitivity value (66%). A significant difference was found between apnoea-hypopnoea indices (AHI) recorded in PSG1, PSG2 and PSGtot (mean±SD, AHI1 33±27, AHI2 45±28, AHItot 40±25 events·h -1 , respectively; p<0.01). A strong correlation was observed between AHItot and AHI1 (r=0.89) and between AHItot and AHI2 (r=0.92), but a weaker correlation between AHI1 and AHI2 (r=0.66). These correlations became weaker when patients were subdivided into two different classes on the basis of disease severity. PSG1 was representative of PSGtot and similar to PSG2 only in those patients with rapid eye movement (REM) phase sleep in the first part of the night.We conclude that split-night protocols are not appropriate for evaluating sleepdisordered breathing in obstructive sleep apnoea syndrome patients when rapid eye movement phase sleep does not occur in the first part of the night.

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Section: Discussionmentioning

confidence: 99%

Obstructive sleep apnoea syndrome: is the "half-night polysomnography" an adequate method for evaluating sleep profile and respiratory events?

Fanfulla¹,

Patruno²,

Bruschi³

et al. 1997

Eur Respir J

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“…However, other authors found pulmonary hypertension also in patients with pure OSAS or those patients who are not extremely obese [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Pulmonary haemodynamics in patients with OSAS or an overlap syndrome

Hawryłkiewicz¹,

Sliwiński²,

Górecka³

et al. 2004

Monaldi Arch Chest Dis

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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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“…It is associated with cardiovascular disease, such as hypertension [2,3] pulmonary hypertension [4,5], myocardial infarction [6], or stroke [7]. Furthermore, patients with OSAS suffer from decreased daytime performance [8].…”

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confidence: 99%

Long-term treatment with continuous positive airway pressure improves quality of life in obstructive sleep apnoea syndrome

Sanner¹,

Klewer²,

Trumm³

et al. 2000

Eur Respir J

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Continuous positive airway pressure (CPAP) is an established treatment of obstructive sleep apnoea syndrome (OSAS). While it is known that CPAP reverses the pathological breathing pattern and improves daytime sleepiness, there are no sufficient data on the long‐term influence of CPAP on quality of life in patients with OSAS. Thirty‐nine patients with polysomnographically verified OSAS (apnoea/hypopnoea index (AHI): (mean±sd) 46.8±21.8 events·h‐1) were prospectively studied. All patients answered three quality of life measures (Complaint List, Nottingham Health Profile Part 1 (NHP), and Verbal Analogue‐Scale “quality of life”) prior to the initiation of CPAP therapy. After a mean of 9 months they were re‐evaluated by polysomnography, and completed the questionnaires once again. As expected, CPAP was effective in treating the sleep‐related breathing disorder. AHI decreased significantly from (mean±sd) 46.8±21.8 events·h‐1 to 3.3±6.3 events·h‐1, and minimum oxygen saturation increased from 77.1±9.3% to 89.9±3.4%, while body mass index did not change significantly (31.3±5.4 versus 30.8±4.8 kg·m‐2). During long‐term treatment with CPAP the Complaint List revealed a significant improvement of the extent of subjective impairment due to physical and general complaints (26.4±9.9 versus 20.4±11.1), and NHP a significant improvement of emotional reactions (19.8±21.7 versus 11.1±14.0) and energy (50.8±36.6 versus 32.1±36.7), but not of pain, physical mobility, sleep, social isolation, and quality of life as assessed by the Verbal Analogue‐Scale. It is concluded that long‐term continuous positive airway pressure therapy is effective in improving not only pathological breathing patterns but also parameters that estimate quality of life in patients with obstructive sleep apnoea syndrome.

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Pulmonary hypertension and hypoxemia in obstructive sleep apnea syndrome.

Cited by 208 publications

References 21 publications

Obstructive sleep apnoea syndrome: is the "half-night polysomnography" an adequate method for evaluating sleep profile and respiratory events?

Obstructive sleep apnoea syndrome: is the "half-night polysomnography" an adequate method for evaluating sleep profile and respiratory events?

Pulmonary haemodynamics in patients with OSAS or an overlap syndrome

Long-term treatment with continuous positive airway pressure improves quality of life in obstructive sleep apnoea syndrome

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