Sleep-Related Breathing Disorders in Patients With Pulmonary Hypertension

Ulrich, Silvia; Fischler, Manuel; Speich, Rudolf; Bloch, Konrad E.

doi:10.1378/chest.07-3035

Cited by 91 publications

(93 citation statements)

References 17 publications

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“…It is also known that more severely reduced LVEF and higher NYHA classes are associated with an increased risk of developing Cheyne-Stokes respiration, one of the types of CSA [19]. In this context a higher proportion of obstructive over CSA observed in our study can be surprising but is in line with several previous reports [11,14,18]. When compared with earlier reports, patients in our study received similar medical treatment, which included widespread use of beta-blockers [14].…”

Section: Discussionsupporting

confidence: 89%

“…It the context of evident association of sleep disturbances with pulmonary haemodynamic parameters, it should be emphasised that the more prevalent sleep disorder breathing in PH is CSA [18]. It is also known that more severely reduced LVEF and higher NYHA classes are associated with an increased risk of developing Cheyne-Stokes respiration, one of the types of CSA [19].…”

Section: Discussionmentioning

confidence: 99%

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The influence of obstructive sleep breathing disturbances on echocardiographic and pulmonary haemodynamic parameters in patients with dilated cardiomyopathy

et al. 2016

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A b s t r a c t Background:It is important to identify the clinical indicators of poor prognosis and treatable conditions that might contribute to the progression of heart failure (HF) and pulmonary hypertension (PH) in the group of patients with dilated cardiomyopathy (DCM) and concomitant obstructive sleep apnoea (OSA). Aim:To evaluate the influence of OSA on echocardiographic and haemodynamic parameters in patients with DCM, and the outcome in long-term follow-up. Methods:We enrolled patients with DCM and severely impaired ejection fraction (EF < 30%). Each patient underwent polygraphy, echocardiography, and right heart catheterisation. Subjects were divided into groups based on the apnoea-hypopnoea index (AHI): > 0 and < 5 (group I), ≥ 5 and ≤ 15 (group II), > 15 and ≤ 30 (group III), and > 30 (group IV). We compared the OSA-free (AHI < 5) subjects with those with OSA (AHI ≥ 5). The evaluated clinical end-points were death and orthotropic heart transplant. Results:The study population comprised 51 patients. Mean EF was 22%; 59% of patients were suffering from OSA. The increased severity of OSA correlated with worse pulmonary haemodynamics. Patients with OSA had higher mean pulmonary arterial pressure and pulmonary vascular resistance than individuals without OSA (p = 0.044, p = 0.032, respectively). The highest chamber diameters assessed in echocardiography were found in group IV (p < 0.05). A total of 10 end-points occurred during follow-up (8.9 ± 5.1 months), with significant differences observed between groups I-IV and the highest rate in group IV (p < 0.001). Conclusions:The increasing severity of OSA worsens the prognosis of DCM patients, independently of severe HF and coexistent PH. Systematic OSA screening in patients with HF might facilitate identification of individuals at high risk of progression of pulmonary haemodynamic impairment and end-point rate.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

The influence of obstructive sleep breathing disturbances on echocardiographic and pulmonary haemodynamic parameters in patients with dilated cardiomyopathy

et al. 2016

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“…One case series of 38 patients with pulmonary hypertension from different etiologies revealed Cheyne-Stokes respiration in 39% of the patients. 145 Similarly, COPD is frequently associated with left ventricle diastolic dysfunction 146 as well as systolic heart failure, 147 both conditions known to be associated with Cheyne-Stokes respiration.…”

Section: Central Sleep Apneamentioning

confidence: 99%

Sleep Disorders in Chronic Obstructive Pulmonary Disease: Etiology, Impact, and Management

Budhiraja

Siddiqi

Quan

2015

Journal of Clinical Sleep Medicine

151

125

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Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality and may frequently be complicated by sleep disorders. Insomnia and obstructive sleep apnea are commonly encountered in patients with COPD. Nocturnal hypoxemia is also prevalent in COPD may occur despite adequate awake oxygenation and can be especially severe in rapid eye movement sleep. Additionally, several factors-some of them unique to COPD-can contribute to sleep-related hypoventilation. Recognition of hypoventilation can be vital as supplemental oxygen therapy itself can acutely worsen hypoventilation and lead to disastrous consequences. Finally, accruing data establish an association between restless leg syndrome and COPDan association that may be driven by hypoxemia and/or hypercapnia. Comorbid sleep disorders portend worse sleep quality, diminished quality of life, and multifarious other adverse consequences. The awareness and knowledge regarding sleep comorbidities in COPD has continued to evolve over past many years. There are still several lacunae, however, in our understanding of the etiologies, impact, and therapies of sleep disorders, specifi cally in patients with COPD. This review summarizes the latest concepts in prevalence, pathogenesis, diagnosis, and management of diverse sleep disorders in COPD. Keywords: COPD, insomnia, obstructive sleep apnea, restless legs syndrome, hypoventilation Citation: Budhiraja R, Siddiqi TA, Quan SF. Sleep disorders in chronic obstructive pulmonary disease: etiology, impact, and management. J Clin Sleep Med 2015;11(3):259-270.pii: jc-00080-14 http://dx.doi.org/10.5664/jcsm.4540 T hat sleep is adversely affected in chronic obstructive pulmonary disease (COPD) has been long recognized. 1 COPD affects 5% to 10% of the adult population in the United States and is a major contributor to global disease burden. 2 The prevalence of insomnia symptoms, insomnia disorder, restless leg syndrome, and hypoxemia is increased in COPD. [3][4][5] Furthermore, polysomnographic (PSG) evaluation generally reveals decreased sleep effi ciency and lower mean overnight oxygen saturation in COPD patients compared to controls. 6 In COPD, the pathogenesis of sleep disorders appears to be a complex and multifactorial process, likely consequent to one or more of the following: physiological changes associated with sleep, hypoxemia, hypercapnia, infl ammation, COPD medications, and/or nicotine use. Comorbid disorders as well as primary sleep disturbances may also contribute to disrupted sleep in COPD patients. For example, nocturnal gastroesophageal refl ux (GERD) is associated with both symptoms of sleep apnea and COPD, and may contribute to the pathogenesis, and concomitant occurrence of both disorders.7 GERD may also infl uence sleep quality which could potentially contribute to some of the sleep complaints reported by persons with COPD. 8 The following sections describe the diverse sleep disorders and sleep-related abnormalities encountered in patients with COPD. Sleep Disorders in Chronic Obstructiv...

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“…This could have been due to obstructive sleep apnea or nocturnal hypoxia from hypoventilation, both of which have been associated with pulmonary hypertension. [36][37][38] We do not have data on right heart catheterization on our patients.…”

mentioning

confidence: 99%

Sleep Disordered Breathing in Isolated Unilateral and Bilateral Diaphragmatic Dysfunction

Khan

Morgenthaler

Ramar

2014

Journal of Clinical Sleep Medicine

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Introduction:The effect of isolated unilateral or bilateral diaphragmatic dysfunction (DD), in the absence of a generalized neuromuscular disorder, on sleep disordered breathing (SDB) is not well understood. The type of positive airway pressure (PAP) device needed to treat SDB in patients with isolated DD is also not well established. Methods: We retrospectively analyzed data on patients with isolated unilateral or bilateral DD who were referred for polysomnography (PSG) for clinical symptoms or abnormal oximetry between 1994 and 2006. Results: We found 66 patients who met criteria, of whom 74.2% were males with an average age of 58.8 ± 10.9 years. 56 had isolated unilateral DD, and 10 had isolated bilateral DD. All had signifi cant SDB with an apnea-hypopnea index (AHI) of 26.6 ± 28.4. There were no signifi cant differences in PSG measures, arterial blood gas analysis, pulmonary function tests, or echocardiographic data, except for lower maximal inspiratory pressure in patients with bilateral DD compared to unilateral DD (40.2% ± 17.8% vs. 57.7% ± 20.5%, p = 0.02). Control of SDB with continuous PAP (CPAP) was possible in only 37.9% of patients with the rest requiring bilevel PAP (BPAP). Patients with isolated bilateral DD and SDB were 6.8 times more likely to fail CPAP than those with unilateral DD (p = 0.03). Conclusions: Most patients with isolated DD failed CPAP and required BPAP. Patients with bilateral DD were more likely to require BPAP than those with unilateral DD. Patients with isolated DD should be considered for in-lab titration to determine adequacy of therapy. Keywords: diaphragmatic weakness, diaphragmatic paralysis, sleep disordered breathing, obstructive sleep apnea, isolated diaphragmatic dysfunction, diaphragmatic dysfunction Citation: Khan A, Morgenthaler TI, Ramar K. Sleep disordered breathing in isolated unilateral and bilateral diaphragmatic dysfunction.

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Sleep-Related Breathing Disorders in Patients With Pulmonary Hypertension

Cited by 91 publications

References 17 publications

The influence of obstructive sleep breathing disturbances on echocardiographic and pulmonary haemodynamic parameters in patients with dilated cardiomyopathy

The influence of obstructive sleep breathing disturbances on echocardiographic and pulmonary haemodynamic parameters in patients with dilated cardiomyopathy

Sleep Disorders in Chronic Obstructive Pulmonary Disease: Etiology, Impact, and Management

Sleep Disordered Breathing in Isolated Unilateral and Bilateral Diaphragmatic Dysfunction

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