Patients with chronic thromboembolic pulmonary hypertension (CTEPH) often have substantial
right ventricular dysfunction. The resulting low cardiac index might predispose to
sleep disordered breathing (SDB) by increasing ventilatory instability. The prevalence
of SDB and potential association with impaired cardiac index was examined in patients
with CTEPH. Patients referred for evaluation for pulmonary thromboendarterectomy surgery
were recruited. Subjects underwent a sleep study, unless already using positive airway
pressure therapy. Hemodynamic data were obtained from contemporaneous right-sided
cardiac catheterization. A total of 49 subjects were included. SDB—defined as ongoing
positive airway pressure use or apnea-hypopnea index (AHI) ≥5/h—was found in 57% of
subjects. SDB was generally mild in severity, with respiratory events mainly consisting
of hypopneas. Cardiac index was found to be significantly lower in subjects with SDB
than those without (2.19 vs 2.55 L/min/m2; p = 0.024), whereas no differences were observed in other characteristics. Additionally,
cardiac index was independently predictive of AHI. In a subgroup of subjects with
an elevated percentage of central events, both cardiac index and lung to finger circulation
time correlated with AHI. In conclusion, SDB is prevalent in patients with CTEPH and
might decrease with treatments that improve cardiac index.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Influence of pulmonary capillary wedge pressure on central apnea in heart failure.Circulation. 1999; 99: 1574-1579
- Peripheral and central ventilatory responses in central sleep apnea with and without congestive heart failure.Am J Respir Crit Care Med. 2000; 162: 2194-2200
- Effect of increased left atrial pressure on breathing frequency in anesthetized dog.J Appl Physiol (1985). 1990; 69: 1973-1980
- Quantitative general theory for periodic breathing in chronic heart failure and its clinical implications.Circulation. 2000; 102: 2214-2221
- Basic oscillating mechanism of Cheyne-Stokes breathing.Am J Physiol. 1956; 187: 395-398
- The impact of cardiac resynchronization therapy on obstructive sleep apnea in heart failure patients: a pilot study.Chest. 2007; 132: 433-439
- Association between hemodynamic impairment and Cheyne-Stokes respiration and periodic breathing in chronic stable congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy.Am J Cardiol. 1999; 84: 900-904
- Nocturnal hypoxemia is common in primary pulmonary hypertension.Chest. 2001; 120: 894-899
- Predictors of nocturnal oxygen desaturation in pulmonary arterial hypertension.Chest. 2007; 131: 109-117
- Nocturnal periodic breathing in primary pulmonary hypertension.Eur Respir J. 2002; 19: 658-663
- Sleep disordered breathing in group 1 pulmonary arterial hypertension.J Clin Sleep Med. 2014; 10: 277-283
- Sleep apnea in precapillary pulmonary hypertension.Sleep Med. 2013; 14: 247-251
- Sleep-related breathing disorders in patients with pulmonary hypertension.Chest. 2008; 133: 1375
- Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force.Sleep. 1999; 22: 667-689
- A noninvasive method for estimating cardiac output using lung to finger circulation time of oxygen.Am J Cardiol. 1998; 82: 915-917
- Circulation time measurement from sleep studies in patients with obstructive sleep apnea.J Clin Sleep Med. 2014; 10 (65A): 759-765
- Hemodynamic monitoring in obese patients: the impact of body mass index on cardiac output and stroke volume.Crit Care Med. 2006; 34: 1243-1246
- Role of nocturnal rostral fluid shift in the pathogenesis of obstructive and central sleep apnoea.J Physiol. 2013; 591: 1179-1193
- Mechanisms of hypoxemia in chronic thromboembolic pulmonary hypertension.Am Rev Respir Dis. 1989; 139: 1149-1154
- Intermittent hypoxia and respiratory plasticity in humans and other animals: does exposure to intermittent hypoxia promote or mitigate sleep apnoea?.Exp Physiol. 2009; 94: 279-296
- Defining phenotypic causes of obstructive sleep apnea. Identification of novel therapeutic targets.Am J Respir Crit Care Med. 2013; 188: 996-1004
- Expiratory pharyngeal narrowing during central hypocapnic hypopnea.Am J Respir Crit Care Med. 2009; 179: 313-319
- An integrative model of physiological traits can be used to predict obstructive sleep apnea and response to non positive airway pressure therapy.Sleep. 2015; 38: 961-970
- Obstructive sleep apnoea: longer respiratory event lengths in patients with heart failure.Eur Respir J. 2013; 41: 1340-1346
- Obstructive sleep apnea and pulmonary hypertension.Prog Cardiovasc Dis. 2009; 51: 363-370
- Echocardiographic features of the right heart in sleep-disordered breathing: the Framingham Heart Study.Am J Respir Crit Care Med. 2001; 164: 933-938
- Selected Contribution: pulmonary hypertension in mice following intermittent hypoxia.J Appl Physiol. 2001; 90: 2502-2507
- Sleep-disordered breathing in deep vein thrombosis and acute pulmonary embolism.Eur Respir J. 2012; 40: 919-924
Article Info
Publication History
Published online: December 31, 2015
Accepted:
December 17,
2015
Received in revised form:
December 17,
2015
Received:
October 21,
2015
Footnotes
Funding Sources: NIH/NHLBI T32 HL098062-05 .
See page 1005 for disclosure information.
Identification
Copyright
© 2016 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
