OSA and pulmonary hypertension: time for a new look.

@article{Ismail2015OSAAP,
  title={OSA and pulmonary hypertension: time for a new look.},
  author={Khalid Ismail and Kari E. Roberts and Patrick Manning and Christopher Manley and Nicholas S. Hill},
  journal={Chest},
  year={2015},
  volume={147 3},
  pages={
          847-861
        }
}
OSA is a common yet underdiagnosed disorder encountered in everyday practice. The disease is a unique physiologic stressor that contributes to the development or progression of many other disorders, particularly cardiovascular conditions. The pulmonary circulation is specifically affected by the intermittent hypoxic apneas associated with OSA. The general consensus has been that OSA is associated with pulmonary hypertension (PH), but only in a minority of OSA patients and generally of a mild… 

Figures from this paper

Obstructive Sleep Apnea and Pulmonary Hypertension: A Review of Literature

A thorough review of the literature examining the interplay between OSA and PH is presented, finding patients suffering from OSA who develop PH tend to have worse cardiovascular and pulmonary changes.

Precapillary Pulmonary Hypertension and Sleep-Disordered Breathing: Is There a Link?

Both nocturnal oxygen administration and acetazolamide have been shown to improve sleep apnea in patients with PH and oxygen therapy also improved exercise performance, and further studies are needed to corroborate the efficacy of these and other treatments.

Obstructive sleep apnea and its effects on cardiovascular diseases: a narrative review

Treatment of patients with OSA with CPAP reduces the frequency of stroke and AF recurrence rate in patients with AF undergoing either medical management or invasive procedures, but well-designed clinical trials are necessary to answer critical questions regarding the management of OSA in Patients with cardiovascular diseases.

Nocturnal Hypoxemia, But Not Sleep Apnea, Is Associated With a Poor Prognosis in Patients With Pulmonary Arterial Hypertension.

SA in patients with PAH was not associated with worse prognosis, unlike left ventricular heart failure, but nocturnal hypoxemia was related to poor prognosis.

Positive Airway Pressure Therapy for Pediatric Obstructive Sleep Apnea

Pediatric obstructive sleep apnea syndrome (OSAS) is a disorder of breathing during sleep, characterized by intermittent or prolonged upper airway obstruction that can disrupt normal ventilation

Obstructive Ventilatory Disorder in Heart Failure—Caused by the Heart or the Lung?

The role of pivotal diagnostic tools such as pulmonary function tests and cardiopulmonary exercise test to determine the contribution of HF and COPD to symptoms and clinical status are discussed.

Sleep-Disordered Breathing in the Context of Pulmonary Hypertension in Pediatric Patients with Co-Morbid Conditions: Case Series and Review of the Literature

All children with PH and sleep-disordered breathing had co-morbid conditions including Trisomy 21 which is associated with PH, and children with PraderWilli Syndrome and PWS should be screened earlier for PH.

References

SHOWING 1-10 OF 81 REFERENCES

Daytime Pulmonary Hypertension in Patients with Obstructive Sleep Apnea

OSA alone constitutes an independent risk factor for the development of pulmonary hypertension, and the effect of continuous positive airway pressure (CPAP) treatment on pulmonary artery pressure (PPA) is assessed.

Overlap syndrome: obstructive sleep apnea in patients with chronic obstructive pulmonary disease.

Patients with overlap have a more important sleep-related O(2) desaturation than do patients with COPD with the same degree of bronchial obstruction, and have an increased risk of developing hypercapnic respiratory insufficiency and pulmonary hypertension when compared with patients with SAHS alone and with Patients with "usual" COPD.

Pulmonary hypertension in patients with obstructive sleep apnea syndrome.

Obstructive sleep apnea syndrome can cause mild pulmonary hypertension, even in the absence of pulmonary disease, and pulmonary hypertension is of the postcapillary type, or-in patients with normal left ventricular function-strongly related to the severity of OSAS.

Pulmonary Hemodynamics in the Obstructive Sleep Apnea Syndrome: Results in 220 Consecutive Patients

In conclusion, PH is observed, in agreement with previous studies, in less than 20% of OSAS patients and is strongly linked to the presence of an obstructive (rather than restrictive) ventilatory pattern, hypoxemia, and hypercapnia.

Pulmonary artery hypertension and sleep-disordered breathing: ACCP evidence-based clinical practice guidelines.

The evidence to date suggests that PAH may occur in the setting of SDB, although the prevalence is low and the limited data available also suggest that SDB is uncommon in patients with idiopathic PAH.

A Predictive Morphometric Model for the Obstructive Sleep Apnea Syndrome

A predictive morphometric model is presented that has a high sensitivity, high specificity, and good intermeasurer and test-retest reliability that will enable clinicians to detect the possibility of OSAS during initial office visits and then decide which patients are at high risk (and urgently need polysomnography) and which are at low risk ( and do not need polynography).

Association of chronic obstructive pulmonary disease and sleep apnea syndrome.

The association of chronic obstructive pulmonary disease (COPD) and sleep apnea syndrome (SAS) is likely to occur in a number of patients, and a large series of patients selected solely on the basis of a confirmed diagnosis of SAS are prospectively investigated.

The obesity-hypoventilation syndrome revisited: a prospective study of 34 consecutive cases.

Patients with OSAS and chronic respiratory insufficiency had in most cases an associated OHS or COPD, suggesting that OHS is an autonomous disease.

Nocturnal hypoxemia is common in primary pulmonary hypertension.

Seventy-seven percent of patients with PPH have significant nocturnal hypoxemia that is unrelated to apneas and hypopneas, and Nocturnal desaturation occurs more frequently in patients with higher P(A-a)O(2) values and lower FEV(1) values, resting arterial PaO (2) and SpO( 2) values.
...