Pulmonary arterial hypertension in patients with sleep apnoea syndrome

• Published in: Thorax Vol. 55; no. 11; pp. 934 - 939
• Main Authors: Bady, E, Achkar, A, Pascal, S, Orvoen-Frija, E, Laaban, J-P
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Thoracic Society 01-11-2000; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Air flow; Biological and medical sciences; Blood Gas Analysis - methods; Body Mass Index; Carbon Dioxide - blood; Cardiac catheterization; Catheters; Chronic obstructive pulmonary disease; Female; Forced Expiratory Volume - physiology; Heart; Hemodynamics; Humans; Hypertension, Pulmonary - etiology; Hypertension, Pulmonary - physiopathology; Male; Medical sciences; Middle Aged; obesity; Obesity - complications; Original; Oxygen - blood; Patients; Pneumology; Prevalence; pulmonary arterial hypertension; Pulmonary arteries; Pulmonary hypertension; Respiratory system : syndromes and miscellaneous diseases; Retrospective Studies; Sleep apnea; Sleep Apnea Syndromes - complications; Sleep Apnea Syndromes - physiopathology; sleep apnoea syndrome; Thromboembolism; Tuberculosis; Veins & arteries; Vital Capacity - physiology; Human; Sleep apnea syndrome; Pathophysiology; Respiratory disease; Etiology; Sleep disorder; Cardiovascular disease; Complication; Exploration; Hemodynamics; Pulmonary hypertension
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thorax.55.11.934

BACKGROUND Pulmonary arterial hypertension (PAH) in patients with sleep apnoea syndrome (SAS) is classically ascribed to associated chronic obstructive pulmonary disease (COPD). The aim of this retrospective study was to evaluate the possible occurrence of PAH as a complication of SAS in patients without COPD. METHODS Right heart catheterisation was performed in 44 patients with SAS and without COPD confirmed by polysomnography (apnoea index >5/h) admitted for the administration of nasal continuous positive airway pressure (CPAP). RESULTS Precapillary PAH, defined as mean pulmonary arterial pressure of >20 mm Hg with pulmonary capillary wedge pressure <15 mm Hg, was observed in 12/44 (27%) patients with SAS. There were no significant differences in apnoea index between patients with (PAH+) and those without PAH (PAH–) (42.6 (26.3) versus 35.8 (21.7) apnoeas/h). The PAH+ group differed significantly from the PAH– group in the following respects: lower daytime arterial oxygen tension (Pao 2) (9.6 (1.1) versus 11.3 (1.5) kPa, p=0.0006); higher daytime arterial carbon dioxide tension (Paco 2) (5.8 (0.5) versus 5.3 (0.5) kPa, p=0.002); more severe nocturnal hypoxaemia with a higher percentage of total sleep time spent at Sao 2<80% (32.2 (28.5)% versus 10.7 (18.8)%, p=0.005); and higher body mass index (BMI) (37.4 (6) versus 30.3 (6.7) kg/m2, p=0.002). The PAH+ patients had significantly lower values of vital capacity (VC) (87 (14)% predicted versus 105 (20)% predicted, p=0.005), forced expiratory volume in one second (FEV1) (82 (14)% predicted versus 101 (17)% predicted, p=0.001), expiratory reserve volume (40 (16)% predicted versus 77 (41)% predicted, p=0.003), and total lung capacity (87 (13)% predicted versus 98 (18)% predicted, p=0.04). Stepwise multiple regression analysis showed that mean pulmonary artery pressure (PAPm) was positively correlated with BMI and negatively with Pao 2. CONCLUSION Pulmonary arterial hypertension is frequently observed in patients with SAS, even when COPD is absent, and appears to be related to the severity of obesity and its respiratory mechanical consequences.