Obstructive sleep apnea and pulmonary hypertension.
Dimitar Sajkov1, R Doug McEvoy
1Flinders Medical Center, Bedford Park, SA, Australia.
Progress in Cardiovascular Diseases
|March 3, 2009
Summary
Obstructive sleep apnea (OSA) causes pulmonary hypertension in humans, characterized by changes in pulmonary arteries and the right ventricle. Continuous positive airway pressure (CPAP) treatment can reduce this pulmonary hypertension.
Area of Science:
- Cardiology
- Pulmonology
- Sleep Medicine
Background:
- Obstructive sleep apnea (OSA) involves nocturnal oxygen desaturation, hypercapnia, and negative intrathoracic pressure swings.
- Rodent models show intermittent hypoxia induces pulmonary vascular remodeling and hypertension.
- Previous human studies were inconclusive on OSA's direct impact on pulmonary hypertension.
Purpose of the Study:
- To investigate whether episodic nocturnal hypoxemia in OSA is sufficient to cause pulmonary vascular and right ventricular changes in humans.
- To determine the prevalence of pulmonary hypertension in OSA patients without other cardiopulmonary disorders.
- To assess the effect of continuous positive airway pressure (CPAP) on pulmonary artery pressure in OSA.
Main Methods:
- Review of recent studies examining pulmonary artery pressure in OSA patients.
- Assessment of pulmonary hypertension prevalence in OSA.
- Evaluation of changes in pulmonary artery pressure following CPAP treatment.
Main Results:
- Pulmonary hypertension is present in 20-40% of OSA patients without other cardiopulmonary conditions.
- CPAP treatment leads to reductions in pulmonary artery pressure in OSA patients.
- OSA-associated pulmonary hypertension may involve pulmonary arteriolar remodeling, hypoxia hyperreactivity, and left ventricular diastolic dysfunction.
Conclusions:
- Episodic nocturnal hypoxemia in OSA can cause pulmonary hypertension in humans.
- OSA-related pulmonary hypertension is generally mild and responsive to CPAP.
- While right ventricular changes occur, right ventricular failure is uncommon in OSA unless other conditions coexist.
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