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Reshma S J, George S, P SK. Pulmonary hypertension in newly diagnosed obstructive sleep apnea-chronic obstructive pulmonary disease overlap syndrome patients attending a tertiary care centre-a cross-sectional analysis. Ir J Med Sci 2024; 193:1917-1921. [PMID: 38472700 DOI: 10.1007/s11845-024-03657-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Overlap syndrome is the association of obstructive sleep apnea (OSA) with chronic obstructive pulmonary disorder and with other chronic respiratory diseases. Patients with overlap syndrome have a worse prognosis compared with chronic obstructive pulmonary disorder or OSA alone. Additionally, patients with combined chronic obstructive pulmonary disorder and OSA are more likely to develop pulmonary hypertension and right heart failure much earlier than those without overlap. AIM To assess the occurrence of pulmonary hypertension (PH) in newly diagnosed OSA-chronic obstructive pulmonary disorder overlap syndrome patients attending a tertiary care centre. MATERIALS AND METHODS This cross-sectional study was conducted at Department of Pulmonary Medicine, Government Medical College, Kozhikode, Kerala, South India, among patients with OSA above 40 years of age who were proactively evaluated to pick out those with undiagnosed overlap. A period of 6 months after getting ethical clearance from June 2018 was selected as the study period. Among patients with symptoms suggestive of OSA above 40 years of age who gave the informed consent were enrolled after screening with Standard Sleep questionnaires (Berlin questionnaire, STOP BANG and Epworth Sleepiness Scale). Enrolled patients underwent routine spirometry and sleep study using the standard Level 1 overnight polysomnography (Level1 OPSG). Patients were classified in to two groups as OSA patients (group I), having an apnea hypopnea index (AHI) > 5/hr alone and the second group as those OSA patients (group II), with an obstructive spirometry pattern who were the overlap group. Arterial blood gas analysis (a sample of radial arterial blood was drawn with the patient awake and supine, and was analyzed for pH, PaCO2 and PaO2) and echocardiography (ECHO) of the two groups were compared as a non-invasive method to assess pulmonary artery hypertension and results were analyzed in a systematic manner. RESULTS Among the 84 patients enrolled, 16.7% had overlap syndrome and the rest had OSA alone. Statistically significant higher mean weight and BMI for those with overlap syndrome compared to the OSA group were observed. Mean FVC (forced vital capacity), FEV1 (forced expiratory volume 1 s), and FEV1/FVC were lower in those with overlap syndrome compared to OSA group. The mean values of ABG parameters revealed higher PaCO2 and lower PaO2 among the group with overlap syndrome which were statistically significant. However, there was no significant difference in resting room air SaO2 value between the two groups. The mean values of sleep duration and efficiency were significantly lower in those with overlap syndrome with a p value < 0.001. The mean value of arousal and REM (rapid eye movement) sleep percentage were significantly higher among those with overlap syndrome (p < 0.001). Mean value of NREM (non-rapid eye movement) sleep percentage was lower among the group with overlap syndrome compared with the OSA group, and this difference was statistically significant. The mean AHI value of the overlap syndrome group was 39.79 ± 7.54 and this was significantly higher than the OSA group (p < 0.004). Among the 14 patients who had ECHO evidence of pulmonary hypertension, 9 (64.3%) belonged to the overlap group which shows that they are a highly vulnerable group for developing pulmonary hypertension (PH) and requires early detection and more rigorous treatment. CONCLUSION This study confirms that OSA patients with modest daytime level of hypoxemia and mild-moderate chronic airflow limitation have a high prevalence of PH. Chronic airway obstruction may be asymptomatic in some subjects and this stresses the necessity of pulmonary function test in OSA.
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Affiliation(s)
- Jyothi Reshma S
- Department of Pulmonary Medicine, Government Medical College, Kozhikode, Kerala, India
| | - Sunny George
- Department of Pulmonary Medicine, Government Medical College, Kozhikode, Kerala, India.
- Government Medical College, Ernakulam, India.
| | - Santhosh Kumar P
- Department of Pulmonary Medicine, Government Medical College, Kozhikode, Kerala, India
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Bjork S, Jain D, Marliere MH, Predescu SA, Mokhlesi B. Obstructive Sleep Apnea, Obesity Hypoventilation Syndrome, and Pulmonary Hypertension: A State-of-the-Art Review. Sleep Med Clin 2024; 19:307-325. [PMID: 38692755 DOI: 10.1016/j.jsmc.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
The pathophysiological interplay between sleep-disordered breathing (SDB) and pulmonary hypertension (PH) is complex and can involve a variety of mechanisms by which SDB can worsen PH. These mechanistic pathways include wide swings in intrathoracic pressure while breathing against an occluded upper airway, intermittent and/or sustained hypoxemia, acute and/or chronic hypercapnia, and obesity. In this review, we discuss how the downstream consequences of SDB can adversely impact PH, the challenges in accurately diagnosing and classifying PH in the severely obese, and review the limited literature assessing the effect of treating obesity, obstructive sleep apnea, and obesity hypoventilation syndrome on PH.
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Affiliation(s)
- Sarah Bjork
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Rush University Medical Center, 1750 W. Harrison Street, Jelke 297, Chicago, IL 60612, USA
| | - Deepanjali Jain
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Rush University Medical Center, 1750 W. Harrison Street, Jelke 297, Chicago, IL 60612, USA
| | - Manuel Hache Marliere
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Rush University Medical Center, 1750 W. Harrison Street, Jelke 297, Chicago, IL 60612, USA
| | - Sanda A Predescu
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Rush University Medical Center, 1750 W. Harrison Street, Jelke 297, Chicago, IL 60612, USA
| | - Babak Mokhlesi
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Rush University Medical Center, 1750 W. Harrison Street, Jelke 297, Chicago, IL 60612, USA.
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Nathani A, Attaway A, Mehra R. Hypoxic and Autonomic Mechanisms from Sleep-Disordered Breathing Leading to Cardiopulmonary Dysfunction. Sleep Med Clin 2024; 19:229-237. [PMID: 38692748 DOI: 10.1016/j.jsmc.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder. Its prevalence has increased due to increasing obesity and improved screening and diagnostic strategies. OSA overlaps with cardiopulmonary diseases to promote intermittent hypoxia and autonomic dysfunction. Intermittent hypoxia increases the risk for oxidative stress and inflammation, which promotes endothelial dysfunction and predisposes to atherosclerosis and other cardiovascular complications. OSA is associated with an increased sympathetic nervous system drive resulting in autonomic dysfunction leading to worsening of cardiopulmonary diseases. Cardiovascular diseases are observed in 40% to 80% of OSA patients. Therefore, it is essential to screen and treat cardiovascular diseases.
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Affiliation(s)
- Avantika Nathani
- Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue A90, Cleveland, OH 44195, USA.
| | - Amy Attaway
- Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue A90, Cleveland, OH 44195, USA
| | - Reena Mehra
- Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue A90, Cleveland, OH 44195, USA; Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA; Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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Balcan B, Akdeniz B, Peker Y, Collaborators TTURCOSACT. Obstructive Sleep Apnea and Pulmonary Hypertension: A Chicken-and-Egg Relationship. J Clin Med 2024; 13:2961. [PMID: 38792502 PMCID: PMC11122166 DOI: 10.3390/jcm13102961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/12/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by repeated episodes of upper airway obstruction during sleep, and it is closely linked to several cardiovascular issues due to intermittent hypoxia, nocturnal hypoxemia, and disrupted sleep patterns. Pulmonary hypertension (PH), identified by elevated pulmonary arterial pressure, shares a complex interplay with OSA, contributing to cardiovascular complications and morbidity. The prevalence of OSA is alarmingly high, with studies indicating rates of 20-30% in males and 10-15% in females, escalating significantly with age and obesity. OSA's impact on cardiovascular health is profound, particularly in exacerbating conditions like systemic hypertension and heart failure. The pivotal role of hypoxemia increases intrathoracic pressure, inflammation, and autonomic nervous system dysregulation in this interplay, which all contribute to PH's pathogenesis. The prevalence of PH among OSA patients varies widely, with studies reporting rates from 15% to 80%, highlighting the variability in diagnostic criteria and methodologies. Conversely, OSA prevalence among PH patients also remains high, often exceeding 25%, stressing the need for careful screening and diagnosis. Treatment strategies like continuous positive airway pressure (CPAP) therapy show promise in mitigating PH progression in OSA patients. However, this review underscores the need for further research into long-term outcomes and the efficacy of these treatments. This review provides comprehensive insights into the epidemiology, pathophysiology, and treatment of the intricate interplay between OSA and PH, calling for integrated, personalized approaches in diagnosis and management. The future landscape of OSA and PH management hinges on continued research, technological advancements, and a holistic approach to improving patient outcomes.
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Affiliation(s)
- Baran Balcan
- Department of Pulmonary Medicine, Koç University School of Medicine, Istanbul 34450, Turkey;
| | - Bahri Akdeniz
- Department of Cardiology, Dokuz Eylül University Faculty of Medicine, Izmir 35340, Turkey;
| | - Yüksel Peker
- Department of Pulmonary Medicine, Koç University School of Medicine, Istanbul 34450, Turkey;
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
- Department of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, 22185 Lund, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
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Lenka J, Foley R, Metersky M, Salmon A. Relationship between obstructive sleep apnea and pulmonary hypertension: past, present and future. Expert Rev Respir Med 2024; 18:85-97. [PMID: 38646681 DOI: 10.1080/17476348.2024.2345684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 04/17/2024] [Indexed: 04/23/2024]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is a widely prevalent condition with consequent multiple organ systems complications. There is consensus that OSA is associated with negative effects on pulmonary hemodynamics but whether it contributes to development of clinical pulmonary hypertension (PH) is unclear. AREAS COVERED In this review, we (1) highlight previous studies looking into the possible bidirectional association of OSA and PH, focusing on those that explore clinical prognostic implications, (2) explore potential pathophysiology, (3) discuss the new metrics in OSA, (4) describe endo-phenotyping of OSA, (5) recommend possible risk assessment and screening pathways. EXPERT OPINION Relying only on symptoms to consider a sleep study in PH patients is a missed opportunity to detect OSA, which, if present and not treated, can worsen outcomes. The potential prognostic role of sleep study metrics such as oxygen desaturation index (ODI), hypoxic burden (HB) and ventilatory burden (VB) in OSA should be studied in prospective trials to identify patients at risk for PH. AHI alone has not provided clarity. In those with PH, we should consider replacing ambulatory overnight pulse oximetry (OPO) with home sleep studies (HST). In PH patients, mild OSA should be sufficient to consider PAP therapy.
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Affiliation(s)
- Jyotirmayee Lenka
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Connecticut, Farmington, CT, USA
| | - Raymond Foley
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Connecticut, Farmington, CT, USA
| | - Mark Metersky
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Connecticut, Farmington, CT, USA
| | - Adrian Salmon
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Connecticut, Farmington, CT, USA
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Bigdelu L, Alimi H, Fazlinezhad A, Ghaderi F, Poorzand H, Vakilian F, Keihanian F, Abbasi Shaye Z, Afshar S. Novel echocardiographic parameters in pulmonary hypertension assessment and the relationship between echocardiography and 6-minute walking test. Medicine (Baltimore) 2024; 103:e35294. [PMID: 38335427 PMCID: PMC10861008 DOI: 10.1097/md.0000000000035294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 02/12/2024] Open
Abstract
Pulmonary artery stiffness (PAS) has been shown to be related to pulmonary artery pressure in patients with pulmonary artery hypertension (PAH). The aim of this study was to determine the correlation between functional capacity and echocardiographic indices of PAS in patients with PAH. This cross-sectional study was performed on patients with PAH who were confirmed by right heart catheterization and referred to Imam Reza PAH clinic for routine follow-up between November 2019 and January 2020. All patients underwent echocardiography and the maximum Doppler frequency shift, pulmonary acceleration time, peak velocity of the pulmonary flow, and velocity time integral, as well as PAS, were measured. All patients performed a 6-minute walk test. Fifty patients with a mean age of 41.90 ± 14.73 years old participated in this study. The majority of the patients were female (74%). The most common cause of PAH was idiopathic (74%). There was a significant correlation between PAS and pulmonary artery systolic pressure (r = 0.302, P = .041), second pulmonary valve pulse Doppler velocity (V2) (r = -0.461, P = .003), time from onset of pulmonary flow ejection to V2/first pulmonary valve pulse Doppler velocity (r = -0.311, P = .037) and Z3 ratio (r = -0.346, P = .023). There was no significant correlation between PAS and 6-minute walk test, pulmonary vascular resistance, and tricuspid annular plane systolic excursion (P > .05). There was a significant correlation between V2 and pulmonary vascular resistance (r = 0.359, P = .049). PAS and first pulmonary valve pulse Doppler velocity are simple, noninvasive, available tools for the evaluation of pulmonary vascular beds and diagnosis of presymptomatic clinical status in patients with PAH.
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Affiliation(s)
- Leila Bigdelu
- Faculty of Medicine, Department of Cardiology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hedieh Alimi
- Faculty of Medicine, Department of Cardiology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Afsoon Fazlinezhad
- Faculty of Medicine, Department of Cardiology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fereshteh Ghaderi
- Faculty of Medicine, Department of Cardiology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hoorak Poorzand
- Faculty of Medicine, Department of Cardiology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farveh Vakilian
- Faculty of Medicine, Department of Cardiology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Faeze Keihanian
- Faculty of Medicine, Department of Cardiology, Imam Reza and Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Abbasi Shaye
- Clinical Research Development Center, Faculty of Medicine, Akbar Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sara Afshar
- Faculty of Medicine, Department of Cardiology, Imam Reza and Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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Kainulainen S, Suni A, Lipponen JA, Kulkas A, Duce B, Korkalainen H, Nikkonen S, Sillanmäki S. Morbid obesity influences the nocturnal electrocardiogram wave and interval durations among suspected sleep apnea patients. Ann Noninvasive Electrocardiol 2024; 29:e13101. [PMID: 38031823 PMCID: PMC10770811 DOI: 10.1111/anec.13101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/20/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Obesity is a global issue with a major impact on cardiovascular health. This study explores how obesity influences nocturnal cardiac electrophysiology in suspected obstructive sleep apnea (OSA) patients. METHODS We randomly selected 12 patients from each of the five World Health Organization body mass index (BMI) classifications groups (ntotal = 60) while keeping the group's age and sex matched. We evaluated 1965 nocturnal electrocardiography (ECG) samples (10 s) using modified lead II recorded during normal saturation conditions. R-wave peaks were detected and confirmed using dedicated software, with the exclusion of ventricular extrasystoles and artifacts. The duration of waves and intervals was manually marked. The average electric potential graphs were computed for each segment. Thresholds for abnormal ECG waveforms were P-wave > 120 ms, PQ interval > 200 ms, QRS complex > 120 ms for, and QTc > 440 ms. RESULTS Obesity was significantly (p < .05) associated with prolonged conduction times. Compared to the normal weight (18.5 ≤ BMI < 25) group, the morbidly obese patients (BMI ≥ 40) had a significantly longer P-wave duration (101.7 vs. 117.2 ms), PQ interval (175.8 vs. 198.0 ms), QRS interval (89.9 vs. 97.7 ms), and QTc interval (402.8 vs. 421.2 ms). We further examined ECG waveform prolongations related to BMI. Compared to other patient groups, the morbidly obese patients had the highest number of ECG segments with PQ interval (44% of the ECG samples), QRS duration (14%), and QTc duration (20%) above the normal limits. CONCLUSIONS Morbid obesity predisposes patients to prolongation of cardiac conduction times. This might increase the risk of arrhythmias, stroke, and even sudden cardiac death.
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Affiliation(s)
- Samu Kainulainen
- Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
| | - Aaron Suni
- The School of MedicineUniversity of Eastern FinlandKuopioFinland
| | - Jukka A. Lipponen
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
- Department of Emergency CareKuopio University HospitalKuopioFinland
| | - Antti Kulkas
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
- Department of Clinical NeurophysiologySeinäjoki Central HospitalSeinäjokiFinland
| | - Brett Duce
- Sleep Disorders Centre, Department of Respiratory & Sleep MedicinePrincess Alexandra HospitalWoolloongabbaQueenslandAustralia
- Institute for Health and Biomedical InnovationQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Henri Korkalainen
- Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
| | - Sami Nikkonen
- Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
| | - Saara Sillanmäki
- Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
- Institute of Clinical MedicineUniversity of Eastern FinlandKuopioFinland
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Stark P, Chang EY. Sleep Apnea Combined with Pulmonary Hypertension in a Veteran Patient Population. J Clin Med 2023; 12:4634. [PMID: 37510749 PMCID: PMC10380333 DOI: 10.3390/jcm12144634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/16/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
We have investigated the concurrence of sleep apnea and pulmonary hypertension in a Veteran population. We retrospectively reviewed 142 patients who underwent chest CT scans and had a dilated main pulmonary artery, defined as a width exceeding 29 mm on axial images. Approximately 40% of patients with pulmonary hypertension had associated sleep apnea. No significant difference in pulmonary artery diameters could be found between the group without sleep apnea and the group with sleep apnea (34.5 ± 4.2 mm vs. 34.7 ± 4.4 mm, p = 0.373).
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Affiliation(s)
- Paul Stark
- Radiology Service, VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Radiology, University of California, San Diego, CA 92093, USA
| | - Eric Y Chang
- Radiology Service, VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Radiology, University of California, San Diego, CA 92093, USA
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Zhang W, Ding Y. Impact of obstructive sleep apnea on outcomes of pulmonary embolism: A systematic review and meta‑analysis. Exp Ther Med 2023; 25:120. [PMID: 36815968 PMCID: PMC9932632 DOI: 10.3892/etm.2023.11819] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/10/2023] [Indexed: 02/04/2023] Open
Abstract
The current review aimed to assess the effect of obstructive sleep apnea (OSA) on the severity and outcomes of pulmonary embolism (PE). PubMed, Embase, ScienceDirect, CENTRAL and Google Scholar were searched for studies assessing the impact of OSA on severity and outcomes of PE. A total of 12 studies were included. Meta-analysis revealed that simplified PE severity index of >1 and pulmonary artery obstruction index score was significantly higher in patients with OSA as compared with controls, but there was no difference in right ventricle to left ventricle short-axis diameter. The need for non-invasive ventilation was significantly higher in patients with OSA but there was no difference in the need for mechanical ventilation. Patients with OSA had a significantly higher incidence of recurrence of PE. Meta-analysis also showed a statistically significantly lower risk of in-hospital mortality in patients with OSA as compared with controls, but without any difference in the risk of late mortality. Adjusted data on mortality indicated a significantly lower risk of mortality in PE patients with comorbid OSA. Limited data shows that comorbid OSA increases the severity of PE but has no effect on right ventricular function. OSA may increase the risk of recurrent PE. Paradoxically, the presence of OSA may also reduce the risk of in-hospital mortality. Results must be interpreted with caution owing to high inter-study heterogeneity and lack of matching of baseline characteristics. Current evidence needs to be confirmed by high-quality prospective studies.
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Affiliation(s)
- Wen Zhang
- Department of Pulmonary and Critical Care Medicine, Shengzhou People's Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch) Shengzhou, Zhejiang 312400, P.R. China
| | - Yongmin Ding
- Department of Pulmonary and Critical Care Medicine, Shengzhou People's Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch) Shengzhou, Zhejiang 312400, P.R. China,Correspondence to: Dr Yongmin Ding, Department of Pulmonary and Critical Care Medicine, Shengzhou People's Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch), 666 Dangui Road, Shengzhou, Zhejiang 312400, P.R. China
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Iturriaga R, Castillo-Galán S. The Beneficial Effect of the Blockade of Stim-Activated TRPC-ORAI Channels on Vascular Remodeling and Pulmonary Hypertension Induced by Intermittent Hypoxia Is Independent of Oxidative Stress. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1427:53-60. [PMID: 37322335 DOI: 10.1007/978-3-031-32371-3_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Obstructive sleep apnea (OSA), a sleep breathing disorder featured by chronic intermittent hypoxia (CIH), is associated with pulmonary hypertension (PH). Rats exposed to CIH develop systemic and lung oxidative stress, pulmonary vascular remodeling, and PH and overexpress Stim-activated TRPC-ORAI channels (STOC) in the lung. Previously, we demonstrated that 2-aminoethyl-diphenylborinate (2-APB)-treatment, a STOC-blocker, prevents PH and the overexpression of STOC induced by CIH. However, 2-APB did not prevent systemic and pulmonary oxidative stress. Accordingly, we hypothesize that the contribution of STOC in the development of PH induced by CIH is independent of oxidative stress. We measured the correlation between right ventricular systolic pressure (RVSP) and lung malondialdehyde (MDA) with the gene expression of STOC and morphological parameters in the lung from control, CIH-treated, and 2-APB-treated rats. We found correlations between RVSP and increased medial layer and STOC pulmonary levels. 2-APB-treated rats showed a correlation between RVSP and the medial layer thickness, α-actin-ir, and STOC, whereas RVSP did not correlate with MDA levels in CIH and 2-APB-treated rats. CIH rats showed correlations between lung MDA levels and the gene expression of TRPC1 and TRPC4. These results suggest that STOC channels play a key role in developing CIH-induced PH that is independent from lung oxidative stress.
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Affiliation(s)
- Rodrigo Iturriaga
- Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
- Centro de Investigación en Fisiología y Medicina de Altura (FIMEDALT), Facultad de Ciencias de la Salud, Universidad de Antofagasta, Antofagasta, Chile
| | - Sebastián Castillo-Galán
- Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
- Centro de Investigación en Fisiología y Medicina de Altura (FIMEDALT), Facultad de Ciencias de la Salud, Universidad de Antofagasta, Antofagasta, Chile
- Laboratory of Nano-Regenerative Medicine, Centro de Investigación e Innovación Biomédica (CIIB), Faculty of Medicine, Universidad de los Andes, Santiago, Chile
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Sleep disordered breathing and its relation to stroke and pulmonary hypertension in children with sickle cell disease: a single-center cross-sectional study. Ann Hematol 2023; 102:271-281. [PMID: 36645459 PMCID: PMC9889484 DOI: 10.1007/s00277-023-05099-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/03/2023] [Indexed: 01/17/2023]
Abstract
Sleep disordered breathing (SDB) is a common underdiagnosed sequela of sickle cell disease (SCD) that has been linked to the frequency of vaso-occlusive crises. To determine the frequency of SDB in children with SCD and its association to SCD-related complications, thirty children and adolescents with SCD at their steady state underwent clinical, laboratory, and radiological assessment using transcranial duplex (TCD) and echo assessment of tricuspid regurge velocity (TRV). All participants had an overnight polysomnography after completing the modified STOP-Bang questionnaire. The mean age of the studied cohort was 10.2 years, with male: female ratio 1.7:1. Six children (20%) had high-risk for obstructive sleep apnea (OSA), while nine (30%) were at intermediate risk. Sleep apnea defined as apnea (AHI) > 1 event/hour was found among 18/30 (60%) subjects (14 males and 4 females). Children with AHI > 5 (moderate to severe OSA) had significantly higher TRV (p = 0.007) and left MCA flow velocity (p = 0.049) when compared to those with AHI < 5. Children with AHI > 5 were at higher risk of OSA according to the modified STOP-Bang questionnaire (p = 0.02). AHI positively correlated with TRV (r = 0.53, p = 0.003), right MCA flow velocity (r = 0.45, p = 0.013), and left MCA flow velocity (r = 0.55, p = 0.002), and negatively correlated to BMI-SDS (r = - 0.48, p = 0.008). The high frequency of OSA in the studied cohort with SCD and its association with increasing risk of PH and TCD changes highlights the importance of early detection and management of OSA in children with SCD.
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Barnes LA, Mesarwi OA, Sanchez-Azofra A. The Cardiovascular and Metabolic Effects of Chronic Hypoxia in Animal Models: A Mini-Review. Front Physiol 2022; 13:873522. [PMID: 35432002 PMCID: PMC9008331 DOI: 10.3389/fphys.2022.873522] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
Animal models are useful to understand the myriad physiological effects of hypoxia. Such models attempt to recapitulate the hypoxemia of human disease in various ways. In this mini-review, we consider the various animal models which have been deployed to understand the effects of chronic hypoxia on pulmonary and systemic blood pressure, glucose and lipid metabolism, atherosclerosis, and stroke. Chronic sustained hypoxia (CSH)-a model of chronic lung or heart diseases in which hypoxemia may be longstanding and persistent, or of high altitude, in which effective atmospheric oxygen concentration is low-reliably induces pulmonary hypertension in rodents, and appears to have protective effects on glucose metabolism. Chronic intermittent hypoxia (CIH) has long been used as a model of obstructive sleep apnea (OSA), in which recurrent airway occlusion results in intermittent reductions in oxyhemoglobin saturations throughout the night. CIH was first shown to increase systemic blood pressure, but has also been associated with other maladaptive physiological changes, including glucose dysregulation, atherosclerosis, progression of nonalcoholic fatty liver disease, and endothelial dysfunction. However, models of CIH have generally been implemented so as to mimic severe human OSA, with comparatively less focus on milder hypoxic regimens. Here we discuss CSH and CIH conceptually, the effects of these stimuli, and limitations of the available data.
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Affiliation(s)
- Laura A. Barnes
- Division of Pulmonary, Critical Care, and Sleep Medicine and Physiology, Department of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Omar A. Mesarwi
- Division of Pulmonary, Critical Care, and Sleep Medicine and Physiology, Department of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Ana Sanchez-Azofra
- Division of Pulmonary, Critical Care, and Sleep Medicine and Physiology, Department of Medicine, University of California, San Diego, San Diego, CA, United States
- Servicio de Neumología, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
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13
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Castillo-Galán S, Riquelme B, Iturriaga R. Crucial Role of Stromal Interaction Molecule-Activated TRPC-ORAI Channels in Vascular Remodeling and Pulmonary Hypertension Induced by Intermittent Hypoxia. Front Physiol 2022; 13:841828. [PMID: 35370769 PMCID: PMC8969100 DOI: 10.3389/fphys.2022.841828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
Obstructive sleep apnea (OSA), a sleep breathing disorder featured by chronic intermittent hypoxia (CIH), is associate with pulmonary hypertension. Rats exposed to CIH develop lung vascular remodeling and pulmonary hypertension, which paralleled the upregulation of stromal interaction molecule (STIM)-activated TRPC-ORAI Ca2+ channels (STOC) in the lung, suggesting that STOC participate in the pulmonary vascular alterations. Accordingly, to evaluate the role played by STOC in pulmonary hypertension we studied whether the STOC blocker 2-aminoethoxydiphenyl borate (2-APB) may prevent the vascular remodeling and the pulmonary hypertension induced by CIH in a rat model of OSA. We assessed the effects of 2-APB on right ventricular systolic pressure (RVSP), pulmonary vascular remodeling, α-actin and proliferation marker Ki-67 levels in pulmonary arterial smooth muscle cells (PASMC), mRNA levels of STOC subunits, and systemic and pulmonary oxidative stress (TBARS) in male Sprague-Dawley (200 g) rats exposed to CIH (5% O2, 12 times/h for 8h) for 28 days. At 14 days of CIH, osmotic pumps containing 2-APB (10 mg/kg/day) or its vehicle were implanted and rats were kept for 2 more weeks in CIH. Exposure to CIH for 28 days raised RVSP > 35 mm Hg, increased the medial layer thickness and the levels of α-actin and Ki-67 in PASMC, and increased the gene expression of TRPC1, TRPC4, TRPC6 and ORAI1 subunits. Treatment with 2-APB prevented the raise in RVSP and the increment of the medial layer thickness, as well as the increased levels of α-actin and Ki-67 in PASMC, and the increased gene expression of STOC subunits. In addition, 2-APB did not reduced the lung and systemic oxidative stress, suggesting that the effects of 2-APB on vascular remodeling and pulmonary hypertension are independent on the reduction of the oxidative stress. Thus, our results supported that STIM-activated TRPC-ORAI Ca2+ channels contributes to the lung vascular remodeling and pulmonary hypertension induced by CIH.
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Affiliation(s)
- Sebastián Castillo-Galán
- Laboratorio de Neurobiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Bárbara Riquelme
- Laboratorio de Neurobiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Iturriaga
- Laboratorio de Neurobiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
- Centro de Excelencia en Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes, Punta Arenas, Chile
- *Correspondence: Rodrigo Iturriaga,
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Macek P, Poręba M, Stachurska A, Martynowicz H, Mazur G, Gać P, Poręba R. Obstructive Sleep Apnea and Sleep Structure Assessed in Polysomnography and Right Ventricular Strain Parameters. Brain Sci 2022; 12:331. [PMID: 35326287 PMCID: PMC8946732 DOI: 10.3390/brainsci12030331] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/17/2022] [Accepted: 02/24/2022] [Indexed: 02/05/2023] Open
Abstract
Our study aimed to assess functional, structural changes of the right ventricular using strain parameters and sleep structure using polysomnography in patients with obstructive sleep apnea (OSA). Our study group consisted of 43 patients, 29 men, 14 women. The mean age was 56.36 ± 14.77. All patients underwent full night polysomnography and transthoracic echocardiography. The right ventricular global longitudinal strain was measured by 2D speckle-tracking echocardiography. The prevalence of OSA (AHI ≥ 5) was 76.7% in the studied group. We observed a significant positive correlation between OAH and average free wall strain (r = 0.37), snore and mid-free wall strain (r = 0.34), average HR, and basal free wall strain (r = 0.34). Moreover, CSB was positively correlated with basal septal strain and mid septal strain (r = 0.36 and 0.42). In summary, among patients with sleep disorders, functional disorders of the right ventricle, assessed using the strain method, are partly observed.
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Affiliation(s)
- Piotr Macek
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (P.M.); (M.P.); (A.S.); (H.M.); (G.M.); (R.P.)
| | - Małgorzata Poręba
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (P.M.); (M.P.); (A.S.); (H.M.); (G.M.); (R.P.)
- Department of Paralympic Sports, Wroclaw University of Health and Sport Sciences, Witelona 25a, 51-617 Wroclaw, Poland
| | - Aneta Stachurska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (P.M.); (M.P.); (A.S.); (H.M.); (G.M.); (R.P.)
| | - Helena Martynowicz
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (P.M.); (M.P.); (A.S.); (H.M.); (G.M.); (R.P.)
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (P.M.); (M.P.); (A.S.); (H.M.); (G.M.); (R.P.)
| | - Paweł Gać
- Department of Population Health, Division of Environmental Health and Occupational Medicine, Wroclaw Medical University, Mikulicza-Radeckiego 7, 50-368 Wroclaw, Poland
| | - Rafał Poręba
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (P.M.); (M.P.); (A.S.); (H.M.); (G.M.); (R.P.)
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15
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The clinical characteristics of patients with pulmonary hypertension combined with obstructive sleep apnoea. BMC Pulm Med 2021; 21:378. [PMID: 34802431 PMCID: PMC8607599 DOI: 10.1186/s12890-021-01755-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 11/19/2021] [Indexed: 11/10/2022] Open
Abstract
Objective Obstructive sleep apnoea (OSA) is one cause of pulmonary hypertension (PH) and can also emerge along with PH. The clinical diagnosis and treatment of OSA in patients with PH are still controversial. The purpose of this clinical observation study was to observe and summarize the incidence and clinical characteristics of OSA in patients with PH and to explore possible predictors of PH combined with OSA. Methods Patients with PH diagnosed by right heart catheterization who underwent overnight cardiorespiratory monitoring from December 2018 to December 2020 were enrolled. OSA was defined as an apnoea–hypopnoea index of ≥ 5/h with ≥ 50% of apnoeic events being obstructive. Baseline clinical characteristics and parameters were collected to compare PH patients with and without OSA. Logistic regression analysis was run to determine the risk factors for OSA in PH patients. Results A total of 35 (25%) of 140 patients had OSA. OSA is relatively frequent in patients with PH, especially in patients with chronic thromboembolic pulmonary hypertension and patients with lung disease– or hypoxia-associated PH. The patients who had OSA were mostly male and had a higher age and a lower daytime arterial oxygen pressure. Logistic regression analysis found that older age, male sex, and lower daytime arterial blood oxygen pressure correlated with OSA in PH patients. Conclusion OSA is common in patients with PH. Lower daytime arterial oxygen pressure is a risk factor for OSA in older male patients with PH.
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Tang M, Wang Y, Wang M, Tong R, Shi T. Risk for Cardiovascular Disease and One-Year Mortality in Patients With Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea Syndrome Overlap Syndrome. Front Pharmacol 2021; 12:767982. [PMID: 34764876 PMCID: PMC8576345 DOI: 10.3389/fphar.2021.767982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSAS) overlap syndrome (OS) are thought to be at increased risk for cardiovascular diseases. Objective: To evaluate the burden of cardiovascular diseases and long-term outcomes in patients with OS. Methods: This was a retrospective cohort study. The prevalence of cardiovascular diseases and 1-year mortality were compared among patients diagnosed with OS (OS group), COPD alone (COPD group) and OSAS alone (OSAS group), and Cox proportional hazards models were used to assess independent risk factors for all-cause mortality. Results: Overall, patients with OS were at higher risk for pulmonary hypertension (PH), heart failure and all-cause mortality than patients with COPD or OSAS (all p < 0.05). In multivariate Cox regression analysis, the Charlson comorbidity index (CCI) score [adjusted hazard ratio (aHR): 1.273 (1.050–1.543); p = 0.014], hypertension [aHR: 2.006 (1.005–4.004); p = 0.048], pulmonary thromboembolism (PTE) [aHR: 4.774 (1.335–17.079); p = 0.016] and heart failure [aHR: 3.067 (1.521–6.185); p = 0.002] were found to be independent risk factors for 1-year all-cause mortality. Conclusion: Patients with OS had an increased risk for cardiovascular diseases and 1-year mortality. More efforts are needed to identify the causal relationship between OS and cardiovascular diseases, promoting risk stratification and the management of these patients.
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Affiliation(s)
- Manyun Tang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yidan Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Mengjie Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Rui Tong
- Department of Geriatric Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Tao Shi
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Janaszak-Jasiecka A, Siekierzycka A, Płoska A, Dobrucki IT, Kalinowski L. Endothelial Dysfunction Driven by Hypoxia-The Influence of Oxygen Deficiency on NO Bioavailability. Biomolecules 2021; 11:biom11070982. [PMID: 34356605 PMCID: PMC8301841 DOI: 10.3390/biom11070982] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/25/2021] [Accepted: 07/02/2021] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular diseases (CVDs) are the leading cause of death worldwide. The initial stage of CVDs is characterized by endothelial dysfunction, defined as the limited bioavailability of nitric oxide (NO). Thus, any factors that interfere with the synthesis or metabolism of NO in endothelial cells are involved in CVD pathogenesis. It is well established that hypoxia is both the triggering factor as well as the accompanying factor in cardiovascular disease, and diminished tissue oxygen levels have been reported to influence endothelial NO bioavailability. In endothelial cells, NO is produced by endothelial nitric oxide synthase (eNOS) from L-Arg, with tetrahydrobiopterin (BH4) as an essential cofactor. Here, we discuss the mechanisms by which hypoxia affects NO bioavailability, including regulation of eNOS expression and activity. What is particularly important is the fact that hypoxia contributes to the depletion of cofactor BH4 and deficiency of substrate L-Arg, and thus elicits eNOS uncoupling-a state in which the enzyme produces superoxide instead of NO. eNOS uncoupling and the resulting oxidative stress is the major driver of endothelial dysfunction and atherogenesis. Moreover, hypoxia induces impairment in mitochondrial respiration and endothelial cell activation; thus, oxidative stress and inflammation, along with the hypoxic response, contribute to the development of endothelial dysfunction.
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Affiliation(s)
- Anna Janaszak-Jasiecka
- Department of Medical Laboratory Diagnostics—Fahrenheit Biobank BBMRI.pl, Medical University of Gdansk, 80-211 Gdansk, Poland; (A.J.-J.); (A.S.); (A.P.)
- Biobanking and Biomolecular Resources Research Infrastructure Poland (BBMRI.pl), 80-211 Gdansk, Poland
| | - Anna Siekierzycka
- Department of Medical Laboratory Diagnostics—Fahrenheit Biobank BBMRI.pl, Medical University of Gdansk, 80-211 Gdansk, Poland; (A.J.-J.); (A.S.); (A.P.)
- Laboratory of Trace Elements Neurobiology, Institute of Pharmacology, Polish Academy of Sciences, 31-343 Krakow, Poland
| | - Agata Płoska
- Department of Medical Laboratory Diagnostics—Fahrenheit Biobank BBMRI.pl, Medical University of Gdansk, 80-211 Gdansk, Poland; (A.J.-J.); (A.S.); (A.P.)
- Biobanking and Biomolecular Resources Research Infrastructure Poland (BBMRI.pl), 80-211 Gdansk, Poland
| | - Iwona T. Dobrucki
- University of Illinois at Urbana-Champaign Beckman Institute for Advanced Science and Technology, 405 N Mathews Ave, MC-251, Urbana, IL 61801, USA;
- Department of Bioengineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Leszek Kalinowski
- Department of Medical Laboratory Diagnostics—Fahrenheit Biobank BBMRI.pl, Medical University of Gdansk, 80-211 Gdansk, Poland; (A.J.-J.); (A.S.); (A.P.)
- Biobanking and Biomolecular Resources Research Infrastructure Poland (BBMRI.pl), 80-211 Gdansk, Poland
- BioTechMed Centre, Department of Mechanics of Materials and Structures, Gdansk University of Technology, 80-233 Gdansk, Poland
- Correspondence:
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Subclinical Changes in Cardiac Functional Parameters as Determined by Cardiovascular Magnetic Resonance (CMR) Imaging in Sleep Apnea and Snoring: Findings from UK Biobank. ACTA ACUST UNITED AC 2021; 57:medicina57060555. [PMID: 34072775 PMCID: PMC8230102 DOI: 10.3390/medicina57060555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/13/2021] [Accepted: 05/27/2021] [Indexed: 11/18/2022]
Abstract
Background and Objectives: Obstructive sleep apnea (OSA) is a common disorder with an increased risk for left ventricular and right ventricular dysfunction. Most studies to date have examined populations with manifest cardiovascular disease using echocardiography to analyze ventricular dysfunction with little or no reference to ventricular volumes or myocardial mass. Our aim was to explore these parameters with cardiac MRI. We hypothesized that there would be stepwise increase in left ventricular mass and right ventricular volumes from the unaffected, to the snoring and the OSA group. Materials and Methods: We analyzed cardiac MRI data from 4978 UK Biobank participants free from cardiovascular disease. Participants were allocated into three cohorts: with OSA, with self-reported snoring and without OSA or snoring (n = 118, 1886 and 2477). We analyzed cardiac parameters from balanced cine-SSFP sequences and indexed them to body surface area. Results: Patients with OSA were mostly males (47.3% vs. 79.7%; p < 0.001) with higher body mass index (25.7 ± 4.0 vs. 31.3 ± 5.3 kg/m²; p < 0.001) and higher blood pressure (135 ± 18 vs. 140 ± 17 mmHg; p = 0.012) compared to individuals without OSA or snoring. Regression analysis showed a significant effect for OSA in left ventricular end-diastolic index (LVEDVI) (β = −4.9 ± 2.4 mL/m²; p = 0.040) and right ventricular end-diastolic index (RVEDVI) (β = −6.2 ± 2.6 mL/m²; p = 0.016) in females and for right ventricular ejection fraction (RVEF) (β = 1.7 ± 0.8%; p = 0.031) in males. A significant effect was discovered in snoring females for left ventricular mass index (LVMI) (β = 3.5 ± 0.9 g/m²; p < 0.001) and in males for left ventricular ejection fraction (LVEF) (β = 1.0 ± 0.3%; p = 0.001) and RVEF (β = 1.2 ± 0.3%; p < 0.001). Conclusion: Our study suggests that OSA is highly underdiagnosed and that it is an evolving process with gender specific progression. Females with OSA show significantly lower ventricular volumes while males with snoring show increased ejection fractions which may be an early sign of hypertrophy. Separate prospective studies are needed to further explore the direction of causality.
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Endothelial Cell-Derived SO 2 Controls Endothelial Cell Inflammation, Smooth Muscle Cell Proliferation, and Collagen Synthesis to Inhibit Hypoxic Pulmonary Vascular Remodelling. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:5577634. [PMID: 33953829 PMCID: PMC8068783 DOI: 10.1155/2021/5577634] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/27/2021] [Accepted: 04/05/2021] [Indexed: 02/08/2023]
Abstract
Hypoxic pulmonary vascular remodelling (PVR) is the major pathological basis of aging-related chronic obstructive pulmonary disease and obstructive sleep apnea syndrome. The pulmonary artery endothelial cell (PAEC) inflammation, and pulmonary artery smooth muscle cell (PASMC) proliferation, hypertrophy and collagen remodelling are the important pathophysiological components of PVR. Endogenous sulfur dioxide (SO2) was found to be a novel gasotransmitter in the cardiovascular system with its unique biological properties. The study was aimed to investigate the role of endothelial cell- (EC-) derived SO2 in the progression of PAEC inflammation, PASMC proliferation, hypertrophy and collagen remodelling in PVR and the possible mechanisms. EC-specific aspartic aminotransferase 1 transgenic (EC-AAT1-Tg) mice were constructed in vivo. Pulmonary hypertension was induced by hypoxia. Right heart catheterization and echocardiography were used to detect mouse hemodynamic changes. Pathologic analysis was performed in the pulmonary arteries. High-performance liquid chromatography was employed to detect the SO2 content. Human PAECs (HPAECs) with lentiviruses containing AAT1 cDNA or shRNA and cocultured human PASMCs (HPASMCs) were applied in vitro. SO2 probe and enzyme-linked immunosorbent assay were used to detect the SO2 content and determine p50 activity, respectively. Hypoxia caused a significant reduction in SO2 content in the mouse lung and HPAECs and increases in right ventricular systolic pressure, pulmonary artery wall thickness, muscularization, and the expression of PAEC ICAM-1 and MCP-1 and of PASMC Ki-67, collagen I, and α-SMA (p < 0.05). However, EC-AAT1-Tg with sufficient SO2 content prevented the above increases induced by hypoxia (p < 0.05). Mechanistically, EC-derived SO2 deficiency promoted HPAEC ICAM-1 and MCP-1 and the cocultured HPASMC Ki-67 and collagen I expression, which was abolished by andrographolide, an inhibitor of p50 (p < 0.05). Meanwhile, EC-derived SO2 deficiency increased the expression of cocultured HPASMC α-SMA (p < 0.05). Taken together, these findings revealed that EC-derived SO2 inhibited p50 activation to control PAEC inflammation in an autocrine manner and PASMC proliferation, hypertrophy, and collagen synthesis in a paracrine manner, thereby inhibiting hypoxic PVR.
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20
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Obstructive Sleep Apnoea and Cardiac Disease Among Aboriginal Patients in the Northern Territory of Australia. Heart Lung Circ 2021; 30:1184-1192. [PMID: 33741255 DOI: 10.1016/j.hlc.2021.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 10/10/2020] [Accepted: 01/26/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is paucity of information on obstructive sleep apnoea (OSA) and cardiac diseases among Aboriginal Australian patients. This study evaluates the association of various cardiac disease profiles among Aboriginal patients undergoing a diagnostic polysomnography (PSG). METHOD In this 5-year retrospective study demographics, clinical characteristics, medical and cardiac -conditions were analysed. RESULTS There were total of 340 eligible patients included in the study. The median age was 47 (38-57) years, 51% were males and obesity was noted in 78%. In the overall study participants, cardiac diseases were present in 46%: coronary artery disease (CAD) in 27%, pulmonary hypertension (PH) 19% and atrial fibrillation (AF) 14%. Diabetes and hypertension were noted in 42 and 41% of patients. Overall, 73/340 (21.5%) had two, 69/340 (20.3%) three, 55/340 (16.2%) four, 40/340 (11.8%) five and 10/340 (2.9%) had six comorbidities. In the overall study participants, 297/340 (87%) had OSA (Apnoea-Hypopnoea Index [AHI]>5/hour). Co-occurrence of OSA and cardiac diseases was found in 140/297 (47%), CAD being the commonest (27%). Patients with OSA had a higher number of comorbidities compared to patients without sleep apnoea. Hospital admissions frequency showed a median 2 (IQR: 0-4) times readmission rates since the diagnosis of OSA overall compliance with CPAP therapy was observed in 63 (43%). CONCLUSION Our study demonstrated that a significant proportion of Aboriginal patients with OSA have co-existing cardiac diseases, with CAD being the commonest. Patients with OSA had a higher number of comorbidities compared to patients without sleep apnoea. Furthermore, hospital admission frequency increased among OSA patients with multiple comorbidities.
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21
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Wu G, Lee YY, Gulla EM, Potter A, Kitzmiller J, Ruben MD, Salomonis N, Whitsett JA, Francey LJ, Hogenesch JB, Smith DF. Short-term exposure to intermittent hypoxia leads to changes in gene expression seen in chronic pulmonary disease. eLife 2021; 10:63003. [PMID: 33599610 PMCID: PMC7909952 DOI: 10.7554/elife.63003] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 02/17/2021] [Indexed: 12/16/2022] Open
Abstract
Obstructive sleep apnea (OSA) results from episodes of airway collapse and intermittent hypoxia (IH) and is associated with a host of health complications. Although the lung is the first organ to sense changes in oxygen levels, little is known about the consequences of IH to the lung hypoxia-inducible factor-responsive pathways. We hypothesized that exposure to IH would lead to cell-specific up- and downregulation of diverse expression pathways. We identified changes in circadian and immune pathways in lungs from mice exposed to IH. Among all cell types, endothelial cells showed the most prominent transcriptional changes. Upregulated genes in myofibroblast cells were enriched for genes associated with pulmonary hypertension and included targets of several drugs currently used to treat chronic pulmonary diseases. A better understanding of the pathophysiologic mechanisms underlying diseases associated with OSA could improve our therapeutic approaches, directing therapies to the most relevant cells and molecular pathways.
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Affiliation(s)
- Gang Wu
- Divisions of Human Genetics and Immunobiology, Center for Circadian Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, United States
| | - Yin Yeng Lee
- Divisions of Human Genetics and Immunobiology, Center for Circadian Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, United States.,Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, United States
| | - Evelyn M Gulla
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, United States
| | - Andrew Potter
- Division of Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, United States
| | - Joseph Kitzmiller
- Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, United States
| | - Marc D Ruben
- Divisions of Human Genetics and Immunobiology, Center for Circadian Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, United States
| | - Nathan Salomonis
- Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, United States.,Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, United States
| | - Jeffery A Whitsett
- Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, United States
| | - Lauren J Francey
- Divisions of Human Genetics and Immunobiology, Center for Circadian Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, United States
| | - John B Hogenesch
- Divisions of Human Genetics and Immunobiology, Center for Circadian Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, United States
| | - David F Smith
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, United States.,Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, United States.,The Center for Circadian Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, United States.,Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, United States
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22
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Berghaus TM, Geissenberger F, Konnerth D, Probst M, Kröncke T, Schwarz F. Right-to-left Ventricular Diameter Ratio At Computed Tomographic Pulmonary Angiography in Patients with Acute Pulmonary Embolism and Obstructive Sleep Apnea. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2020; 14:1179548420976430. [PMID: 33354113 PMCID: PMC7734538 DOI: 10.1177/1179548420976430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/04/2020] [Indexed: 12/12/2022]
Abstract
Purpose: Right ventricular (RV) dysfunction in acute pulmonary embolism (PE) is a critical determinant of outcome. Obstructive sleep apnea (OSA) is a common comorbidity of PE and might also affect RV function. Therefore, we sought to investigate RV dysfunction in PE patients in proportion to the severity of OSA by evaluating the right-to-left ventricular (RV/LV) diameter ratio on computed tomographic pulmonary angiography (CTPA). Materials and Methods: 197 PE patients were evaluated for sleep-disordered breathing by portable monitoring and nocturnal polysomnography. RV dilatation was defined as an RV/LV diameter ratio of ⩾ 1.0. Results: RV dilatation was significantly more frequent in OSA patients compared to study participants without OSA (66.4% vs 49.1%, P = .036). Elevated troponin I values, indicating myocardial injury due to acute, PE-related RV strain, were significantly more frequent in OSA patients with an apnea-hypopnea index (AHI) ⩾ 15/h compared to those with an AHI < 15/h (62.1% vs 45.8%, P = .035). However, RV dysfunction documented by the RV/LV diameter ratio on CTPA was not significantly associated with the severity of OSA in multivariable regression analysis. Conclusion: Patients with moderate or severe OSA might compensate acute, PE-related RV strain better, as they are adapted to repetitive right heart pressure overloads during sleep.
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Affiliation(s)
- Thomas M Berghaus
- Department of Cardiology, Respiratory Medicine and Intensive Care, University Hospital Augsburg, University of Augsburg, Germany.,Ludwig-Maximilians-University Munich, Germany
| | - Fabian Geissenberger
- Department of Cardiology, Respiratory Medicine and Intensive Care, University Hospital Augsburg, University of Augsburg, Germany
| | - Dinah Konnerth
- Department of Cardiology, Respiratory Medicine and Intensive Care, University Hospital Augsburg, University of Augsburg, Germany
| | - Michael Probst
- Department of Radiology, University Hospital Augsburg, University of Augsburg, Germany
| | - Thomas Kröncke
- Department of Radiology, University Hospital Augsburg, University of Augsburg, Germany
| | - Florian Schwarz
- Ludwig-Maximilians-University Munich, Germany.,Department of Radiology, University Hospital Augsburg, University of Augsburg, Germany
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23
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Jen R, Orr JE, Gilbertson D, Fine J, Li Y, Wong D, Bosompra NO, Hopkins SR, Raisinghani A, Malhotra A. Impact of obstructive sleep apnea on cardiopulmonary performance, endothelial dysfunction, and pulmonary hypertension during exercise. Respir Physiol Neurobiol 2020; 283:103557. [PMID: 33010457 DOI: 10.1016/j.resp.2020.103557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/21/2020] [Accepted: 09/26/2020] [Indexed: 11/15/2022]
Abstract
RATIONALE OSA has been associated with reduced exercise capacity. Endothelial dysfunction and exercise-induced pulmonary hypertension (ePH) may be mediators of this impairment. We hypothesized that OSA severity would be associated with impaired exercise performance, endothelial dysfunction, and ePH. METHODS Subjects with untreated OSA were recruited. Subjects underwent endothelial function, and cardiopulmonary exercise testing with an echocardiogram immediately before and following exercise. RESULTS 22 subjects were recruited with mean age 56 ± 8 years, 74 % male, BMI 29 ± 3 kg/m2, and AHI 22 ± 12 events/hr. Peak V˙O2 did not differ from normal (99.7 ± 17.3 % predicted; p = 0.93). There was no significant association between OSA severity (as AHI, ODI) and exercise capacity, endothelial function, or pulmonary artery pressure. However, ODI, marker of RV diastolic dysfunction, and BMI together explained 59.3 % of the variability of exercise performance (p < 0.001) via our exploratory analyses. CONCLUSIONS Exercise capacity was not impaired in this OSA cohort. Further work is needed to elucidate mechanisms linking sleep apnea, obesity, endothelial dysfunction and exercise impairment.
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Affiliation(s)
- Rachel Jen
- Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada; Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, CA, United States.
| | - Jeremy E Orr
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, CA, United States
| | - Dillon Gilbertson
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, CA, United States
| | - Janelle Fine
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, CA, United States
| | - Yanru Li
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, CA, United States; Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology, Head and Neck Surgery (Ministry of Education of China), Beijing, China
| | - Darrin Wong
- Division of Cardiology, University of California, San Diego, La Jolla, CA, United States
| | - Naa-Oye Bosompra
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, CA, United States
| | - Susan R Hopkins
- Departments of Medicine and Radiology, University of California, San Diego, La Jolla, CA, United States
| | - Ajit Raisinghani
- Division of Cardiology, University of California, San Diego, La Jolla, CA, United States
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, CA, United States
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24
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Zhu J, Kang J, Li X, Wang M, Shang M, Luo Y, Xiong M, Hu K. Chronic intermittent hypoxia vs chronic continuous hypoxia: Effects on vascular endothelial function and myocardial contractility. Clin Hemorheol Microcirc 2020; 74:417-427. [PMID: 31683472 DOI: 10.3233/ch-190706] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIM Both chronic intermittent hypoxia (CIH) and chronic continuous hypoxia (CCH) are risk factors for cardiovascular disease, which are associated with cardiac systolic function and associated with dysfunction of endothelia and coagulation-fibrinolysis system in the vasculature. However, the different effects of these two hypoxic models are not fully understood. In our study, we systemically compared the effects of CIH and CCH on cardiac function and related factor levels in serum using rat model. METHODS Forty-five male Sprague-Dawley rats were randomly divided into the normoxia control (NC), CIH and CCH groups. The rat CIH and CCH models were established, then the blood and tissue samples were collected to analyze the function of endothelium and the coagulation-fibrinolysis system. Also, the ultrasound cardiogram was performed to directly assess myocardial contractility. RESULTS Both CIH and CCH significantly decreased the NO, eNOS, P-eNOS and AT-III levels in the rat serum but significantly increased the levels of ET-1, vWF, COX-2, NF-κB, FIB, FVIII and PAI-1 in the rat serum (P < 0.05). The expression of ET-1, VWF and ICAM-1 in CIH group were higher than CCH group (P < 0.05), however, the expression of CD62p was increased in CCH group but not in CIH group. The expression of t-PA in CIH group were lower than CCH group (P < 0.05), but there were no significant differences in CCH group and NC group (P > 0.05). Using transmission electron microscope, we found that the mitochondrial ultrastructure of thoracic aorta endothelial cells in CIH and CCH group were damaged. Moreover, the myocardial contractility in CIH and CCH group were significantly decreased compared with NC group. CONCLUSION Our results suggested that CIH and CCH could cause endothelial dysfunction, dysfunction of the coagulation-fibrinolysis system and decreasing of myocardial contractility. Compared with CCH, CIH has greater effect on vasoconstriction and adhesion of vascular endothelial cells, and stronger procoagulant effect.
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Affiliation(s)
- Jing Zhu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jing Kang
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xiaochen Li
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Mengmei Wang
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Min Shang
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yuchuan Luo
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Mengqing Xiong
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Ke Hu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
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25
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Wang J, Wu J, Zhu X, Chen J, Zhao J, Xu Y, Xie J. Absence of the MFG-E8 gene prevents hypoxia-induced pulmonary hypertension in mice. J Cell Physiol 2020; 236:587-600. [PMID: 32592231 PMCID: PMC7689852 DOI: 10.1002/jcp.29885] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/02/2020] [Accepted: 06/07/2020] [Indexed: 01/08/2023]
Abstract
Pulmonary hypertension (PH) is a chronic vascular disease characterized by elevated pulmonary arterial resistance and vascular remodeling, and chronic hypoxia plays an important role in PH. Milk fat globule‐EGF factor 8 (MFG‐E8) is a glycoprotein that regulates cell proliferation and apoptosis, but its role in hypoxia‐induced PH is unknown. The current study aimed to determine the function and fundamental mechanisms of MFG‐E8 in hypoxia‐induced PH. Herein, we exposed mice to hypoxia for 5 weeks, and MFG‐E8 was found to be elevated in mouse lung tissues, arteries, and plasma. Compared with wild‐type littermates, mice lacking MFG‐E8 showed a significant increase in the ratio of pulmonary artery acceleration time to ejection time (PAT/PET), while they showed decreases in right ventricular systolic pressure, the Fulton's Index, percent medial wall thickness (%WT), and vascular muscularization in pulmonary arteries. In addition, MFG‐E8 protein levels were also increased in the serum of patients with chronic PH. Similarly, we observed a higher expression of MFG‐E8 in human pulmonary artery smooth muscle cells (PASMCs) in the presence of hypoxic stimulation than MFG‐E8 in cells in normoxic conditions. Furthermore, MFG‐E8 silencing resulted in partial inhibition of proliferation, migration and cell cycle progression in human PASMCs, and the possible mechanisms might involve the interaction between MFG‐E8 and the p‐Akt/cyclin D1 pathway. Collectively, our study suggests that the absence of MFG‐E8 can attenuate the development of hypoxia‐induced PH and vascular remodeling. MFG‐E8 can be a potential therapeutic target or a biomarker for PH.
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Affiliation(s)
- Jun Wang
- Department of Respiratory and Critical Care Medicine, National Clinical Research Center of Respiratory Disease, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Department of Rheumatology and Immunology, Beijing Chaoyang Hospital of Capital Medical University, Beijing, China
| | - Jixing Wu
- Department of Respiratory and Critical Care Medicine, National Clinical Research Center of Respiratory Disease, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xianying Zhu
- Department of Respiratory and Critical Care Medicine, National Clinical Research Center of Respiratory Disease, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jinkun Chen
- St. John's-Ravenscourt School, Winnipeg, MB, Canada
| | - Jianping Zhao
- Department of Respiratory and Critical Care Medicine, National Clinical Research Center of Respiratory Disease, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yongjian Xu
- Department of Respiratory and Critical Care Medicine, National Clinical Research Center of Respiratory Disease, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jungang Xie
- Department of Respiratory and Critical Care Medicine, National Clinical Research Center of Respiratory Disease, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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26
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Nakatsuka Y, Chen-Yoshikawa T, Kinoshita H, Aoyama A, Kubo H, Murase K, Hamada S, Takeyama H, Minami T, Takahashi N, Tanizawa K, Handa T, Hirai T, Date H, Chin K. Nocturnal hypercapnia with daytime normocapnia in patients with advanced pulmonary arterial hypertension awaiting lung transplantation. PLoS One 2020; 15:e0227775. [PMID: 32294102 PMCID: PMC7159234 DOI: 10.1371/journal.pone.0227775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/27/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is frequently complicated by sleep disordered breathing (SDB), and previous studies have largely focused on hypoxemic SDB. Even though nocturnal hypercapnia was shown to exacerbate pulmonary hypertension, the clinical significance of nocturnal hypercapnia among PAH patients has been scarcely investigated. METHOD Seventeen patients with PAH were identified from 246 consecutive patients referred to Kyoto University Hospital for the evaluation of lung transplant registration from January 2010 to December 2017. Included in this study were 13 patients whose nocturnal transcutaneous carbon dioxide partial pressure (PtcCO2) monitoring data were available. Nocturnal hypercapnia was diagnosed according to the guidelines of the American Academy of Sleep Medicine. Associations of nocturnal PtcCO2 measurements with clinical features, the findings of right heart catheterization and pulmonary function parameters were evaluated. RESULTS Nocturnal hypercapnia was diagnosed in six patients (46.2%), while no patient had daytime hypercapnia. Of note, nocturnal hypercapnia was found for 5 out of 6 patients with idiopathic PAH (83.3%). Mean nocturnal PtcCO2 levels correlated negatively with the percentage of predicted total lung capacity (TLC), and positively with cardiac output and cardiac index. CONCLUSION Nocturnal hypercapnia was prevalent among advanced PAH patients who were waiting for lung transplantation, and associated with %TLC. Nocturnal hypercapnia was associated with the increase in cardiac output, which might potentially worsen pulmonary hypertension especially during sleep. Further studies are needed to investigate hemodynamics during sleep and to clarify whether nocturnal hypercapnia can be a therapeutic target for PAH patients.
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Affiliation(s)
- Yoshinari Nakatsuka
- Department of Respiratory Care and Sleep Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Hideyuki Kinoshita
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akihiro Aoyama
- Department of Thoracic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiroyasu Kubo
- Division of Medical Equipment, Kyoto University Hospital, Kyoto, Japan
| | - Kimihiko Murase
- Department of Respiratory Care and Sleep Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Hamada
- Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hirofumi Takeyama
- Department of Respiratory Care and Sleep Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takuma Minami
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Naomi Takahashi
- Department of Respiratory Care and Sleep Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kiminobu Tanizawa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomohiro Handa
- Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Kazuo Chin
- Department of Respiratory Care and Sleep Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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27
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Steiger D, Han D, Yip R, Li K, Chen X, Liu L, Liu J, Ma T, Siddiqi F, Yankelevitz DF, Henschke CI. Increased main pulmonary artery diameter and main pulmonary artery to ascending aortic diameter ratio in smokers undergoing lung cancer screening. Clin Imaging 2020; 63:16-23. [PMID: 32120308 DOI: 10.1016/j.clinimag.2019.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/15/2019] [Accepted: 11/20/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Pulmonary hypertension (PH) is a progressive, potentially fatal disease, difficult to diagnose early due to non-specific nature of symptoms. PH is associated with increased morbidity and death in many respiratory and cardiac disorders, and with all-cause mortality, independent of age and cardiopulmonary disease. The main pulmonary artery diameter (MPA), and ratio of MPA to adjacent ascending aorta (AA), MPA:AA, on Chest CT are strong indicators of suspected PH. Our goal was to determine the prevalence of abnormally high values of these indicators of PH in asymptomatic low-dose CT (LDCT) screening participants at risk of lung cancer, and determine the associated risk factors. METHODS We reviewed consecutive baseline LDCT scans of 1949 smokers in an IRB-approved study. We measured the MPA and AA diameter and calculated MPA:AA ratio. We defined abnormally high values as being more than two standard deviations above the average (MPA ≥ 34 mm and MPA:AA ≥ 1.0). Regression analyses were used to identify risk factors and CT findings of participants associated with high values. RESULTS The prevalence of MPA ≥ 34 mm and MPA:AA ≥ 1.0 was 4.2% and 6.9%, respectively. Multivariable regression demonstrated that BMI was a significant risk factor, both for MPA ≥ 34 mm (OR = 1.07, p < 0.0001) and MPA:AA ≥ 1.0 (OR = 1.04, p = 0.003). Emphysema was significant in the univariate but not in the multivariate analysis. CONCLUSIONS We determined that the possible prevalence of PH as defined by abnormally high values of MPA and of MPA:AA was greater than previously described in the general population and that pulmonary consultation be recommended for these participants, in view of the significance of PH.
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Affiliation(s)
- David Steiger
- Division of Pulmonary Medicine, Icahn School of Medicine, New York, NY, United States of America
| | - Dan Han
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Xicheng District, Beijing, China
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Kunwei Li
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Xiangmeng Chen
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Radiology, Jiangmen Central Hospital, Jiangmen, China
| | - Li Liu
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Diagnostic Radiology, Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Chaoyang District, Beijing, China
| | - Jiayi Liu
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing, China
| | - Teng Ma
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Radiology, Tong Ren Hospital, Capital Medical University, Dongcheng District, Beijing, China
| | - Faisal Siddiqi
- Division of Pulmonary Medicine, Icahn School of Medicine, New York, NY, United States of America
| | - David F Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
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28
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Pi H, Kosanovich CM, Handen A, Tao M, Visina J, Vanspeybroeck G, Simon MA, Risbano MG, Desai A, Mathier MA, Rivera-Lebron BN, Nguyen Q, Kliner J, Nouraie M, Chan SY. Outcomes of Pulmonary Arterial Hypertension Are Improved in a Specialty Care Center. Chest 2020; 158:330-340. [PMID: 32109446 DOI: 10.1016/j.chest.2020.01.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 12/22/2019] [Accepted: 01/26/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is characterized by elevated pulmonary arterial pressures and is managed by vasodilator therapies. Current guidelines encourage PAH management in specialty care centers (SCCs), but evidence is sparse regarding improvement in clinical outcomes and correlation to vasodilator use with referral. RESEARCH QUESTION Is PAH management at SCCs associated with improved clinical outcomes? STUDY DESIGNAND METHODS A single-center, retrospective study was performed at the University of Pittsburgh Medical Center (UPMC; overseeing 40 hospitals). Patients with PAH were identified between 2008 and 2018 and classified into an SCC or non-SCC cohort. Cox proportional hazard modeling was done to compare for all-cause mortality, as was negative binomial regression modeling for hospitalizations. Vasodilator therapy was included to adjust outcomes. RESULTS Of 580 patients with PAH at UPMC, 455 (78%) were treated at the SCC, comprising a younger (58.8 vs 64.8 years; P < .001) and more often female (68.4% vs 51.2%; P < .001) population with more comorbidities without differences in race or income. SCC patients demonstrated improved survival (hazard ratio, 0.68; P = .012) and fewer hospitalizations (incidence ratio, 0.54; P < .001), and provided more frequent disease monitoring. Early patient referral to SCC (< 6 months from time of diagnosis) was associated with improved outcomes compared with non-SCC patients. SCC patients were more frequently prescribed vasodilators (P < .001) and carried more diagnostic PAH coding (P < .001). Vasodilators were associated with improved outcomes irrespective of location but without statistical significance when comparing between locations (P > .05). INTERPRETATION The UPMC SCC demonstrated improved outcomes in mortality and hospitalizations. The SCC benefit was multifactorial, with more frequent vasodilator therapy and disease monitoring. These findings provide robust evidence for early and regular referral of patients with PAH to SCCs.
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Affiliation(s)
- Hongyang Pi
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Chad M Kosanovich
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Adam Handen
- Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Pittsburgh, PA
| | - Michael Tao
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jacqueline Visina
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Marc A Simon
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA; Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Pittsburgh, PA; Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Michael G Risbano
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA; Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Pittsburgh, PA; Division of Pulmonary, Allergy and Critical Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Aken Desai
- Division of Cardiovascular Medicine, University of Colorado, Aurora, CO
| | - Michael A Mathier
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA; Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Pittsburgh, PA; Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Belinda N Rivera-Lebron
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA; Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Pittsburgh, PA; Division of Pulmonary, Allergy and Critical Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Quyen Nguyen
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA; Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Pittsburgh, PA; Division of Pulmonary, Allergy and Critical Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Jennifer Kliner
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA; Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Pittsburgh, PA; Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Mehdi Nouraie
- Division of Pulmonary, Allergy and Critical Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Stephen Y Chan
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA; Center for Pulmonary Vascular Biology and Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, Pittsburgh, PA; Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
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29
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Orr JE, Schmickl CN, Edwards BA, DeYoung PN, Brena R, Sun XS, Jain S, Malhotra A, Owens RL. Pathogenesis of obstructive sleep apnea in individuals with the COPD + OSA Overlap syndrome versus OSA alone. Physiol Rep 2020; 8:e14371. [PMID: 32061194 PMCID: PMC7023887 DOI: 10.14814/phy2.14371] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/11/2020] [Indexed: 02/02/2023] Open
Abstract
Overlap syndrome (OVS) is the concurrence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), and is associated with poor outcomes. We hypothesized that physiological changes in COPD may affect the pathogenesis of OSA in important ways. We therefore sought to measure the anatomical and nonanatomical OSA traits in individuals with OVS and compare to those with OSA alone. Patients with established OVS were recruited, along with age, gender, and BMI matched OSA only controls. Smoking and relevant comorbidities or medications were excluded. Subjects underwent baseline polysomnography followed by an overnight physiological research study to measure the OSA traits (Veupnea , Varousal , Vpassive , Vactive , and loop gain). Fifteen subjects with OVS and 15 matched controls with OSA alone were studied (overall 66 ± 8 years, 20% women, BMI 31 ± 4 kg/m2 , apnea-hypopnea index 49 ± 36/hr). Mixed-modeling was used to incorporate each measurement (range 52-270 measures/trait), and account for age, gender, and BMI. There were no significant differences in the traits between OVS and OSA subjects, although OVS subjects potentially tolerated a lower ventilation before arousal (i.e., harder to wake; p = .06). Worsened lung function was significantly associated with worsened upper airway response and more unstable breathing (p < .05 for all). Consistent differences in key OSA traits were not observed between OVS and OSA alone. However, worse lung function does appear to exert an influence on several OSA traits. These findings indicate that a diagnosis of OVS should not generally influence the approach to OSA, but that lung function might be considered if utilizing OSA trait-specific treatment.
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Affiliation(s)
- Jeremy E. Orr
- Division of Pulmonary, Critical Care, and Sleep MedicineUniversity of California San DiegoLa JollaCAUSA
| | - Christopher N. Schmickl
- Division of Pulmonary, Critical Care, and Sleep MedicineUniversity of California San DiegoLa JollaCAUSA
| | - Bradley A. Edwards
- Sleep and Circadian Medicine LaboratoryDepartment of PhysiologyMonash UniversityMelbourneVICAustralia
- Turner Institute for Brain and Mental HealthMonash UniversityMelbourneVICAustralia
| | - Pamela N. DeYoung
- Division of Pulmonary, Critical Care, and Sleep MedicineUniversity of California San DiegoLa JollaCAUSA
| | - Rebbecca Brena
- Division of Pulmonary, Critical Care, and Sleep MedicineUniversity of California San DiegoLa JollaCAUSA
| | - Xiaoying S. Sun
- Division of Biostatistics and BioinformaticsDepartment of Family Medicine and Public HealthUniversity of California San DiegoLa JollaCAUSA
| | - Sonia Jain
- Division of Biostatistics and BioinformaticsDepartment of Family Medicine and Public HealthUniversity of California San DiegoLa JollaCAUSA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, and Sleep MedicineUniversity of California San DiegoLa JollaCAUSA
| | - Robert L. Owens
- Division of Pulmonary, Critical Care, and Sleep MedicineUniversity of California San DiegoLa JollaCAUSA
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Tietjens JR, Claman D, Kezirian EJ, De Marco T, Mirzayan A, Sadroonri B, Goldberg AN, Long C, Gerstenfeld EP, Yeghiazarians Y. Obstructive Sleep Apnea in Cardiovascular Disease: A Review of the Literature and Proposed Multidisciplinary Clinical Management Strategy. J Am Heart Assoc 2020; 8:e010440. [PMID: 30590966 PMCID: PMC6405725 DOI: 10.1161/jaha.118.010440] [Citation(s) in RCA: 194] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | - David Claman
- 1 Department of Medicine University of California San Francisco CA
| | - Eric J Kezirian
- 4 USC Caruso Department of Otolaryngology - Head & Neck Surgery Keck School of Medicine University of Southern California Los Angeles CA
| | - Teresa De Marco
- 1 Department of Medicine University of California San Francisco CA
| | | | - Bijan Sadroonri
- 6 Division of Pulmonary Diseases and Sleep Medicine Holy Family Hospital Methuen MA
| | - Andrew N Goldberg
- 7 Department of Otolaryngology - Head & Neck Surgery University of California San Francisco CA
| | - Carlin Long
- 1 Department of Medicine University of California San Francisco CA
| | | | - Yerem Yeghiazarians
- 1 Department of Medicine University of California San Francisco CA.,2 Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research University of California San Francisco CA.,3 Cardiovascular Research Institute University of California San Francisco CA
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Impact of obstructive sleep apnea on pulmonary hypertension in patients with chronic obstructive pulmonary disease. Chin Med J (Engl) 2019; 132:1272-1282. [PMID: 30973448 PMCID: PMC6629366 DOI: 10.1097/cm9.0000000000000247] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) syndrome are highly prevalent respiratory conditions. Their coexistence is referred to as the overlap syndrome. They are both related to pulmonary hypertension (PH) development. This study investigated the effects of OSA on PH in patients with COPD and the associated factors. Methods: Consecutive patients with stable COPD were recruited for an observational cross-sectional study from September 2016 to May 2018 at Peking University Third Hospital. In total, 106 patients with COPD were enrolled and performed home portable monitoring and echocardiography. OSA was defined by an apnea hypopnea index (AHI) ≥10 events/h. Based on OSA absence or presence, patients were divided into the COPD with OSA and COPD without OSA groups. Factors affecting pulmonary artery pressure (PAP) and PH were identified using univariate analysis and logistic regression models. Results: In the 106 patients with COPD, the mean age was 69.52 years, 91.5% were men, and the mean forced expiratory volume in 1 s (FEV1) percentage of predicted was 56.15%. Fifty-six (52.8%) patients with COPD were diagnosed with OSA, and 24 (22.6%) patients with COPD were diagnosed as PH. Compared with COPD without OSA group, the median PAP in COPD with severe OSA group increased by 5 mmHg (36.00 [26.00–50.00] mmHg vs. 31.00 [24.00–34.00] mmHg, P = 0.036). COPD with percent of night-time spent with oxygen saturation below 90% (T90) > 10% group had higher PAP than COPD with T90 ≤ 1% group (36.00 [29.00–50.00)] mmHg vs. 29.00 [25.50–34.00] mmHg, F = 7.889, P = 0.007). Univariate analysis revealed age, FEV1% predicted, T90, and Charlson index had statistically significant effects on PH. Multiple regression analysis showed a significant and independent effect of both FEV1% predicted (odds ratio [OR] = 3.46; 95% confidence interval [CI]: 1.15–10.46; P = 0.028) and AHI (OR = 3.20; 95% CI: 1.09–19.35; P = 0.034) on PH. Conclusions: Patients with COPD with OSA are more susceptible to PH, which is associated with declining lung function and increased severity of OSA. Thus, nocturnal hypoxemia and OSA in elderly patients with COPD should be identified and treated.
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Lang IM, Palazzini M. The burden of comorbidities in pulmonary arterial hypertension. Eur Heart J Suppl 2019; 21:K21-K28. [PMID: 31857797 PMCID: PMC6915052 DOI: 10.1093/eurheartj/suz205] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Indexed: 01/22/2023]
Abstract
Patients with comorbidities are often excluded from clinical trials, limiting the evidence base for pulmonary arterial hypertension (PAH)-specific therapies. This review aims to discuss the effect of comorbidities on the diagnosis and management of PAH. The comorbidities discussed in this review (systemic hypertension, obesity, sleep apnoea, clinical depression, obstructive airway disease, thyroid disease, diabetes, and ischaemic cardiovascular event) were chosen based on their prevalence in patients with idiopathic PAH in the REVEAL registry (Registry to EValuate Early and Long-term PAH disease management). Comorbidities can mask the symptoms of PAH, leading to delays in diagnosis and also difficulty evaluating disease progression and treatment effects. Due to the multifactorial pathophysiology of pulmonary hypertension (PH), the presence of comorbidities can lead to difficulties in distinguishing between Group 1 PH (PAH) and the other group classifications of PH. Many comorbidities contribute to the progression of PAH through increased pulmonary artery pressures and cardiac output, therefore treatment of the comorbidity may also reduce the severity of PAH. Similarly, the development of one comorbidity can be a risk factor for the development of other comorbidities. The management of comorbidities requires consideration of drug interactions, polypharmacy, adherence and evidence-based strategies. A multidisciplinary team should be involved in the management of patients with PAH and comorbidities, with appropriate referral to supportive services when necessary. The treatment goals and expectations of patients must be managed in the context of comorbidities.
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Affiliation(s)
- Irene M Lang
- Department of Internal Medicine II, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Massimiliano Palazzini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Zamboni, 33 - 40126 Bologna, Italy
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Miceli R, Colombo D, Scagliola R, Balbi M, Braido F, Ameri P. No indication for right heart catheterisation for patients with isolated severe obstructive sleep apnoea syndrome according to a guideline-recommended approach. Eur J Prev Cardiol 2019; 27:2212-2215. [PMID: 31581821 DOI: 10.1177/2047487319878106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Roberta Miceli
- Department of Internal Medicine, University of Genova, Italy.,Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Italy
| | - Daniele Colombo
- Unit of Respiratory Diseases and Allergies, IRCCS Ospedale Policlinico San Martino, Italy
| | - Riccardo Scagliola
- Department of Internal Medicine, University of Genova, Italy.,Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Italy
| | - Manrico Balbi
- Department of Internal Medicine, University of Genova, Italy.,Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Italy
| | - Fulvio Braido
- Department of Internal Medicine, University of Genova, Italy.,Unit of Respiratory Diseases and Allergies, IRCCS Ospedale Policlinico San Martino, Italy
| | - Pietro Ameri
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Italy.,Department of Internal Medicine and Center of Excellence for Biomedical Research, University of Genova, Italy
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Small-world properties of the whole-brain functional networks in patients with obstructive sleep apnea‐hypopnea syndrome. Sleep Med 2019; 62:53-58. [DOI: 10.1016/j.sleep.2018.08.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/03/2018] [Accepted: 08/27/2018] [Indexed: 11/21/2022]
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Yu L, Li H, Liu X, Fan J, Zhu Q, Li J, Jiang J, Wang J. Left ventricular remodeling and dysfunction in obstructive sleep apnea : Systematic review and meta-analysis. Herz 2019; 45:726-738. [PMID: 31555891 PMCID: PMC7695673 DOI: 10.1007/s00059-019-04850-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 08/11/2019] [Accepted: 08/13/2019] [Indexed: 12/19/2022]
Abstract
Background Obstructive sleep apnea syndrome (OSAS) is associated with cardiovascular mortality and morbidity. Several studies have reported that it affects the left ventricle; however, large randomized controlled trials are lacking. The current study aimed to summarize the association between OSAS and left ventricular (LV) structure and function. Methods Electronic databases (PubMed, Embase, and Cochrane) and references were searched for articles published until March 2018. A systematic review and meta-analysis were performed to assess LV structure and function in OSAS patients based on echocardiography. Results In total, 17 studies with 747 OSAS patients and 426 control participants were included. Patients with OSAS showed an increase in LV diastolic diameter (weighted mean difference [WMD], 95% CI: 1.24 [0.68, 1.80]; p < 0.001), LV systolic diameter (WMD, 95% CI: 1.14 [0.47, 1.81]; p = 0.001), and LV mass (WMD, 95% CI: 35.34 [20.67, 50.00]; p < 0.001). In addition, left ventricular ejection fraction (LVEF) significantly decreased in the OSAS group compared with the controls (WMD, 95% CIs: −1.82 [−2.76, −0.87]; p < 0.001), and the reduction in LVEF was consistent with the severity of OSAS. The OSAS group also showed an increase in left atrial diameter (WMD, 95% CI: 2.13 [1.48, 2.77]; p < 0.001) and left atrial diameter volume index (WMD, 95% CIs: 3.96 [3.32, 4.61]; p < 0.001). Conclusion Obstructive sleep apnea syndrome leads to atrial dilatation, left ventricular hypertrophy, enlargement, mass increase and reduction of systolic function. Treatments for OSAS might be beneficial for the preservation of left cardiac structure and function. Electronic supplementary material The online version of this article (10.1007/s00059-019-04850-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lei Yu
- Department of Ultrasonography, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huajun Li
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - Xianbao Liu
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - Jiaqi Fan
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - Qifeng Zhu
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - Jing Li
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - Jubo Jiang
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China
| | - Jian'an Wang
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, 310009, Hangzhou, China.
- Zhejiang University School of Medicine, Hangzhou, China.
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Abstract
Synchronization of molecular, metabolic, and cardiovascular circadian oscillations is fundamental to human health. Sleep-disordered breathing, which disrupts such temporal congruence, elicits hemodynamic, autonomic, chemical, and inflammatory disturbances with acute and long-term consequences for heart, brain, and circulatory and metabolic function. Sleep apnea afflicts a substantial proportion of adult men and women but is more prevalent in those with established cardiovascular diseases and especially fluid-retaining states. Despite the experimental, epidemiological, observational, and interventional evidence assembled in support of these concepts, this substantial body of work has had relatively modest pragmatic impact, thus far, on the discipline of cardiology. Contemporary estimates of cardiovascular risk still are derived typically from data acquired during wakefulness. The impact of sleep-related breathing disorders rarely is entered into such calculations or integrated into diagnostic disease-specific algorithms or therapeutic recommendations. Reasons for this include absence of apnea-related symptoms in most with cardiovascular disease, impediments to efficient diagnosis at the population level, debate as to target, suboptimal therapies, difficulties mounting large randomized trials of sleep-specific interventions, and the challenging results of those few prospective cardiovascular outcome trials that have been completed and reported. The objectives of this review are to delineate the bidirectional interrelationship between sleep-disordered breathing and cardiovascular disease, consider the findings and implications of observational and randomized trials of treatment, frame the current state of clinical equipoise, identify principal current controversies and potential paths to their resolution, and anticipate future directions.
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Affiliation(s)
- John S Floras
- From the University Health Network and Sinai Health System Division of Cardiology, Department of Medicine, University of Toronto, Ontario, Canada.
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Abstract
The pulmonary circulation carries deoxygenated blood from the systemic veins through the pulmonary arteries to be oxygenated in the capillaries that line the walls of the pulmonary alveoli. The pulmonary circulation carries the cardiac output with a relatively low driving pressure, and so differs considerably in structure and function from the systemic circulation to maintain a low-resistance vascular system. The pulmonary circulation is often considered to be a quasi-static system in both experimental and computational studies of pulmonary perfusion and its matching to ventilation (air flow) for exchange. However, the system is highly dynamic, with cardiac output and regional perfusion changing with posture, exercise, and over time. Here we review this dynamic system, with a focus on understanding the physiology of pulmonary vascular dynamics across spatial and temporal scales, and the changes to these dynamics that are reflective of disease. © 2019 American Physiological Society. Compr Physiol 9:1081-1100, 2019.
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Affiliation(s)
- Alys Clark
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Merryn Tawhai
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
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Obstructive sleep apnea is associated with pulmonary artery thrombus load, disease severity, and survival in acute pulmonary embolism. Clin Res Cardiol 2019; 109:13-21. [PMID: 31016383 DOI: 10.1007/s00392-019-01479-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/11/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) may have prothrombotic effects. OBJECTIVE To investigate the effect of OSA on disease severity, pulmonary artery thrombus load, and prognosis in patients with acute pulmonary embolism (PE). METHODS In 101 PE patients, disease severity was determined by the simplified PE severity index (sPESI) score, pulmonary artery thrombus load was quantified by the pulmonary artery obstruction index (PAOI), and sleep-disordered breathing was evaluated by nocturnal polygraphy. RESULTS Obstructive sleep apnea patients with an apnea-hypopnea index (AHI) ≥ 15/h cohort were significantly older (p < 0.001) and had significantly lower oxygen saturations (p = 0.008) when acute PE was diagnosed. The sPESI scores (p < 0.001), the PAOI (p = 0.005) and the N-terminal pro-brain-type natriuretic peptide (NT-proBNP) values (p = 0.009), were significantly higher in the AHI ≥ 15/h subgroup. In a multivariate regression analysis, the AHI remains a significant predictor for sPESI scores ≥ 1 (p = 0.003), increased NT-proBNP levels (p = 0.047), and elevated PAOI (p = 0.032). During the median follow-up time of 53 (interquartile range 38-70) months, all-cause and cardiovascular-related mortality was significantly higher in the AHI ≥ 15/h cohort (p = 0.004 and p = 0.015, respectively). CONCLUSIONS Obstructive sleep apnea is associated with pulmonary artery thrombus load, disease severity, and survival in acute PE possibly due to its prothrombotic effects.
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Yu X, Huang Z, Zhang Y, Liu Z, Luo Q, Zhao Z, Zhao Q, Gao L, Jin Q, Yan L. Obstructive sleep apnea in patients with chronic thromboembolic pulmonary hypertension. J Thorac Dis 2018; 10:5804-5812. [PMID: 30505488 DOI: 10.21037/jtd.2018.09.118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Due to its effects, like an exaggerated negative intrathoracic pressure, sympathetic activation, systemic inflammation, oxidative stress, and endothelial dysfunction, obstructive sleep apnea (OSA) has been involved as a cause in multiple cardiovascular diseases. These diseases include coronary artery disease, hypertension, heart failure, and pulmonary hypertension (PH). Furthermore, OSA often coexists with chronic thromboembolic pulmonary hypertension (CTEPH) in clinical practice. However, few studies focus on OSA and its relationship with CTEPH. This study aims to determine whether OSA has an influence on the clinic status of patients with CTEPH, and to identify what possible factors are associated with OSA in CTEPH. Methods Patients who were newly diagnosed with CTEPH and received overnight polysomnography (PSG) monitoring from September 2015 to December 2017 were enrolled. OSA was defined as apnea-hypopnea index (AHI) of ≥5/h and the obstructive events at ≥50%. Baseline clinical characteristics and parameters were collected and compared between CTEPH patients with and without OSA. In addition, logistic regression analysis was performed to identify possible factors associated with OSA in CTEPH. Results Fifty-seven patients with CTEPH were eventually enrolled. Among them, 32 patients were diagnosed with OSA by PSG. CTEPH patients with OSA showed an older age, a higher body mass index (BMI), a higher hemoglobin level, a lower oxygen saturation and a worse World Health Organization functional class (WHO FC) (all P<0.05) when compared to CTEPH patients without OSA. In addition, sleep data including AHI, oxygen desaturation index and minimum oxygen saturation were also statistically different between two groups (all P<0.05). Adjusted for age, sex and BMI, hemoglobin [odd ratio (OR) =1.057, 95% confidence interval (CI): 1.001-1.117, P=0.046], oxygen saturation (OR =0.718, 95% CI: 0.554-0.929, P=0.012), N-terminal pro-brain natriuretic peptide (OR =1.001, 95% CI: 1.000-1.002, P=0.016), mean right atrium pressure (OR =1.284, 95% CI: 1.030-1.600, P=0.026), mean pulmonary arterial pressure (mPAP) (OR =1.087, 95% CI: 1.001-1.180, P=0.048), cardiac index (CI) (OR =0.058, 95% CI: 0.008-0.433, P=0.037), pulmonary vascular resistance (OR =1.004, 95% CI: 1.001-1.007, P=0.014) and WHO FC III-IV (OR =18.550, 95% CI: 2.363-144.128, P=0.005) were associated with OSA in CTEPH. Multivariate logistic regression analysis demonstrated CI (OR =0.051, 95% CI: 0.003-0.868, P=0.040) was independently associated with OSA in CTEPH in addition to age, sex and BMI. Conclusions OSA may aggravate the clinical status of CTEPH patients to some degree. In turn, a worse hemodynamics, oxygenation state and cardiac function are associated with OSA in CTEPH after being adjusted for age, sex and BMI. Among them, CI is the most important parameter in indicating the coexistence of OSA and CTEPH.
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Affiliation(s)
- Xue Yu
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Zhiwei Huang
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yi Zhang
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Zhihong Liu
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Qin Luo
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Zhihui Zhao
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Qing Zhao
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Liu Gao
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Qi Jin
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Lu Yan
- Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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Nakamoto T. Sleep-Disordered Breathing―a Real Therapeutic Target for Hypertension, Pulmonary Hypertension, Ischemic Heart Disease, and Chronic Heart Failure? J NIPPON MED SCH 2018; 85:70-77. [DOI: 10.1272/jnms.2018_85-12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Cho HJ, Heo W, Han JW, Lee YH, Park JM, Kang MJ, Yoon JH, Lee MG, Kim CH, Kim JY. Chronological Change of Right Ventricle by Chronic Intermittent Hypoxia in Mice. Sleep 2017. [PMID: 28637196 DOI: 10.1093/sleep/zsx103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Study Objective No studies have investigated sequential changes in the heart on magnetic resonance imaging (MRI), along with observation of functional lung phenotypes and genetics, over the duration of chronic intermittent hypoxia (CIH). We investigated chronological changes in heart and lung phenotypes after CIH using a mouse model to provide new insights into the pathophysiology of sleep apnea-induced cardiovascular disease. Methods C57BL/6J adult male mice were randomized to 4 or 8 weeks of CIH. Cardiac cine-MRI images were analyzed to assess functional parameters of right ventricle (RV). Histopathological features of myocytes and pulmonary vessels, as well as genes involved in the endothelin (ET) system, were investigated. Results Function of the RV reduced significantly at 4 weeks and continuously decreased following another 4 weeks of CIH, although the rate of decrease was attenuated. Notably, persistence of reduced ejection fraction and end-systole RV wall thickness (WT) and increases in the ET system of the lungs and blood strongly implied the development of pulmonary hypertension after 8 weeks of CIH. Conclusions RV dysfunction with reduced end-systole RV WT could be a late phenotype in long-standing CIH and possibly also in obstructive sleep apnea.
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Affiliation(s)
- Hyung-Ju Cho
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea.,The Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Woon Heo
- Department of Pharmacology and Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Woo Han
- Department of Pharmacology and Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Hyuk Lee
- Research Center for Human Natural Defense System, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Myung Park
- Research Center for Human Natural Defense System, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jung Kang
- Research Center for Human Natural Defense System, Yonsei University College of Medicine, Seoul, Korea
| | - Joo-Heon Yoon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea.,The Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea.,Research Center for Human Natural Defense System, Yonsei University College of Medicine, Seoul, Korea
| | - Min Goo Lee
- Department of Pharmacology and Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Chang-Hoon Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea.,The Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Young Kim
- Department of Pharmacology and Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
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Abstract
Heart failure is the quintessential cardiovascular syndrome of aging that results from common cardiovascular conditions in older adults in conjunction with age-associated changes in cardiovascular structure and function. To a large extent, heart failure is a geriatric syndrome in much the same way that dementia, falls, and frailty are geriatric syndromes. The incidence and prevalence of heart failure increase strikingly with age and make heart failure the most common reason for hospitalization among older adults. Although outcomes for older adults with heart failure have improved over time, mortality, hospitalization, and rehospitalization rates remain high.
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Affiliation(s)
- Kumar Dharmarajan
- Section of Cardiovascular Medicine, Department of Internal Medicine, Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, Yale University School of Medicine, 1 Church Street, Suite 200, New Haven, CT 06510, USA.
| | - Michael W Rich
- Division of Cardiology, Department of Internal Medicine, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8086, St Louis, MO 63110, USA
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Medrek SK, Sharafkhaneh A, Spiegelman AM, Kak A, Pandit LM. Admission for COPD Exacerbation Is Associated with the Clinical Diagnosis of Pulmonary Hypertension: Results from a Retrospective Longitudinal Study of a Veteran Population. COPD 2017; 14:484-489. [PMID: 28715281 DOI: 10.1080/15412555.2017.1336209] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Patients with chronic obstructive pulmonary disease and pulmonary hypertension (PH-COPD) have an increased risk of hospitalizations and death compared to COPD alone. Identifying PH in COPD is challenging because performing right heart catheterization, the gold standard for PH diagnosis, is invasive and not routinely performed. Clinical characterization of COPD patients at risk who are progressing toward PH will aid therapeutic development at earlier stages of progressively fatal PH-COPD. We studied the records of 5,45,086 patients in a large Veterans Affairs healthcare network (2000-2012) with a primary discharge diagnosis of COPD based on encounters' ICD-9 codes and further stratified into those who received an additional ICD-9 code for a PH diagnosis. Patients with PH-COPD were assigned to one of the four subgroups: those with (a) no history of exacerbation or hospital admissions, (b) history of exacerbations but no hospital admissions, (c) hospital admissions unrelated to COPD and (d) history of COPD exacerbation-related hospital admissions. We also examined the COPD and COPD-PH cohorts for associated comorbidities such as cardiac disease and the presence of obstructive sleep apnea (OSA). A regression analysis revealed that patients with COPD exacerbation-related hospital admissions had 7 × higher risk of having a concomitant clinical diagnosis of PH compared to non-hospitalized patients. COPD-PH patients had higher rates of cardiac comorbidities (89% vs. 66%) and OSA (34% vs. 16%) compared to COPD alone. We conclude that COPD patients hospitalized for COPD exacerbations are at a higher risk for developing PH, and hospitalized COPD patients with cardiac comorbidities and/or OSA should be screened as at-risk population for developing PH.
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Affiliation(s)
- Sarah K Medrek
- a Department of Pulmonary, Sleep, and Critical Care Medicine , Baylor College of Medicine , Houston , TX , USA
| | - Amir Sharafkhaneh
- a Department of Pulmonary, Sleep, and Critical Care Medicine , Baylor College of Medicine , Houston , TX , USA.,c Department of Pulmonary, Sleep, and Critical Care Medicine , Michael E. DeBakey Veterans Affairs Medicine Center , Houston , TX , USA
| | - Andrew M Spiegelman
- b Department of Defense , Veterans Health Administration , Washington, DC , USA
| | - Arnav Kak
- d University of Texas System , Austin , TX , USA
| | - Lavannya M Pandit
- a Department of Pulmonary, Sleep, and Critical Care Medicine , Baylor College of Medicine , Houston , TX , USA.,c Department of Pulmonary, Sleep, and Critical Care Medicine , Michael E. DeBakey Veterans Affairs Medicine Center , Houston , TX , USA
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Ghigna MR, Mooi WJ, Grünberg K. Pulmonary hypertensive vasculopathy in parenchymal lung diseases and/or hypoxia: Number 1 in the Series "Pathology for the clinician" Edited by Peter Dorfmüller and Alberto Cavazza. Eur Respir Rev 2017; 26:26/144/170003. [PMID: 28659502 DOI: 10.1183/16000617.0003-2017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/01/2017] [Indexed: 01/01/2023] Open
Abstract
Pulmonary hypertension (PH) with complicating chronic lung diseases and/or hypoxia falls into group 3 of the updated classification of PH. Patients with chronic obstructive lung disease (COPD), diffuse lung disease (such as idiopathic pulmonary fibrosis (IPF)) and with sleep disordered breathing are particularly exposed to the risk of developing PH. Although PH in such a context is usually mild, a minority of patients exhibit severe haemodynamic impairment, defined by a mean pulmonary arterial pressure (mPAP) of ≥35 mmHg or mPAP values ranging between 25 mmHg and 35 mmHg with a low cardiac index (<2 L·min-1·m-2). The overlap between lung parenchymal disease and PH heavily affects life expectancy in such a patient population and complicates their therapeutic management. In this review we illustrate the pathological features and the underlying pathophysiological mechanisms of pulmonary circulation in chronic lung diseases, with an emphasis on COPD, IPF and obstructive sleep apnoea syndrome.
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Affiliation(s)
- Maria Rosa Ghigna
- Service d'Anatomie et de Cytologie Pathologiques, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Wolter J Mooi
- Dept of Pathology, VU University Medical Center, Amsterdam, The Netherlands
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Balachandran DD, Bashoura L, Faiz SA. Sleep-Related Breathing Disorders and Cancer. CURRENT PULMONOLOGY REPORTS 2017. [DOI: 10.1007/s13665-017-0182-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Buonauro A, Galderisi M, Santoro C, Canora A, Bocchino ML, Lo Iudice F, Lembo M, Esposito R, Castaldo S, Trimarco B, Sanduzzi A. Obstructive sleep apnoea and right ventricular function: A combined assessment by speckle tracking and three-dimensional echocardiography. Int J Cardiol 2017; 243:544-549. [PMID: 28526545 DOI: 10.1016/j.ijcard.2017.05.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/04/2017] [Accepted: 05/02/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND Little is known on right ventricular (RV) involvement in obstructive sleep apnoea (OSA). This study aimed at evaluating early RV dysfunction by standard and advanced echocardiography in OSA. METHODS Fifty-nine OSA patients without heart failure and 29 age-matched controls underwent standard, speckle tracking and real time 3D echocardiography of right ventricle. OSA patients performed lung function tests and overnight cardio-respiratory monitoring with evaluation of apnea-hypopnea index (AHI). RESULTS OSA had significantly higher body mass index and systolic blood pressure (BP) than controls. RV diameters and systolic pulmonary arterial pressure (sPAP) were significantly higher in OSA, in presence of comparable tricuspid annular plane systolic excursion (TAPSE). OSA showed marginally lower RV global longitudinal strain (GLS) (p<0.05) and RV lateral wall strain (RV LLS) (p=0.04). Three-dimensional RV ejection fraction did not differ between the two groups. By stratifying patients according to sPAP, 18 OSA patients with sPAP≥30mmHg had lower TAPSE (p<0.05), RV GLS and RV LLS (both p<0.001) than 37 patients with normal sPAP. By separate multivariate analyses, RV GLS and RV LLS were independently associated with sPAP (both p<0.0001), AHI (p=0.035 and p=0.015 respectively) and BMI (p<0.05 and p=0.034) but not with age and systolic BP in OSA. CONCLUSIONS A subclinical RV dysfunction is detectable by speckle tracking in OSA. The impairment of RV GLS and RV LLS is more prominent than that of TAPSE and is evident when RVEF is still normal. GLS is independently associated with sPAP and OSA severity.
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Affiliation(s)
- Agostino Buonauro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy.
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Angelo Canora
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Maria Luisa Bocchino
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Francesco Lo Iudice
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Maria Lembo
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Roberta Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Sabrina Castaldo
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Alessandro Sanduzzi
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
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Khayat R, Pleister A. Consequences of Obstructive Sleep Apnea: Cardiovascular Risk of Obstructive Sleep Apnea and Whether Continuous Positive Airway Pressure Reduces that Risk. Sleep Med Clin 2017; 11:273-86. [PMID: 27542874 DOI: 10.1016/j.jsmc.2016.05.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Obstructive sleep apnea (OSA) is present in up to 25% of otherwise healthy individuals. OSA is associated with intermittent hypoxia, oxidative stress, sympathetic activation, and an inflammatory response. These perturbations mediate the role of OSA as an independent and modifiable risk factor for cardiovascular disease (CVD). OSA can induce CVD or accelerate the progression of CVD into an end-stage disorder, including heart failure and stroke. Current clinical recommendations are based on existing clinical trial data and the clinical experience of our program; current and future clinical trials will help to optimize management of OSA in the setting of CVD.
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Affiliation(s)
- Rami Khayat
- Internal Medicine-Pulmonary, Allergy, Critical Care, and Sleep Medicine, Wexner Medical Center, The Ohio State University, Suite 200, 473 West 12th Avenue, Columbus, OH 43210-1267, USA
| | - Adam Pleister
- Division of Cardiovascular Medicine (Advanced Heart Failure & Cardiac Transplant), Department of Internal Medicine, Wexner Medical Center, Davis Heart & Lung Research Institute, The Ohio State University, Suite 200, 473 West 12th Avenue, Columbus, OH 43210-1267, USA; Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine (Sleep Medicine), Department of Internal Medicine, Wexner Medical Center, Davis Heart & Lung Research Institute, The Ohio State University, Suite 200, 473 West 12th Avenue, Columbus, OH 43210-1267, USA.
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Lu H, Wu X, Fu C, Zhou J, Li S. Lung injury and inflammation response by chronic intermittent hypoxia in rats. SLEEP SCIENCE AND PRACTICE 2017. [DOI: 10.1186/s41606-016-0006-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Carnelio S, Morton A, McIntyre HD. Sleep disordered breathing in pregnancy: the maternal and fetal implications. J OBSTET GYNAECOL 2016; 37:170-178. [PMID: 27924661 DOI: 10.1080/01443615.2016.1229273] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Sleep disordered breathing (SDB) which includes obstructive sleep apnoea (OSA) and upper airway resistance syndrome (UARS), has emerged as a risk factor for adverse maternal-foetal outcomes in pregnancy. Physiological changes of pregnancy predispose a woman 'at risk' towards developing SDB. The increasing incidence of OSA in pregnancy closely correlates with the population trends of obesity. Common screening tools validated in non-pregnant subjects including Epworth Sleepiness Scale (ESS) and Berlin Questionnaire (BQ) are poor predictors of SDB in pregnancy. Preeclampsia, gestational hypertension and gestational diabetes mellitus (GDM) are linked with SDB. Preeclampsia and OSA share common pathological associations. It is unclear if one predisposes the other. Foetal morbidity includes intrauterine growth restriction (IUGR), preterm delivery, low birth weight, neonatal intensive care unit (NICU) admission and Apgar score of less than seven at one minute. Continuous positive airway pressure (CPAP) is a well-documented treatment of SDB in pregnancy and has been shown to reverse some of the adverse events. It becomes imperative to diagnose and manage this condition as OSA causes substantial morbidity in the untreated pregnant patient and foetus. Three short clinical cases and a literature review on SDB on pregnancy are presented.
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Affiliation(s)
| | - Adam Morton
- b Department of Obstetric Medicine , Mater Health Services , Brisbane , Australia
| | - H David McIntyre
- b Department of Obstetric Medicine , Mater Health Services , Brisbane , Australia
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