Chronic thromboembolic pulmonary hypertension: Reversal of pulmonary hypertension but not sleep disordered breathing following pulmonary endarterectomy

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Abstract

Background: It has been hypothesized that pre-capillary pulmonary hypertension (PH) may trigger sleep disordered breathing (SDB). In patients with chronic thromboembolic PH (CTEPH), pulmonary endarterectomy (PEA) is potentially effective to improve PH. We assessed the pre- and post-operative prevalence of SDB in CTEPH patients submitted to PEA and the relationship between SDB and clinical, pulmonary and hemodynamic factors. Methods: Unattended cardiorespiratory recording was performed the night before and one month after elective PEA in 50 patients. Results: Before the intervention SDB prevalence (obstructive or central AHI ≥ 5/h) was 64%: 18 patients (66% female) had No-SDB, 22 (68% female) had dominant obstructive (dOSA), and 10 (20% female) had dominant central sleep apnea (dCSA). There were no differences in risk factors and the need for supplemental oxygen. Mean right atrial (mRAP) and pulmonary artery pressures (mPAP) showed a more compromised profile from No-SDB to dOSA and dCSA (mRAP: 5.5 ± 3.9 vs 7.0 ± 4.5 vs 9.7 ± 4.3 mm Hg (p = 0.054), mPAP: 39 ± 12 vs 48 ± 11 vs 51 ± 16 mm Hg (p = 0.0.47)). By contrast, cardiac index did not differ. At post-intervention, the prevalence of SDB was 68%: 16 patients had No-SDB, while 30 had dOSA and 4 dCSA, with no relationship with the relief from PH. Interestingly, 5 patients with previous CSA moved to the OSA group and 2 normalized. Conclusions: Prevalence of SDB is high in patients with CTEPH even after resolution of PH. Our data support the hypothesis that pre-capillary PH may trigger CSA but not OSA, and suggest that OSA may play a role in the development of CTEPH.

Original languageEnglish
Pages (from-to)147-152
Number of pages6
JournalInternational Journal of Cardiology
Volume264
DOIs
Publication statusPublished - Aug 1 2018

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Endarterectomy
Sleep Apnea Syndromes
Pulmonary Hypertension
Lung
Central Sleep Apnea
Pulmonary Artery
Pressure
Hemodynamics
Oxygen

Keywords

  • Cardiac index
  • Central sleep apnea
  • Chronic thromboembolic pulmonary hypertension
  • Obstructive sleep apnea
  • Pre-capillary pulmonary hypertension
  • Pulmonary endarterectomy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{79db2aa969cc4d03a1778be3133a4442,
title = "Chronic thromboembolic pulmonary hypertension: Reversal of pulmonary hypertension but not sleep disordered breathing following pulmonary endarterectomy",
abstract = "Background: It has been hypothesized that pre-capillary pulmonary hypertension (PH) may trigger sleep disordered breathing (SDB). In patients with chronic thromboembolic PH (CTEPH), pulmonary endarterectomy (PEA) is potentially effective to improve PH. We assessed the pre- and post-operative prevalence of SDB in CTEPH patients submitted to PEA and the relationship between SDB and clinical, pulmonary and hemodynamic factors. Methods: Unattended cardiorespiratory recording was performed the night before and one month after elective PEA in 50 patients. Results: Before the intervention SDB prevalence (obstructive or central AHI ≥ 5/h) was 64{\%}: 18 patients (66{\%} female) had No-SDB, 22 (68{\%} female) had dominant obstructive (dOSA), and 10 (20{\%} female) had dominant central sleep apnea (dCSA). There were no differences in risk factors and the need for supplemental oxygen. Mean right atrial (mRAP) and pulmonary artery pressures (mPAP) showed a more compromised profile from No-SDB to dOSA and dCSA (mRAP: 5.5 ± 3.9 vs 7.0 ± 4.5 vs 9.7 ± 4.3 mm Hg (p = 0.054), mPAP: 39 ± 12 vs 48 ± 11 vs 51 ± 16 mm Hg (p = 0.0.47)). By contrast, cardiac index did not differ. At post-intervention, the prevalence of SDB was 68{\%}: 16 patients had No-SDB, while 30 had dOSA and 4 dCSA, with no relationship with the relief from PH. Interestingly, 5 patients with previous CSA moved to the OSA group and 2 normalized. Conclusions: Prevalence of SDB is high in patients with CTEPH even after resolution of PH. Our data support the hypothesis that pre-capillary PH may trigger CSA but not OSA, and suggest that OSA may play a role in the development of CTEPH.",
keywords = "Cardiac index, Central sleep apnea, Chronic thromboembolic pulmonary hypertension, Obstructive sleep apnea, Pre-capillary pulmonary hypertension, Pulmonary endarterectomy",
author = "{La Rovere}, {Maria Teresa} and Francesco Fanfulla and Taurino, {Anna Eugenia} and Claudio Bruschi and Roberto Maestri and Elena Robbi and Rita Maestroni and Caterina Pronzato and Maurizio Pin and D'Armini, {Andrea M.} and Pinna, {Gian Domenico}",
year = "2018",
month = "8",
day = "1",
doi = "10.1016/j.ijcard.2018.02.112",
language = "English",
volume = "264",
pages = "147--152",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Chronic thromboembolic pulmonary hypertension

T2 - Reversal of pulmonary hypertension but not sleep disordered breathing following pulmonary endarterectomy

AU - La Rovere, Maria Teresa

AU - Fanfulla, Francesco

AU - Taurino, Anna Eugenia

AU - Bruschi, Claudio

AU - Maestri, Roberto

AU - Robbi, Elena

AU - Maestroni, Rita

AU - Pronzato, Caterina

AU - Pin, Maurizio

AU - D'Armini, Andrea M.

AU - Pinna, Gian Domenico

PY - 2018/8/1

Y1 - 2018/8/1

N2 - Background: It has been hypothesized that pre-capillary pulmonary hypertension (PH) may trigger sleep disordered breathing (SDB). In patients with chronic thromboembolic PH (CTEPH), pulmonary endarterectomy (PEA) is potentially effective to improve PH. We assessed the pre- and post-operative prevalence of SDB in CTEPH patients submitted to PEA and the relationship between SDB and clinical, pulmonary and hemodynamic factors. Methods: Unattended cardiorespiratory recording was performed the night before and one month after elective PEA in 50 patients. Results: Before the intervention SDB prevalence (obstructive or central AHI ≥ 5/h) was 64%: 18 patients (66% female) had No-SDB, 22 (68% female) had dominant obstructive (dOSA), and 10 (20% female) had dominant central sleep apnea (dCSA). There were no differences in risk factors and the need for supplemental oxygen. Mean right atrial (mRAP) and pulmonary artery pressures (mPAP) showed a more compromised profile from No-SDB to dOSA and dCSA (mRAP: 5.5 ± 3.9 vs 7.0 ± 4.5 vs 9.7 ± 4.3 mm Hg (p = 0.054), mPAP: 39 ± 12 vs 48 ± 11 vs 51 ± 16 mm Hg (p = 0.0.47)). By contrast, cardiac index did not differ. At post-intervention, the prevalence of SDB was 68%: 16 patients had No-SDB, while 30 had dOSA and 4 dCSA, with no relationship with the relief from PH. Interestingly, 5 patients with previous CSA moved to the OSA group and 2 normalized. Conclusions: Prevalence of SDB is high in patients with CTEPH even after resolution of PH. Our data support the hypothesis that pre-capillary PH may trigger CSA but not OSA, and suggest that OSA may play a role in the development of CTEPH.

AB - Background: It has been hypothesized that pre-capillary pulmonary hypertension (PH) may trigger sleep disordered breathing (SDB). In patients with chronic thromboembolic PH (CTEPH), pulmonary endarterectomy (PEA) is potentially effective to improve PH. We assessed the pre- and post-operative prevalence of SDB in CTEPH patients submitted to PEA and the relationship between SDB and clinical, pulmonary and hemodynamic factors. Methods: Unattended cardiorespiratory recording was performed the night before and one month after elective PEA in 50 patients. Results: Before the intervention SDB prevalence (obstructive or central AHI ≥ 5/h) was 64%: 18 patients (66% female) had No-SDB, 22 (68% female) had dominant obstructive (dOSA), and 10 (20% female) had dominant central sleep apnea (dCSA). There were no differences in risk factors and the need for supplemental oxygen. Mean right atrial (mRAP) and pulmonary artery pressures (mPAP) showed a more compromised profile from No-SDB to dOSA and dCSA (mRAP: 5.5 ± 3.9 vs 7.0 ± 4.5 vs 9.7 ± 4.3 mm Hg (p = 0.054), mPAP: 39 ± 12 vs 48 ± 11 vs 51 ± 16 mm Hg (p = 0.0.47)). By contrast, cardiac index did not differ. At post-intervention, the prevalence of SDB was 68%: 16 patients had No-SDB, while 30 had dOSA and 4 dCSA, with no relationship with the relief from PH. Interestingly, 5 patients with previous CSA moved to the OSA group and 2 normalized. Conclusions: Prevalence of SDB is high in patients with CTEPH even after resolution of PH. Our data support the hypothesis that pre-capillary PH may trigger CSA but not OSA, and suggest that OSA may play a role in the development of CTEPH.

KW - Cardiac index

KW - Central sleep apnea

KW - Chronic thromboembolic pulmonary hypertension

KW - Obstructive sleep apnea

KW - Pre-capillary pulmonary hypertension

KW - Pulmonary endarterectomy

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U2 - 10.1016/j.ijcard.2018.02.112

DO - 10.1016/j.ijcard.2018.02.112

M3 - Article

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VL - 264

SP - 147

EP - 152

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

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