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

Maria Teresa La Rovere, Francesco Fanfulla, Anna Eugenia Taurino, Claudio Bruschi, Roberto Maestri, Elena Robbi, Rita Maestroni, Caterina Pronzato, Maurizio Pin, Andrea M. D'Armini, Gian Domenico Pinna

Research output: Contribution to journalArticlepeer-review

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

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

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