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Balloon pulmonary angioplasty attenuates sleep apnea in patients with chronic thromboembolic pulmonary hypertension

      Abstract

      Background

      Balloon pulmonary angioplasty (BPA) improves pulmonary hemodynamics in chronic thromboembolic pulmonary hypertension (CTEPH) patients. However, whether it affects the severity of sleep apnea (SA) remains unknown. We investigated the effect of BPA on the severity of SA in CTEPH patients.

      Methods

      We studied 13 patients with CTEPH who had an apnea hypopnea index (AHI) > 10 before BPA and underwent a second polygraph test 6 months after the last BPA session.

      Results

      BPA decreased pulmonary vascular resistance, mean pulmonary artery pressure (PAP), and plasma B-type natriuretic peptide levels, and increased the 6-minute walking distance. BPA decreased the AHI (from 20.9 [13.9–35.7] to 16.3 [7.7–21.8] times/hour, P = 0.023) and hypopnea index (from 13.2 [8.4–22.5] to 6.4 [3.8–10.9] times/hour, P = 0.013), but not the obstructive, central, or mixed apnea index. The change in AHI correlated with that in mean PAP, but not with the change in body mass index or other parameters of hemodynamics.

      Conclusions

      BPA-induced improvement in hemodynamics was associated with the attenuation of SA in patients with CTEPH and SA. Therefore, close attention should be paid to SA in CTEPH patients, and SA should be re-evaluated after BPA to avoid overestimating its severity.

      Keywords

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      References

        • Ulrich S
        • Fischler M
        • Speich R
        • Bloch KE
        Sleep-related breathing disorders in patients with pulmonary hypertension.
        Chest. 2008; 133: 1375-1380
        • Minai OA
        • Pandya CM
        • Golish JA
        • et al.
        Predictors of nocturnal oxygen desaturation in pulmonary arterial hypertension.
        Chest. 2007; 131: 109-117
        • Orr JE
        • Auger WR
        • DeYoung PN
        • Kim NH
        • Malhotra A
        • Owens RL
        Usefulness of low cardiac index to predict sleep-disordered breathing in chronic thromboembolic pulmonary hypertension.
        Am J Cardiol. 2016; 117: 1001-1005
        • Kohno T
        • Kataoka M
        • Kawakami T
        • et al.
        Moderate-to-severe obstructive sleep apnea is associated with subclinical myocardial injury and impaired hemodynamics in pulmonary hypertension patients.
        Sleep Med. 2017; 30: 121-127
        • Kasai T
        • Floras JS
        • Bradley TD
        Sleep apnea and cardiovascular disease: a bidirectional relationship.
        Circulation. 2012; 126: 1495-1510
        • Yumino D
        • Bradley TD
        Central sleep apnea and Cheyne-Stokes respiration.
        Proc Am Thoracic Soc. 2008; 5: 226-236
        • Tamura A
        • Kawano Y
        • Kadota J
        Carvedilol reduces the severity of central sleep apnea in chronic heart failure.
        Circ J. 2009; 73: 295-298
        • Stanchina ML
        • Ellison K
        • Malhotra A
        • et al.
        The impact of cardiac resynchronization therapy on obstructive sleep apnea in heart failure patients: a pilot study.
        Chest. 2007; 132: 433-439
        • Agostoni P
        • Contini M
        • Vignati C
        • et al.
        Acute increase of cardiac output reduces central sleep apneas in heart failure patients.
        J Am Coll Cardiol. 2015; 66: 2571-2572
        • Tsugu T
        • Murata M
        • Kawakami T
        • et al.
        Significance of echocardiographic assessment for right ventricular function after balloon pulmonary angioplasty in patients with chronic thromboembolic induced pulmonary hypertension.
        Am J Cardiol. 2015; 115: 256-261
        • Galie N
        • Humbert M
        • Vachiery JL
        • et al.
        2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: the joint task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): endorsed by: association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT).
        Eur Heart J. 2016; 37: 67-119
        • Santos-Silva R
        • Sartori DE
        • Truksinas V
        • et al.
        Validation of a portable monitoring system for the diagnosis of obstructive sleep apnea syndrome.
        Sleep. 2009; 32: 629-636
        • Redline S
        • Tosteson T
        • Boucher MA
        • Millman RP
        Measurement of sleep-related breathing disturbances in epidemiologic studies. Assessment of the validity and reproducibility of a portable monitoring device.
        Chest. 1991; 100: 1281-1286
        • Takama N
        • Kurabayashi M.
        Effectiveness of a portable device and the need for treatment of mild-to-moderate obstructive sleep-disordered breathing in patients with cardiovascular disease.
        J Cardiol. 2010; 56: 73-78
        • Chesson Jr., AL
        • Berry RB
        • Pack A
        American academy of sleep M, American Thoracic S, American College of Chest P. Practice parameters for the use of portable monitoring devices in the investigation of suspected obstructive sleep apnea in adults.
        Sleep. 2003; 26: 907-913
        • Kataoka M
        • Inami T
        • Hayashida K
        • et al.
        Percutaneous transluminal pulmonary angioplasty for the treatment of chronic thromboembolic pulmonary hypertension.
        Circ Cardiovasc Intervent. 2012; 5: 756-762
        • Kimura M
        • Kohno T
        • Kawakami T
        • et al.
        Midterm effect of balloon pulmonary angioplasty on hemodynamics and subclinical myocardial damage in chronic thromboembolic pulmonary hypertension.
        Can J Cardiol. 2017; 33: 463-470
        • Somers VK
        • White DP
        • Amin R
        • et al.
        Sleep apnea and cardiovascular disease: an American Heart Association/american College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council On Cardiovascular Nursing. In collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health).
        Circulation. 2008; 118: 1080-1111
        • Solin P
        • Bergin P
        • Richardson M
        • Kaye DM
        • Walters EH
        • Naughton MT
        Influence of pulmonary capillary wedge pressure on central apnea in heart failure.
        Circulation. 1999; 99: 1574-1579
        • Sajkov D
        • Wang T
        • Saunders NA
        • Bune AJ
        • McEvoy RD
        Continuous positive airway pressure treatment improves pulmonary hemodynamics in patients with obstructive sleep apnea.
        American journal of respiratory and critical care medicine. 2002; 165: 152-158
        • Randerath W
        • Verbraecken J
        • Andreas S
        • et al.
        Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep.
        Eur Respir J. 2017; 49