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
- Sleep-related breathing disorders in patients with pulmonary hypertension.Chest. 2008; 133: 1375-1380
- Predictors of nocturnal oxygen desaturation in pulmonary arterial hypertension.Chest. 2007; 131: 109-117
- Usefulness of low cardiac index to predict sleep-disordered breathing in chronic thromboembolic pulmonary hypertension.Am J Cardiol. 2016; 117: 1001-1005
- 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
- Sleep apnea and cardiovascular disease: a bidirectional relationship.Circulation. 2012; 126: 1495-1510
- Central sleep apnea and Cheyne-Stokes respiration.Proc Am Thoracic Soc. 2008; 5: 226-236
- Carvedilol reduces the severity of central sleep apnea in chronic heart failure.Circ J. 2009; 73: 295-298
- The impact of cardiac resynchronization therapy on obstructive sleep apnea in heart failure patients: a pilot study.Chest. 2007; 132: 433-439
- Acute increase of cardiac output reduces central sleep apneas in heart failure patients.J Am Coll Cardiol. 2015; 66: 2571-2572
- 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
- 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
- Validation of a portable monitoring system for the diagnosis of obstructive sleep apnea syndrome.Sleep. 2009; 32: 629-636
- 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
- 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
- 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
- Percutaneous transluminal pulmonary angioplasty for the treatment of chronic thromboembolic pulmonary hypertension.Circ Cardiovasc Intervent. 2012; 5: 756-762
- Midterm effect of balloon pulmonary angioplasty on hemodynamics and subclinical myocardial damage in chronic thromboembolic pulmonary hypertension.Can J Cardiol. 2017; 33: 463-470
- 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
- Influence of pulmonary capillary wedge pressure on central apnea in heart failure.Circulation. 1999; 99: 1574-1579
- 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
- Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep.Eur Respir J. 2017; 49
Article info
Publication history
Published online: April 24, 2019
Accepted:
April 2,
2019
Received in revised form:
April 2,
2019
Received:
October 22,
2018
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
