Schulz R, Eisele H J, Weissmann N, Seeger W
Medizinische Klinik II, Justus-Liebig-Universität, Giessen.
Pneumologie. 2005 Apr;59(4):270-4. doi: 10.1055/s-2004-830189.
Pulmonary hypertension (PH), i. e. an increase of mean pulmonary artery pressure above 20 mm Hg under resting conditions, can be observed in different forms of sleep-disordered breathing (SDB). In obstructive sleep apnea (OSA) the apnea-associated triggers of hypoxia and intrathoracic pressure swings lead to repetitive rises of pulmonary artery pressure during sleep. In 20 - 30 % of these patients daytime PH occurs. PH in the setting of OSA is usually mild and rarely causes clinically evident cor pulmonale. Effective CPAP therapy has a beneficial influence on pulmonary hemodynamics in OSA. Severe congestive heart failure (i. e. with a LVEF < 40 %) might provoke pulmonary venous hypertension and thereby stimulation of pulmonary stretch and irritant receptors. The ensuing hyperventilation leads to a decrease of pCO (2) levels below the apneic threshold and thus contributes to the emergence of Cheyne Stokes respiration (CSR) in up to one half of the affected patients. Patients suffering from advanced idiopathic pulmonary arterial hypertension (IPAH) might show a similar breathing pattern while asleep. Possible pathogenetic factors of the nocturnal periodic breathing occurring in end-stage IPAH are prolonged circulation times and hypocapnia. In conclusion, SDB might cause PH (OSA-associated PH). On the other hand, PH might lead to the development of SDB (CSR in congestive heart failure, periodic breathing in IPAH).
肺动脉高压（PH），即在静息状态下平均肺动脉压升高超过20 mmHg，可在不同形式的睡眠呼吸障碍（SDB）中观察到。在阻塞性睡眠呼吸暂停（OSA）中，与呼吸暂停相关的缺氧和胸内压波动触发因素会导致睡眠期间肺动脉压反复升高。在这些患者中，20% - 30%会出现日间PH。OSA患者的PH通常较轻，很少引起临床上明显的肺心病。有效的持续气道正压通气（CPAP）治疗对OSA患者的肺血流动力学有有益影响。严重充血性心力衰竭（即左心室射血分数<40%）可能引发肺静脉高压，从而刺激肺牵张和刺激感受器。随之而来的过度通气导致pCO₂水平降至呼吸暂停阈值以下，从而在多达一半的受影响患者中促成潮式呼吸（CSR）的出现。患有晚期特发性肺动脉高压（IPAH）的患者在睡眠时可能表现出类似的呼吸模式。终末期IPAH中出现夜间周期性呼吸的可能致病因素是循环时间延长和低碳酸血症。总之，SDB可能导致PH（OSA相关的PH）。另一方面，PH可能导致SDB的发生（充血性心力衰竭中的CSR，IPAH中的周期性呼吸）。
