Minai Omar A, Ricaurte Basma, Kaw Roop, Hammel Jeff, Mansour Mary, McCarthy Kevin, Golish Joseph A, Stoller James K
Respiratory Institute, Cleveland Clinic, Ohio, USA.
Am J Cardiol. 2009 Nov 1;104(9):1300-6. doi: 10.1016/j.amjcard.2009.06.048.
The correlates and consequences of pulmonary hypertension (PH) associated with obstructive sleep apnea (OSA) are poorly understood. Patients undergoing pulmonary artery catheterization within 6 months of an overnight polysomnography showing OSA were included in the present analysis. A total of 83 patients with complete data were analyzed (no PH, n = 25 [30%]; PH, 58 [70%]; of these, 18 had a pulmonary capillary wedge pressure of <15 mm Hg). No significant differences were observed between the PH and no PH groups regarding age or apnea-hypopnea index. The correlates of PH were elevated right ventricular systolic pressure (p <0.001), body mass index (p = 0.026), female gender (p = 0.01), nocturnal desaturation (82% vs 18%), and forced vital capacity <70% (p = 0.04) on univariate analysis and female gender (p = 0.03), age <49 years (p = 0.02), body mass index of > or =26 kg/m(2) (p = 0.08), and right ventricular systolic pressure of > or =30 mm Hg (p <0.001) on multivariate analysis. Patients with PH had a lower 6-minute walk distance (285.5 +/- 122 m vs 343 +/- 213 m, p = 0.4). The survival rate at 1, 4, and 8 years for patients with PH was 93%, 75%, and 43% compared to 100%, 90%, and 76% for patients without PH, respectively. Patients with severe PH (n = 27; 33%) had more nocturnal desaturation (p = 0.045), worse pulmonary hemodynamics, and greater mortality (37%) than the groups with mild or moderate PH (16%) or no PH (16%). In conclusion, our results have shown that, although generally mild to moderate, severe PH can occur in patients with OSA. Female gender, younger age, obesity, and nocturnal desaturation were associated with PH. PH can cause functional limitations and increased mortality in patients with OSA.
与阻塞性睡眠呼吸暂停（OSA）相关的肺动脉高压（PH）的相关因素和后果目前尚不清楚。本分析纳入了在夜间多导睡眠图显示OSA后6个月内接受肺动脉导管插入术的患者。共分析了83例有完整数据的患者（无PH，n = 25 [30%]；PH，58 [70%]；其中18例肺毛细血管楔压<15 mmHg）。在年龄或呼吸暂停低通气指数方面，PH组和无PH组之间未观察到显著差异。单因素分析显示，PH的相关因素为右心室收缩压升高（p <0.001）、体重指数（p = 0.026）、女性（p = 0.01）、夜间低氧血症（82%对18%）和用力肺活量<70%（p = 0.04）；多因素分析显示，相关因素为女性（p = 0.03）、年龄<49岁（p = 0.02）、体重指数≥26 kg/m²（p = 0.08）和右心室收缩压≥30 mmHg（p <0.001）。PH患者的6分钟步行距离较短（285.5±122 m对343±213 m，p = 0.4）。PH患者1年、4年和8年的生存率分别为93%、75%和43%，而无PH患者分别为100%、90%和76%。重度PH患者（n = 27；33%）比轻度或中度PH患者（16%）或无PH患者（16%）有更多的夜间低氧血症（p = 0.045）、更差的肺血流动力学和更高的死亡率（37%）。总之，我们的结果表明，虽然通常为轻度至中度，但OSA患者可能会出现重度PH。女性、年轻、肥胖和夜间低氧血症与PH相关。PH可导致OSA患者出现功能受限和死亡率增加。
