Clinic of Pneumology and Sleep Disorders Center, University Hospital Zurich, Zurich, Switzerland.
Dept of Respiratory, Critical Care and Sleep Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic.
Eur Respir J. 2017 Feb 2;49(2). doi: 10.1183/13993003.01530-2016. Print 2017 Feb.
This case-control study evaluates a possible association between high altitude pulmonary hypertension (HAPH) and sleep apnoea in people living at high altitude.Ninety highlanders living at altitudes >2500 m without excessive erythrocytosis and with normal spirometry were studied at 3250 m (Aksay, Kyrgyzstan); 34 healthy lowlanders living below 800 m were studied at 760 m (Bishkek, Kyrgyzstan). Echocardiography, polysomnography and other outcomes were assessed. Thirty-six highlanders with elevated mean pulmonary artery pressure (mPAP) >30 mmHg (31-42 mmHg by echocardiography) were designated as HAPH+. Their data were compared to that of 54 healthy highlanders (HH, mPAP 13-28 mmHg) and 34 healthy lowlanders (LL, mPAP 8-24 mmHg).The HAPH+ group (median age 52 years (interquartile range 47-59) had a higher apnoea-hypopnoea index (AHI) of 33.8 events·h (26.9-54.6) and spent a greater percentage of the night-time with an oxygen saturation <90% (T<90; 78% (61-89)) than the HH group (median age 39 years (32-48), AHI 9.0 events·h (3.6-16), T<90 33% (10-69)) and the LL group (median age 40 years (30-47), AHI 4.3 events·h (1.4-12.6), T<90 0% (0-0)); p<0.007 for AHI and T<90, respectively, in HAPH+ versus others. In highlanders, multivariable regression analysis confirmed an independent association between mPAP and both AHI and T<90, when controlled for age, gender and body mass index.Pulmonary hypertension in highlanders is associated with sleep apnoea and hypoxaemia even when adjusted for age, gender and body mass index, suggesting pathophysiologic interactions between pulmonary haemodynamics and sleep apnoea.
本病例对照研究评估了生活在高海拔地区的人群中，高原性肺动脉高压（HAPH）与睡眠呼吸暂停之间可能存在的关联。在海拔 2500 米以上的地区（吉尔吉斯斯坦阿克赛），对 90 名没有过度红细胞增多且肺功能正常的高原居民进行了研究；在海拔 760 米的（吉尔吉斯斯坦比什凯克），对 34 名健康的低地居民进行了研究。评估了超声心动图、多导睡眠图和其他结果。36 名平均肺动脉压（mPAP）升高（超声心动图为 30-42mmHg）的高原居民被指定为 HAPH+。将他们的数据与 54 名健康高原居民（HH，mPAP 13-28mmHg）和 34 名健康低地居民（LL，mPAP 8-24mmHg）的数据进行了比较。HAPH+组（中位数年龄 52 岁（四分位距 47-59）的睡眠呼吸暂停低通气指数（AHI）更高，为 33.8 次·小时（26.9-54.6），夜间血氧饱和度<90%（T<90）的时间百分比更大（78%（61-89）），高于 HH 组（中位数年龄 39 岁（32-48），AHI 9.0 次·小时（3.6-16），T<90 33%（10-69））和 LL 组（中位数年龄 40 岁（30-47），AHI 4.3 次·小时（1.4-12.6），T<90 0%（0-0））；HAPH+与其他组相比，AHI 和 T<90 分别有显著性差异（p<0.007）。在高原居民中，多变量回归分析在控制年龄、性别和体重指数后，证实 mPAP 与 AHI 和 T<90 之间存在独立关联。因此，提示肺血流动力学与睡眠呼吸暂停之间存在病理生理相互作用。
