Pulmonary Division, Lady Davis Carmel Medical Center, Haifa, Israel.
Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.
Eur Respir J. 2021 Jan 5;57(1). doi: 10.1183/13993003.02258-2020. Print 2021 Jan.
Sleep-related breathing disorders (SBDs) include obstructive apnoea, central apnoea and sleep-related hypoventilation. These nocturnal events have the potential to increase pulmonary arterial pressure (PAP) during sleep but also in the waking state. "Pure" obstructive sleep apnoea syndrome (OSAS) is responsible for a small increase in PAP whose clinical impact has not been demonstrated. By contrast, in obesity hypoventilation syndrome (OHS) or overlap syndrome (the association of chronic obstructive pulmonary disease (COPD) with obstructive sleep apnoea (OSA)), nocturnal respiratory events contribute to the development of pulmonary hypertension (PH), which is often severe. In the latter circumstances, treatment of SBDs is essential in order to improve pulmonary haemodynamics.Patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) are at risk of developing SBDs. Obstructive and central apnoea, as well as a worsening of ventilation-perfusion mismatch, can be observed during sleep. There should be a strong suspicion of SBDs in such a patient population; however, the precise indications for sleep studies and the type of recording remain to be specified. The diagnosis of OSAS in patients with PAH or CTEPH should encourage treatment with continuous positive airway pressure (CPAP). The presence of isolated nocturnal hypoxaemia should also prompt the initiation of long-term oxygen therapy. These treatments are likely to avoid worsening of PH; however, it is prudent not to treat central apnoea and Cheyne-Stokes respiration (CSR) with adaptive servo-ventilation in patients with chronic right-heart failure because of a potential risk of serious adverse effects from such treatment.In this review we will consider the current knowledge of the consequences of SBDs on pulmonary haemodynamics in patients with and without chronic respiratory disease (group 3 of the clinical classification of PH) and the effect of treatments of respiratory events during sleep on PH. The prevalence and consequences of SBDs in PAH and CTEPH (groups 1 and 4 of the clinical classification of PH, respectively), as well as therapeutic options, will also be discussed.
睡眠相关呼吸障碍（SBDs）包括阻塞性呼吸暂停、中枢性呼吸暂停和睡眠相关通气不足。这些夜间事件有可能在睡眠期间和清醒状态下增加肺动脉压（PAP）。“单纯”阻塞性睡眠呼吸暂停综合征（OSAS）导致 PAP 轻度升高，但临床影响尚未得到证实。相比之下，在肥胖低通气综合征（OHS）或重叠综合征（慢性阻塞性肺疾病（COPD）与阻塞性睡眠呼吸暂停（OSA）并存）中，夜间呼吸事件会导致肺动脉高压（PH）的发展，而这种 PH 通常较为严重。在后一种情况下，治疗 SBDs 对于改善肺血液动力学至关重要。
患有肺动脉高压（PAH）或慢性血栓栓塞性肺动脉高压（CTEPH）的患者有发生 SBDs 的风险。阻塞性和中枢性呼吸暂停以及通气-灌注不匹配的恶化，可在睡眠期间观察到。在这种患者群体中，应强烈怀疑存在 SBDs；然而，对于睡眠研究的精确适应证和记录类型仍有待确定。PAH 或 CTEPH 患者的 OSAS 诊断应鼓励使用持续气道正压通气（CPAP）治疗。孤立性夜间低氧血症的存在也应促使开始长期氧疗。这些治疗可能会避免 PH 的恶化；然而，对于慢性右心衰竭患者，谨慎起见不应使用适应性伺服通气来治疗中枢性呼吸暂停和 Cheyne-Stokes 呼吸（CSR），因为这种治疗可能会有严重不良反应的风险。
在这篇综述中，我们将考虑 SBDs 对伴有和不伴有慢性呼吸系统疾病的患者的肺血液动力学的影响的现有知识（PH 临床分类的第 3 组），以及治疗睡眠期间呼吸事件对 PH 的影响。还将讨论 PAH 和 CTEPH（PH 临床分类的第 1 组和第 4 组）中 SBDs 的患病率和后果，以及治疗选择。
