Yan Lu, Luo Qin, Zhao Zhihui, Zhao Qing, Jin Qi, Zhang Yi, Liu Zhihong
Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Pulm Circ. 2020 Aug 21;10(3):2045894019885364. doi: 10.1177/2045894019885364. eCollection 2020 Jul-Sep.
Sleep-disordered breathing causes a variety of cardiovascular complications and increases the risk of a poor prognosis in patients. There is still some controversy regarding the clinical diagnosis and treatment of sleep-disordered breathing in patients with pulmonary hypertension. The aim of this study was to determine the incidence of desaturation in idiopathic pulmonary arterial hypertension (IPAH) patients, evaluate the effect of desaturation on the clinical status of patients with IPAH, and identify possible influencing factors.
Patients with IPAH diagnosed by right heart catheterization who underwent overnight cardiorespiratory monitoring from January 2018 to July 2019 were enrolled. Nocturnal hypoxic time was defined as the time that oxygen saturation remained below 90%. Desaturation was defined as a nocturnal oxygen saturation level less than 90% for more than 10% of the total recording time. Baseline clinical characteristics and parameters were collected to compare IPAH patients with and without desaturation. In addition, logistic regression was performed to identify possible factors associated with desaturation in IPAH patients.
Fifty patients with IPAH were included. Among them, 17 patients presented desaturation. Patients with desaturation were older, had a shorter six-min walking distance (6MWD), had a higher mean right atrial pressure, and had a lower daytime arterial oxygen partial pressure than patients without desaturation, and there were significant differences in the VE/VCO and VE/VCO slope ( < 0.05). The multivariate logistic regression analysis indicated that the 6 MWD (OR = 0.971, 95% CI: 0.948-0.994, = 0.013) and; VE/VCO slope (OR = 1.095, 95% CI: 1.010-1.307, = 0.032) were independently associated with desaturation after adjusting for age, sex, and body mass index.
Nocturnal hypoxia is common in IPAH patients. Desaturation may aggravate the clinical situation of patients with IPAH. In IPAH patients, a poor exercise capacity (6 MWD) and the VE/VCO slope can predict desaturation after adjusting for age, sex, and body mass index.
睡眠呼吸障碍会引发多种心血管并发症，并增加患者预后不良的风险。对于肺动脉高压患者睡眠呼吸障碍的临床诊断和治疗仍存在一些争议。本研究的目的是确定特发性肺动脉高压（IPAH）患者中血氧饱和度降低的发生率，评估血氧饱和度降低对IPAH患者临床状况的影响，并识别可能的影响因素。
纳入2018年1月至2019年7月期间经右心导管检查确诊为IPAH且接受过夜心肺监测的患者。夜间低氧时间定义为血氧饱和度低于90%的时间。血氧饱和度降低定义为夜间血氧饱和度水平低于90%的时间超过总记录时间的10%。收集基线临床特征和参数，以比较有和没有血氧饱和度降低的IPAH患者。此外，进行逻辑回归分析以识别IPAH患者中与血氧饱和度降低相关的可能因素。
纳入50例IPAH患者。其中，17例患者出现血氧饱和度降低。与没有血氧饱和度降低的患者相比，出现血氧饱和度降低的患者年龄更大，6分钟步行距离（6MWD）更短，平均右心房压力更高，日间动脉血氧分压更低，且在VE/VCO和VE/VCO斜率方面存在显著差异（P<0.05）。多因素逻辑回归分析表明，在调整年龄、性别和体重指数后，6MWD（OR=0.971，95%CI：0.948-0.994，P=0.013）和VE/VCO斜率（OR=1.095，95%CI：1.010-1.307，P=0.032）与血氧饱和度降低独立相关。
夜间低氧在IPAH患者中很常见。血氧饱和度降低可能会加重IPAH患者的临床状况。在IPAH患者中，运动能力差（6MWD）和VE/VCO斜率在调整年龄、性别和体重指数后可预测血氧饱和度降低。
