Center for Respiratory and Pulmonary Vascular Disease, Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China.
J Clin Sleep Med. 2023 Feb 1;19(2):213-223. doi: 10.5664/jcsm.10286.
The unique pathophysiologic contributions of obstructive sleep apnea (OSA) toward pulmonary hypertension and right ventricular (RV) dysfunction still represent an understudied area. We aimed to investigate the impacts of various respiratory parameters on pulmonary hemodynamics and RV performance in OSA.
Data of consecutive patients with OSA who completed right heart catheterization for evaluation of pulmonary hemodynamics were retrospectively reviewed and analyzed. Univariable and multivariable regression analyses were used to determine the significant respiratory parameter associated with right heart catheterization metrics.
Of 205 patients with OSA (43.4% male), 134 (65.4%) had pulmonary hypertension. Among various sleep parameters, the time percentage spent with SpO below 90% (T90) was the sole and the strongest independent factor associated with mean pulmonary artery pressure (mPAP) (β = 0.467, < .001), pulmonary vascular resistance (PVR) (β = 0.433, < .001), and RV stroke work index (RVSWI) (β = 0.338, < .001). For every 5-unit increase in T90, there was approximately 36% greater risk of mPAP ≥ 25 mmHg (odds ratio [OR] 1.36, 95% confidence interval [CI] 1.16-1.59, < .001), and 45% greater risk of PVR > 3 Woods units (OR 1.45, 95% CI 1.21-1.74, < .001), respectively. T90 per 5-unit increment was also related to a nearly 1.2-fold higher risk of RVSWI ≥ 12 g/m/beat (OR 1.19, 95% CI 1.11-1.28, < .001). These associations remained significant even after multivariable adjustment for confounding factors (all < .05).
Increased mPAP, PVR, and RVSWI were associated with prolonged T90 in patients with OSA. Assessment of OSA with insights into hypoxemic duration may aid in early recognition of impaired pulmonary hemodynamics and RV dysfunction.
Huang Z, Duan A, Hu M, et al. Implication of prolonged nocturnal hypoxemia and obstructive sleep apnea for pulmonary hemodynamics in patients being evaluated for pulmonary hypertension: a retrospective study. . 2023;19(2):213-223.
阻塞性睡眠呼吸暂停（OSA）对肺动脉高压和右心室（RV）功能障碍的独特病理生理贡献仍是一个研究不足的领域。我们旨在研究各种呼吸参数对 OSA 患者肺血流动力学和 RV 功能的影响。
回顾性分析了因评估肺血流动力学而接受右心导管检查的连续 OSA 患者的数据。采用单变量和多变量回归分析确定与右心导管检查指标显著相关的呼吸参数。
在 205 例 OSA 患者（43.4%为男性）中，134 例（65.4%）患有肺动脉高压。在各种睡眠参数中，SpO2 低于 90%的时间百分比（T90）是唯一且最强的独立因素，与平均肺动脉压（mPAP）（β=0.467， < .001）、肺血管阻力（PVR）（β=0.433， < .001）和 RV 每搏功指数（RVSWI）（β=0.338， < .001）相关。T90 每增加 5 个单位，mPAP≥25mmHg 的风险大约增加 36%（优势比[OR]1.36，95%置信区间[CI]1.16-1.59， < .001），PVR>3Woods 单位的风险增加 45%（OR 1.45，95%CI 1.21-1.74， < .001）。T90 每增加 5 个单位，RVSWI≥12g/m/beat 的风险也几乎增加 1.2 倍（OR 1.19，95%CI 1.11-1.28， < .001）。即使在多变量调整混杂因素后，这些关联仍然显著（所有 P<0.05）。
OSA 患者的 mPAP、PVR 和 RVSWI 增加与 T90 延长有关。对 OSA 进行评估并了解低氧血症持续时间，可能有助于早期识别肺血流动力学和 RV 功能障碍。
