Duan Anqi, Huang Zhihua, Hu Meixi, Zhao Zhihui, Zhao Qing, Jin Qi, Yan Lu, Zhang Yi, Li Xin, An Chenhong, Luo Qin, Liu Zhihong
Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Rd, Xicheng District, Beijing, 100037, China.
Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 Beilishi Rd, Xicheng District, Beijing, 100037, China; Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China.
Sleep Med. 2023 Jan;101:146-153. doi: 10.1016/j.sleep.2022.10.029. Epub 2022 Nov 2.
Pre-capillary pulmonary hypertension (PH) with risk factors for left ventricular diastolic dysfunction, described as an atypical phenotype of "mixed" pre- and post-capillary PH, has become a research focus. However, the relationship between obstructive sleep apnea (OSA), a known risk factor for cardiometabolic conditions, and comorbidity burden and disease phenotype in PH remains unclear.
This study aimed to investigate the effect of the presence and severity of OSA on the left ventricular function, comorbidity burden and disease phenotype in pre-capillary PH patients.
We retrospectively examined 450 consecutive pre-capillary PH patients undergoing cardiorespiratory polygraphy and right heart catheterization between May 2020 to November 2021 at Fuwai Hospital. The prevalence of OSA was 34.2%, and the presence and severity of OSA in pre-capillary PH patients was associated with increased left heart mass index (P < 0.001), pulmonary arterial wedge pressure (P = 0.06) and HFPEF score (P < 0.001). After adjustment for confounding factors, the severity of OSA measured as apnea-hypopnea index (AHI) was an independent risk factor associated with obesity, systemic hypertension, diabetes mellitus and an atypical phenotype (OR: 1.054, P = 0.004) in pre-capillary PH. A dose-response relationship was also identified between sleep parameters (AHI, oxygen desaturation index, the percentage of sleep time with oxygen saturation<80%) and the number of key comorbidities. Patients with ≥3 comorbidities (atypical phenotype) were older, experienced negative alterations in left ventricular structure and function, and were at a higher risk of OSA.
OSA is relatively prevalent in pre-capillary PH patients, independently associated with the presence of a variety of comorbidities and the atypical phenotype of PH. These findings highlight the importance of OSA as a modifiable target for optimal treatment in PH with comorbidities.
毛细血管前性肺动脉高压（PH）伴有左心室舒张功能障碍风险因素，被描述为“混合性”毛细血管前和毛细血管后PH的非典型表型，已成为研究热点。然而，阻塞性睡眠呼吸暂停（OSA）作为已知的心脏代谢疾病风险因素，与PH中的合并症负担和疾病表型之间的关系仍不清楚。
本研究旨在探讨OSA的存在和严重程度对毛细血管前性PH患者左心室功能、合并症负担和疾病表型的影响。
我们回顾性研究了2020年5月至2021年11月期间在阜外医院接受心肺多导睡眠监测和右心导管检查的450例连续性毛细血管前性PH患者。OSA的患病率为34.2%，毛细血管前性PH患者中OSA的存在和严重程度与左心室质量指数增加（P<0.001）、肺动脉楔压（P=0.06）和HFpEF评分（P<0.001）相关。在调整混杂因素后，以呼吸暂停低通气指数（AHI）衡量的OSA严重程度是毛细血管前性PH中与肥胖、系统性高血压、糖尿病和非典型表型相关的独立危险因素（OR：1.054，P=0.004）。睡眠参数（AHI、氧饱和度下降指数、氧饱和度<80%的睡眠时间百分比）与关键合并症数量之间也存在剂量反应关系。合并症≥3种（非典型表型）的患者年龄更大，左心室结构和功能出现负面改变，且OSA风险更高。
OSA在毛细血管前性PH患者中相对普遍，与多种合并症的存在及PH的非典型表型独立相关。这些发现凸显了OSA作为合并症PH最佳治疗中可改变靶点的重要性。
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