Nocturnal hypercapnia with daytime normocapnia in patients with advanced pulmonary arterial hypertension awaiting lung transplantation
Nocturnal hypercapnia with daytime normocapnia in patients with advanced pulmonary arterial hypertension awaiting lung transplantation
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DOI：
10.1371/journal.pone.0227775
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发表时间：
2020-04-15
期刊：
影响因子：
3.7
通讯作者：
Chin, Kazuo
中科院分区：
文献类型：
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作者：
Nakatsuka, Yoshinari;Chen-Yoshikawa, Toyofumi;Chin, Kazuo
背景肺动脉高压（PAH）经常并发睡眠呼吸障碍（SDB），之前的研究主要集中在低氧性SDB。尽管夜间高碳酸血症被证明会加剧肺动脉高压，但PAH患者夜间高碳酸血症的临床意义却很少被研究。方法从2010年1月至2017年12月转诊到京都大学医院进行肺移植登记评估的连续246名患者中，确定了17名PAH患者。本研究包括13名夜间经皮二氧化碳分压（PtcCO（2））监测数据的患者。可用。夜间高碳酸血症是根据美国睡眠医学会的指南诊断的。评估夜间PtcCO(2)测量与临床特征、右心导管检查结果和肺功能参数的关联。结果6名患者（46.2%）被诊断为夜间高碳酸血症，而没有患者出现白天高碳酸血症。值得注意的是，6 名特发性 PAH 患者中有 5 名（83.3%）发现夜间高碳酸血症。夜间平均 PtcCO(2) 水平与预测总肺活量 (TLC) 百分比呈负相关，与心输出量和心脏指数呈正相关。结论 夜间高碳酸血症在等待肺移植的晚期 PAH 患者中普遍存在，并与 %TLC 相关。夜间高碳酸血症与心输出量增加有关，这可能会加重肺动脉高压，尤其是在睡眠期间。需要进一步的研究来调查睡眠期间的血流动力学，并阐明夜间高碳酸血症是否可以成为 PAH 患者的治疗目标。
BackgroundPulmonary arterial hypertension (PAH) is frequently complicated by sleep disordered breathing (SDB), and previous studies have largely focused on hypoxemic SDB. Even though nocturnal hypercapnia was shown to exacerbate pulmonary hypertension, the clinical significance of nocturnal hypercapnia among PAH patients has been scarcely investigated.MethodSeventeen patients with PAH were identified from 246 consecutive patients referred to Kyoto University Hospital for the evaluation of lung transplant registration from January 2010 to December 2017. Included in this study were 13 patients whose nocturnal transcutaneous carbon dioxide partial pressure (PtcCO(2)) monitoring data were available. Nocturnal hypercapnia was diagnosed according to the guidelines of the American Academy of Sleep Medicine. Associations of nocturnal PtcCO(2) measurements with clinical features, the findings of right heart catheterization and pulmonary function parameters were evaluated.ResultsNocturnal hypercapnia was diagnosed in six patients (46.2%), while no patient had daytime hypercapnia. Of note, nocturnal hypercapnia was found for 5 out of 6 patients with idiopathic PAH (83.3%). Mean nocturnal PtcCO(2) levels correlated negatively with the percentage of predicted total lung capacity (TLC), and positively with cardiac output and cardiac index.ConclusionNocturnal hypercapnia was prevalent among advanced PAH patients who were waiting for lung transplantation, and associated with %TLC. Nocturnal hypercapnia was associated with the increase in cardiac output, which might potentially worsen pulmonary hypertension especially during sleep. Further studies are needed to investigate hemodynamics during sleep and to clarify whether nocturnal hypercapnia can be a therapeutic target for PAH patients.