Pulmonary hemodynamics in obstructive sleep apnea: Frequency and causes of pulmonary hypertension
Pulmonary hemodynamics in obstructive sleep apnea: Frequency and causes of pulmonary hypertension
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DOI：
10.1007/s00408-003-1017-y
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发表时间：
2003-05-01
期刊：
影响因子：
5
通讯作者：
Hetzel, J
中科院分区：
文献类型：
--
作者：
Hetzel, M;Kochs, M;Hetzel, J
夜间呼吸暂停和短暂性肺动脉高压（PHT）之间的关系已被充分证明。然而，阻塞性睡眠呼吸暂停（OSAS）患者日间肺动脉高压的发生率和病理生理机制仍存在争议。本研究旨在评估OSAS患者肺动脉高压的发生率和机制。它包括49例连续的多导睡眠图证实的OSAS患者，没有病理肺功能检查。所有患者在休息和运动（50- 75 W）期间进行日间肺血流动力学测量。6名患者（12%）静息时PHT平均肺动脉压（PAPM）>20 mmHg，而39名患者（80%）在运动期间显示PHT（PAPM >30 mmHg）。多元回归分析显示，影响运动时平均肺动脉压（PAPMmax）的3个独立因素为：体重指数、年龄和总肺活量占预计值的百分比。39例病理性高PAPMmax患者中有25例（64%）显示肺毛细血管楔压升高（PCWPmax > 20 mmHg），而无患者肺血管阻力升高（PVRmax > 120达因）。S . cm（-5））。总之，OSAS和肺功能检测正常的患者在运动过程中经常出现日间PHT，主要是由异常高的PCWP引起的，而PVR似乎起次要作用。
The association between nocturnal apneas and transient pulmonary hypertension (PHT) has been well documented. However, there is controversy over the frequency and pathophysiological mechanisms of daytime pulmonary hypertension in patients with obstructive sleep apnea (OSAS). The present study sought to evaluate frequency and mechanisms of pulmonary hypertension in patients with OSAS. It included 49 consecutive patients with polysomnographically proven OSAS without pathological lung function testing. All patients performed daytime measurements of pulmonary hemodynamics at rest and during exercise (50-75W). Six patients (12%) had resting PHT mean pulmonary of artery pressure (PAPM) of >20 mmHg), whereas 39 patients (80%) showed PHT during exercise (PAPM >30 mmHg). Multiple regression analysis revealed 3 independent contributing factors for mean pulmonary artery pressure during exercise (PAPMmax): body mass index, age and total lung capacity % of predicted. Twenty-five of the 39 patients with pathologically high PAPMmax (64%) showed elevated pulmonary capillary wedge pressures (PCWPmax > 20 mmHg), whereas no patient had elevated pulmonary vascular resistance (PVRmax > 120 dynes . s . cm(-5)). In conclusion, daytime PHT during exercise is frequently seen in patients with OSAS and normal lung function testing and is mainly caused by abnormally high PCWP, whereas PVR seems to play a minor role.