Sleep-Related Hypoxia, Right Ventricular Dysfunction, and Survival in Patients With Group 1 Pulmonary Arterial Hypertension.
Sleep-Related Hypoxia, Right Ventricular Dysfunction, and Survival in Patients With Group 1 Pulmonary Arterial Hypertension.
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1 组肺动脉高压患者的睡眠相关缺氧、右心室功能障碍和生存率。
DOI：
10.1016/j.jacc.2023.09.806
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发表时间：
2023
影响因子：
24
通讯作者：
Hemn
中科院分区：
文献类型：
--
作者：
Lowery,MeganM;Hill,NicholasS;Wang,Lu;Rosenzweig,ErikaB;Bhat,Aparna;Erzurum,Serpil;Finet,JEmanuel;Jellis,ChristineL;Kaur,Sunjeet;Kwon,DeborahH;Nawabit,Rawan;Radeva,Milena;Beck,GeraldJ;Frantz,RobertP;Hassoun,PaulM;Hemn
背景1组肺动脉高压（PAH）是一种以右心室（RV）衰竭为特征的进行性致死性疾病，在结缔组织病（CTD）中预后较差。阻塞性睡眠呼吸暂停和睡眠相关性缺氧可能导致RV功能障碍，尽管两者之间的关系尚不清楚。ObjectivesThe aim of this study is to prospectively evaluate the association of the apnea-hypopnea index（AHI）and sleep-related hypoxia with RV function and survival.（国家心肺和血液研究所）队列参与者（第1组PAH患者、对照药物和健康对照参与者）纳入睡眠研究。多模式RV功能测量与AHI和每10单位增量氧饱和度<90%（T90）的记录时间百分比相关。线性模型，调整人口统计学，氧气，肺一氧化碳弥散量，肺动脉高压药物，评估AHI和T90，RV措施。对数秩检验/考克斯比例风险模型调整人口统计学，氧气，气道正压，构建了移植无survivalanalysis.ResultsAnalysis包括186名参与者与组1 PAH的平均年龄为52.6 ± 14.1岁，71.5%是女性，80.8%是白人，有43个事件（移植或死亡）。AHI和T90与RV射血分数降低（磁共振成像）相关，分别为2.18%（−2.18; 95%CI：−4.00至−0.36;P= 0.019）和0.93%（−0.93; 95%CI：−1.47至−0.40;P< 0.001）。T90与RV收缩压升高相关（超声心动图），2.52 mm Hg（2.52; 95% CI：1.61至3.43;P< 0.001）;平均肺动脉压升高（右心导管插入术），0.27 mm Hg（0.27; 95% CI：0.05至0.49;P= 0.019）;右心室肥大（心电图），1.24 mm（1.24; 95% CI：1.10至1.40;P< 0.001）。T90，而不是AHI，与移植或死亡的5年风险增加17%相关（HR：1.17; 95%CI：1.07至1.28）。在非CTD相关PAH中，T90与移植或死亡风险增加21%相关（HR：1.21; 95% CI：1.08 - 1.34）。在CTD相关的PAH，T90与RV功能障碍，但不死亡或transplantation.ConclusionsSleep-related缺氧是更强的相关性比AHI与措施的RV功能障碍，死亡，或移植的整体和组1非CTD相关的PAH，但只有与RV功能障碍CTD相关的PAH。（肺血管疾病表型组学项目[PVDOMICS]; NCT 02980887）
BackgroundGroup 1 pulmonary arterial hypertension (PAH) is a progressive fatal condition characterized by right ventricular (RV) failure with worse outcomes in connective tissue disease (CTD). Obstructive sleep apnea and sleep-related hypoxia may contribute to RV dysfunction, though the relationship remains unclear.ObjectivesThe aim of this study was to prospectively evaluate the association of the apnea-hypopnea index (AHI) and sleep-related hypoxia with RV function and survival.MethodsPulmonary Vascular Disease Phenomics (National Heart, Lung, and Blood Institute) cohort participants (patients with group 1 PAH, comparators, and healthy control participants) with sleep studies were included. Multimodal RV functional measures were examined in association with AHI and percentage of recording time with oxygen saturation <90% (T90) per 10-unit increment. Linear models, adjusted for demographics, oxygen, diffusing capacity of the lungs for carbon monoxide, pulmonary hypertension medications, assessed AHI and T90, and RV measures. Log-rank test/Cox proportional hazards models adjusted for demographics, oxygen, and positive airway pressure were constructed for transplantation-free survival analyses.ResultsAnalysis included 186 participants with group 1 PAH with a mean age of 52.6 ± 14.1 years; 71.5% were women, 80.8% were Caucasian, and there were 43 events (transplantation or death). AHI and T90 were associated with decreased RV ejection fraction (on magnetic resonance imaging), by 2.18% (−2.18; 95% CI: −4.00 to −0.36;P= 0.019) and 0.93% (−0.93; 95% CI: −1.47 to −0.40;P< 0.001), respectively. T90 was associated with increased RV systolic pressure (on echocardiography), by 2.52 mm Hg (2.52; 95% CI: 1.61 to 3.43;P< 0.001); increased mean pulmonary artery pressure (on right heart catheterization), by 0.27 mm Hg (0.27; 95% CI: 0.05 to 0.49;P= 0.019); and RV hypertrophy (on electrocardiography), 1.24 mm (1.24; 95% CI: 1.10 to 1.40;P< 0.001). T90, but not AHI, was associated with a 17% increased 5-year risk for transplantation or death (HR: 1.17; 95% CI: 1.07 to 1.28). In non-CTD-associated PAH, T90 was associated with a 21% increased risk for transplantation or death (HR: 1.21; 95% CI: 1.08 to 1.34). In CTD-associated PAH, T90 was associated with RV dysfunction, but not death or transplantation.ConclusionsSleep-related hypoxia was more strongly associated than AHI with measures of RV dysfunction, death, or transplantation overall and in group 1 non-CTD-associated PAH but only with RV dysfunction in CTD-associated PAH. (Pulmonary Vascular Disease Phenomics Program [PVDOMICS]; NCT02980887)