Skip to main content
SpringerLink
Log in

Pulmonary hypertension and echocardiogram parameters in obstructive sleep apnea

  • Miscellaneous
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Obstructive sleep apnea (OSA) is a growing health hazard in the United States and worldwide. OSA is now recognized as a disorder with systemic manifestations and its association with obesity and adverse cardiovascular consequences. There is increasing evidence that OSA may be associated with systemic hypertension and an increased incidence of stroke, heart failure, myocardial infarction, and arrhythmias. Less information is available about the association between OSA and pulmonary hypertension (PH). We therefore conduct this study to look at the prevalence of the pulmonary hypertension in obstructive sleep apnea patient and to identify risk factors leading to pulmonary hypertension among OSA patient. We studied and analyzed all OSA patient confirmed by polysomnograph in the year 2015. Twenty-five patients with OSA were included in this study with prevalence of pulmonary hypertension of 16%. Univariate analysis of various factors revealed a statistically significant association between having the lowest SpO2 of <70% and pulmonary hypertension (p = 0.016). There were no statistically significant associations between age, gender, smoking status, hypertension, body mass index (BMI), or apnea–hypopnea index (AHI) with occurrence of pulmonary hypertension. AHI is not a good predictor for pulmonary hypertension. The real value of using AHI to predict the health risk of OSA is doubtful. We recommend routine echocardiogram among OSA patient. The objective information in the echocardiogram provides evidence for counseling of patient with disease of OSA and hence hopefully can improve compliance of patient to treatment especially usage of CPAP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lopez-Jimenez F, Kuniyoshi FH, Gami A, Somers VK (2008) Obstructive sleep apnea: implications for cardiac and vascular disease. Chest J 133(3):793–804

    Article  Google Scholar 

  2. Kamil MA, Teng CL, Hassan SA (2007) Snoring and breathing pauses during sleep in the Malaysian population. Respirology 12(3):375–380

    Article  PubMed  Google Scholar 

  3. Yusoff MF, Baki MM, Mohamed N, Mohamed AS, Yunus MR, Ami M, Othman I, Ishak AI (2010) Obstructive sleep apnea among express bus drivers in Malaysia: important indicators for screening. Traffic Inj Prev 11(6):594–599

    Article  PubMed  Google Scholar 

  4. Puvanendran K, Goh KL (1998) From snoring to sleep apnea in a Singapore population. Sleep Res Online SRO 2(1):11–14

    Google Scholar 

  5. McNicholas WT (2007) Cardiovascular outcomes of CPAP therapy in obstructive sleep apnea syndrome. Am J Physiol Regul Integr Comp Physiol 293(4):R1666–R1670

    Article  CAS  PubMed  Google Scholar 

  6. Minai OA, Ricaurte B, Kaw R, Hammel J, Mansour M, McCarthy K, Golish JA, Stoller JK (2009) Frequency and impact of pulmonary hypertension in patients with obstructive sleep apnea syndrome. Am J Cardiol 104(9):1300–1306

    Article  PubMed  Google Scholar 

  7. Bady E, Achkar A, Pascal S, Orvoen-Frija E, Laaban JP (2000) Pulmonary arterial hypertension in patients with sleep apnoea syndrome. Thorax 55(11):934–939

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Yamakawa H, Shiomi T, Sasanabe R, Hasegawa R, Ootake K, Banno K, Wakayama H, Katada M, Kobayashi T (2002) Pulmonary hypertension in patients with severe obstructive sleep apnea. Psychiatry Clin Neurosci 56(3):311–312

    Article  PubMed  Google Scholar 

  9. Podszus T, Bauer W, Mayer J, Penzel T, Peter JH, Von Wichert P (1986) Sleep apnea and pulmonary hypertension. Klin Wochenschr 64(3):131–134

    Article  CAS  PubMed  Google Scholar 

  10. Alchanatis M, Tourkohoriti G, Kakouros S, Kosmas E, Podaras S, Jordanoglou JB (2001) Daytime pulmonary hypertension in patients with obstructive sleep apnea. Respiration 68(6):566–572

    Article  CAS  PubMed  Google Scholar 

  11. Weitzenblum E, Krieger J, Apprill M, Vallée E, Ehrhart M, Ratomaharo J, Oswald M, Kurtz D (1988) Daytime pulmonary hypertension in patients with obstructive sleep apnea syndrome. Am Rev Respir Dis 138(2):345–349

    Article  CAS  PubMed  Google Scholar 

  12. Chaouat A, Weitzenblum E, Krieger J, Oswald M, Kessler R (1996) Pulmonary hemodynamics in the obstructive sleep apnea syndrome: results in 220 consecutive patients. Chest J 109(2):380–386

    Article  CAS  Google Scholar 

  13. Sanner BM, Doberauer C, Konermann M, Sturm A, Zidek W (1997) Pulmonary hypertension in patients with obstructive sleep apnea syndrome. Arch Intern Med 157(21):2483–2487

    Article  CAS  PubMed  Google Scholar 

  14. Krieger J, Sforza E, Apprill M, Lampert E, Weitzenblum E, Ratomaharo J (1989) Pulmonary hypertension, hypoxemia, and hypercapnia in obstructive sleep apnea patients. CHEST J 96(4):729–737

    Article  CAS  Google Scholar 

  15. Laks L, Lehrhaft B, Grunstein RR, Sullivan CE (1995) Pulmonary hypertension in obstructive sleep apnoea. Eur Respir J 8(4):537–541

    CAS  PubMed  Google Scholar 

  16. Sajkov D, Wang T, Saunders NA, Bune AJ, Neill AM, Mcevoy RD (1999) Daytime pulmonary hemodynamics in patients with obstructive sleep apnea without lung disease. Am J Respir Crit Care Med 159(5):1518–1526

    Article  CAS  PubMed  Google Scholar 

  17. Abou Shehata ME, El-Desoky ME, Maaty AE, Abd-ElMaksoud AM, Suliman LA (2013) Pulmonary hypertension in obstructive sleep apnea hypopnea syndrome. Egypt J Chest Dis Tuberc 62(3):459–465

    Article  Google Scholar 

  18. Arias MA, García-Río F, Alonso-Fernández A, Martínez I, Villamor J (2006) Pulmonary hypertension in obstructive sleep apnoea: effects of continuous positive airway pressure. Eur Heart J 27(9):1106–1113

    Article  PubMed  Google Scholar 

  19. Fletcher EC, Schaaf JW, Miller J, Fletcher JG (1987) Long-term cardiopulmonary sequelae in patients with sleep apnea and chronic lung disease 1–3. Am Rev Respir Dis 135(3):525–533

    CAS  PubMed  Google Scholar 

  20. Kessler R, Chaouat A, Weitzenblum E, Oswald M, Ehrhart M, Apprill M, Krieger J (1996) Pulmonary hypertension in the obstructive sleep apnoea syndrome: prevalence, causes and therapeutic consequences. Eur Respir J 9(4):787–794

    Article  CAS  PubMed  Google Scholar 

  21. Kulkas A, Tiihonen P, Julkunen P, Mervaala E, Töyräs J (2013) Novel parameters indicate significant differences in severity of obstructive sleep apnea with patients having similar apnea–hypopnea index. Med Biol Eng Comp 51(6):697–708

    Article  Google Scholar 

  22. Muraja-Murro A, Kulkas A, Hiltunen M, Kupari S, Hukkanen T, Tiihonen P, Mervaala E, Töyräs J (2013) The severity of individual obstruction events is related to increased mortality rate in severe obstructive sleep apnea. J Sleep Res 22(6):663–669

    Article  PubMed  Google Scholar 

  23. Noda A, Okada T, Yasuma F, Nakashima N, Yokota M (1995) Cardiac hypertrophy in obstructive sleep apnea syndrome. Chest 107(6):1538–1544

    Article  CAS  PubMed  Google Scholar 

  24. Zamarrón C, Valdés Cuadrado L, Álvarez-Sala R (2013) Pathophysiologic mechanisms of cardiovascular disease in obstructive sleep apnea syndrome. Pulm Med

  25. Ge X, Han F, Huang Y, Zhang Y, Yang T, Bai C, Guo X (2013) Is obstructive sleep apnea associated with cardiovascular and all-cause mortality? PLoS One 8(7):e69432

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Butt M, Dwivedi G, Shantsila A, Khair OA, Lip GY (2012) Left ventricular systolic and diastolic function in obstructive sleep apnea impact of continuous positive airway pressure therapy. Circ Heart Fail 5(2):226–233

    Article  PubMed  Google Scholar 

  27. Usui Y, Takata Y, Inoue Y, Tomiyama H, Kurohane S, Hashimura Y, Kato K, Saruhara H, Asano K, Shiina K, Yamashina A (2013) Severe obstructive sleep apnea impairs left ventricular diastolic function in non-obese men. Sleep Med 14(2):155–159

    Article  PubMed  Google Scholar 

  28. Wachter R, Lüthje L, Klemmstein D, Lüers C, Stahrenberg R, Edelmann F, Holzendorf V, Hasenfuß G, Andreas S, Pieske B (2013) Impact of obstructive sleep apnoea on diastolic function. Eur Respir J 41(2):376–383

    Article  PubMed  Google Scholar 

  29. Meier M, Andreas S (2012) Mechanisms of cardiovascular co-morbidity in patients with obstructive sleep apnoea syndrome. Pneumologie, Stuttgart, pp 650–657

  30. Murri M, García-Delgado R, Alcázar-Ramírez J, Fernández-Ramos A, Alcaide J, Cardona F, Tinahones FJ (2011) Effect of CPAP on oxidative stress and circulating progenitor cell levels in sleep patients with apnea–hypopnea syndrome. Respir Care 56(11):1830–1836

    Article  PubMed  Google Scholar 

  31. Kim SM, Cho KI, Kwon JH, Lee HG, Kim TI (2012) Impact of obstructive sleep apnea on left atrial functional and structural remodeling beyond obesity. J Cardiol 60(6):475–483

    Article  PubMed  Google Scholar 

  32. Cho KI, Kwon JH, Kim SM, Park TJ, Lee HG, Kim TI (2012) Impact of obstructive sleep apnea on the global myocardial performance beyond obesity. Echocardiography 29(9):1071–1780

    Article  PubMed  Google Scholar 

  33. Danica LP, Krotin M, Zdravkovic M, Soldatovic I, Zdravkovic D, Brajkovic M, Gardijan V, Saric J, Pokrajac R, Lovic D, Stevanovic P (2014) Early left ventricular systolic and diastolic dysfunction in patients with newly diagnosed obstructive sleep apnoea and normal left ventricular ejection fraction. Sci World J. doi:10.1155/2014/898746

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia

    H. T. Wong & A. W. Chong

  2. Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia

    K. H. Chee

Authors
  1. H. T. Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. H. Chee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. W. Chong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. T. Wong.

Ethics declarations

Funding

The research is carried out under the post-graduate research Grant (PPP) Grant with project number of PO068-2014B.

Conflict of interest

There is no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wong, H.T., Chee, K.H. & Chong, A.W. Pulmonary hypertension and echocardiogram parameters in obstructive sleep apnea. Eur Arch Otorhinolaryngol 274, 2601–2606 (2017). https://doi.org/10.1007/s00405-017-4491-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-017-4491-1

Keywords

Search

Navigation