Skip to main content
SpringerLink
Log in

Pulmonary Hemodynamics in Obstructive Sleep Apnea: Frequency and Causes of Pulmonary Hypertension

  • Published:
Lung Aims and scope Submit manuscript

Abstract

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.

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

Figure 1
Figure 2

Similar content being viewed by others

References

  1. MR Bonsignore O Marrone G Insalaco et al. (1994) ArticleTitleThe cardiovascular effects of obstructive sleep apnoeas: analysis of pathogenic mechanisms. Eur Respir J 7 IssueID4 786–805 Occurrence Handle1:STN:280:ByuB2szosVU%3D Occurrence Handle8005263

    CAS  PubMed  Google Scholar 

  2. E Weitzenblum J Krieger M Apprill et al. (1988) ArticleTitleDaytime pulmonary hypertension in patients with obstructive sleep apnea syndrome. Am Rev Respir Dis 138 IssueID2 345–349 Occurrence Handle1:STN:280:BiaD28%2FntVE%3D Occurrence Handle3143285

    CAS  PubMed  Google Scholar 

  3. L Laks B Lehrhaft RR Grunstein et al. (1995) ArticleTitlePulmonary hypertension in obstructive sleep apnoea. Eur Respir J 8 IssueID4 537–541 Occurrence Handle1:STN:280:ByqA1MvhtFU%3D Occurrence Handle7664850

    CAS  PubMed  Google Scholar 

  4. AG Tilkian C Guilleminault JS Schroeder et al. (1976) ArticleTitleHemodynamics in sleep apnea and pulmonary hypertension. Studies during wakefulness and sleep. Ann Intern Med 85 IssueID6 714–719 Occurrence Handle1:STN:280:CSiD28vgt1Q%3D Occurrence Handle999107

    CAS  PubMed  Google Scholar 

  5. TD Bradley R Rutherford RF Grossman et al. (1985) ArticleTitleRole of daytime hypoxemia in the pathogenesis of right heart failure in the obstructive sleep apnea syndrome. Am Rev Respir Dis 131 IssueID6 835–539 Occurrence Handle1:STN:280:BiqB38zktFY%3D Occurrence Handle4003933

    CAS  PubMed  Google Scholar 

  6. T Podszus W Bauer J Mayer et al. (1986) ArticleTitleSleep apnea and pulmonary hypertension. Klin Wochenschr 64 IssueID3 131–134 Occurrence Handle1:STN:280:BimC2critFw%3D Occurrence Handle3951169

    CAS  PubMed  Google Scholar 

  7. J Krieger E Sforza M Apprill et al. (1989) ArticleTitlePulmonary hypertension, hypoxemia, and hypercapnia in obstructive sleep apnea patients. Chest 96 IssueID4 729–737 Occurrence Handle1:STN:280:By%2BD3cvltFU%3D Occurrence Handle2791665

    CAS  PubMed  Google Scholar 

  8. D Sajkov RJ Cowie AT Thornton et al. (1994) ArticleTitlePulmonary hypertension and hypoxemia in obstructive sleep apnea syndrome. Am J Respir Crit Care Med 149 IssueID2 416–422 Occurrence Handle1:STN:280:ByuC3sfmtVA%3D Occurrence Handle8306039

    CAS  PubMed  Google Scholar 

  9. A Chaouat E Weitzenblum J Krieger et al. (1996) ArticleTitlePulmonary hemodynamics in the obstructive sleep apnea syndrome. Results in 220 consecutive patients. Chest 109 IssueID2 380–386 Occurrence Handle1:STN:280:BymC1cjmsFM%3D Occurrence Handle8620709

    CAS  PubMed  Google Scholar 

  10. A Rechtschaffen A Kales (Eds) (1968) A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. National Institutes of Health Bethesda

    Google Scholar 

  11. DP White (1994) Central sleep apnea. MH Kryger T Roth WC Dement (Eds) Principles and practice of sleep medicine. Saunders Company Philadelphia, London, Toronto, Montreal, Sydney, Tokyo 630

    Google Scholar 

  12. BE Marshall MQ Wyche Jr. (1972) ArticleTitleHypoxemia during and after anesthesia. Anesthesiology 37 IssueID2 178–209 Occurrence Handle1:STN:280:CS2B2MjmsVQ%3D Occurrence Handle4559455

    CAS  PubMed  Google Scholar 

  13. W Grossman E Braunwald (1992) Pulmonary hypertension. E Braunwald (Eds) Heart disease. Textbook of cardiovascular medicine. Saunders Philadelphia, London, Toronto, Montreal, Sydney, Tokyo 790

    Google Scholar 

  14. BM Sanner C Doberauer M Konermann et al. (1997) ArticleTitlePulmonary hypertension in patients with obstructive sleep apnea syndrome. Arch Intern Med 157 2483–2487 Occurrence Handle10.1001/archinte.157.21.2483 Occurrence Handle1:STN:280:DyaK1c%2Fks1altQ%3D%3D Occurrence Handle9385300

    Article  CAS  PubMed  Google Scholar 

  15. EC Fletcher JW Schaaf J Miller et al. (1987) ArticleTitleLong-term cardiopulmonary sequelae in patients with sleep apnea and chronic lung disease. Am Rev Respir Dis 135 IssueID3 525–533 Occurrence Handle1:STN:280:BiiC2MvmvF0%3D Occurrence Handle3826878

    CAS  PubMed  Google Scholar 

  16. J Hedner H Ejnell K Caidahl (1990) ArticleTitleLeft ventricular hypertrophy independent of hypertension in obstructive sleep apnea. J Hypertens 8 941–946 Occurrence Handle1:STN:280:By6D2s3pvFA%3D Occurrence Handle2174947

    CAS  PubMed  Google Scholar 

  17. PE Peppard T Young M Palta et al. (2000) ArticleTitleProspective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342 1378–1384 Occurrence Handle10.1056/NEJM200005113421901 Occurrence Handle1:STN:280:DC%2BD3c3kvVyhuw%3D%3D Occurrence Handle10805822

    Article  CAS  PubMed  Google Scholar 

  18. JT Carlson J Hedner M Elam et al. (1993) ArticleTitleAugmented resting sympathetic activity in awake patients with obstructive sleep apnea. Chest 103 1763–1768 Occurrence Handle1:STN:280:ByuD3cfgt1M%3D Occurrence Handle8404098

    CAS  PubMed  Google Scholar 

  19. JA Hedner I Wilcox L Laks et al. (1992) ArticleTitleA specific and potent pressor effect of hypoxia in patients with sleep apnea. Am Rev Respir Dis 146 IssueID5 1240–1245 Occurrence Handle1:STN:280:ByyD2szitlw%3D Occurrence Handle1443878

    CAS  PubMed  Google Scholar 

  20. BJ Morgan DC Crabtree M Palta et al. (1995) ArticleTitleCombined hypoxia and hypercapnia evokes long-lasting sympathetic activation in humans. J Appl Physiol 79 IssueID1 205–213 Occurrence Handle1:STN:280:BymD3srkvF0%3D Occurrence Handle7559221

    CAS  PubMed  Google Scholar 

  21. R Kessler A Chaouat E Weitzenblum et al. (1996) ArticleTitlePulmonary hypertension in the obstructive sleep apnea syndrome: prevalence, causes and therapeutic options. Eur Respir J 9 787–794 Occurrence Handle10.1183/09031936.96.09040787 Occurrence Handle1:STN:280:BymA38nos1Y%3D Occurrence Handle8726947

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We are grateful to Helga von Beauvais, Irmgard Eck, and Anna Fink for expert technical assistance.

Author information

Authors and Affiliations

  1. Department of Internal Medicine II, University Hospital, Ulm University, Germany

    M. Hetzel, M. Kochs, N. Marx, H. Woehrle, I. Mobarak, V. Hombach & J. Hetzel

Authors
  1. M. Hetzel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Kochs
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N. Marx
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Woehrle
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. I. Mobarak
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. V. Hombach
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. Hetzel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Hetzel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hetzel, M., Kochs, M., Marx, N. et al. Pulmonary Hemodynamics in Obstructive Sleep Apnea: Frequency and Causes of Pulmonary Hypertension . Lung 181, 157–166 (2003). https://doi.org/10.1007/s00408-003-1017-y

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00408-003-1017-y

Keywords

Search

Navigation