TY - JOUR
T1 - OSA and pulmonary hypertension
T2 - Time for a new look
AU - Ismail, Khalid
AU - Roberts, Kari
AU - Manning, Patrick
AU - Manley, Christopher
AU - Hill, Nicholas S.
N1 - Publisher Copyright:
© 2015 American College of Chest Physicians.
PY - 2015/3/1
Y1 - 2015/3/1
N2 - OSA is a common yet underdiagnosed disorder encountered in everyday practice. The disease is a unique physiologic stressor that contributes to the development or progression of many other disorders, particularly cardiovascular conditions. The pulmonary circulation is specifically affected by the intermittent hypoxic apneas associated with OSA. The general consensus has been that OSA is associated with pulmonary hypertension (PH), but only in a minority of OSA patients and generally of a mild degree. Consequently, there has been no sense of urgency to screen for either condition when evaluating the other. In this review, we explore available evidence describing the interaction between OSA and PH and seek to better understand underlying pathophysiology. We describe certain groups of patients who have a particular preponderance of OSA and PH. Failure to recognize the mutual additive effects of these disorders can lead to suboptimal patient outcomes. Among patients with PH and OSA, CPAP, the mainstay treatment for OSA, may ameliorate pulmonary pressure elevations, but has not been studied adequately. Conversely, among patients with OSA, PH significantly limits functional capacity and potentially shortens survival; yet, there is no routine screening for PH in patients with OSA. We think it is time to study the interaction between OSA and PH more carefully to identify high-risk subgroups. These would be screened for the presence of combined disorders, facilitating earlier institution of therapy and improving outcomes.
AB - OSA is a common yet underdiagnosed disorder encountered in everyday practice. The disease is a unique physiologic stressor that contributes to the development or progression of many other disorders, particularly cardiovascular conditions. The pulmonary circulation is specifically affected by the intermittent hypoxic apneas associated with OSA. The general consensus has been that OSA is associated with pulmonary hypertension (PH), but only in a minority of OSA patients and generally of a mild degree. Consequently, there has been no sense of urgency to screen for either condition when evaluating the other. In this review, we explore available evidence describing the interaction between OSA and PH and seek to better understand underlying pathophysiology. We describe certain groups of patients who have a particular preponderance of OSA and PH. Failure to recognize the mutual additive effects of these disorders can lead to suboptimal patient outcomes. Among patients with PH and OSA, CPAP, the mainstay treatment for OSA, may ameliorate pulmonary pressure elevations, but has not been studied adequately. Conversely, among patients with OSA, PH significantly limits functional capacity and potentially shortens survival; yet, there is no routine screening for PH in patients with OSA. We think it is time to study the interaction between OSA and PH more carefully to identify high-risk subgroups. These would be screened for the presence of combined disorders, facilitating earlier institution of therapy and improving outcomes.
KW - Comorbidity
KW - Continuous Positive Airway Pressure
KW - Humans
KW - Hypertension, Pulmonary/epidemiology
KW - Kaplan-Meier Estimate
KW - Mass Screening
KW - Prevalence
KW - Sleep Apnea, Obstructive/epidemiology
KW - Treatment Outcome
UR - http://www.scopus.com/inward/record.url?scp=84924873385&partnerID=8YFLogxK
U2 - 10.1378/chest.14-0614
DO - 10.1378/chest.14-0614
M3 - Article
C2 - 25732450
AN - SCOPUS:84924873385
SN - 0012-3692
VL - 147
SP - 847
EP - 861
JO - Chest
JF - Chest
IS - 3
ER -