Sleep-Disordered Breathing in Adults with Precapillary Pulmonary Hypertension: Prevalence and Predictors of Nocturnal Hypoxemia

• Published in: Lung Vol. 200; no. 4; pp. 523 - 530
• Main Authors: Murta, Marcia S., Duarte, Ricardo L. M., Waetge, Daniel, Gozal, David, Cardoso, Alexandre P., Mello, Fernanda C. Q.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.08.2022; Springer; Springer Nature B.V
• Subjects: Adults; Analysis; Apnea; Breathing; Dependent variables; Desaturation; Diagnosis; Evaluation; Goodness of fit; Hemodynamics; Hypertension; Hypoxemia; Hypoxia; Medicine; Medicine & Public Health; Oxygen content; Parameters; Pneumology/Respiratory System; Pulmonary arteries; Pulmonary artery; Pulmonary hypertension; Regression analysis; Regression coefficients; Regression models; Respiration; Sleep; Sleep apnea; Sleep apnea syndromes; Sleep Disordered Breathing and Pulmonary Hypertension; Sleep disorders; Thromboembolism; Brazil; Polysomnography; Nocturnal hypoxemia; Sleep-disordered breathing; Pulmonary hypertension
• ISSN: 0341-2040; 1432-1750
• DOI: 10.1007/s00408-022-00547-w

Purpose To evaluate the frequency of sleep-disordered breathing (SDB) and predictors of the presence of nocturnal desaturation in adults with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. Methods Outpatients with a hemodynamic diagnosis of precapillary pulmonary hypertension who underwent portable polysomnography were evaluated. Diagnosis and severity of SDB were assessed using three well-established respiratory disturbance index (RDI) thresholds: 5.0/h, 15.0/h, and 30.0/h, while nocturnal hypoxemia was defined by the average oxygen saturation (SpO 2 ) < 90%. Multiple linear regression analysis evaluated the potential relationships among explanatory variables with the dependent variable (average SpO 2 values), with comparisons based on the standardized regression coefficient ( β ). The R -squared ( R 2 ; coefficient of determination) was used to evaluate the goodness-of-fit measure for the linear regression model. Results Thirty-six adults were evaluated (69.4% females). The majority of the participants (75.0%) had SDB (26 with obstructive sleep apnea [OSA] and one with central sleep apnea [CSA]); while 50% of them had nocturnal hypoxemia. In the linear regression model ( R 2  = 0.391), the mean pulmonary artery pressure [mPAP] ( β − 0.668; p  = 0.030) emerged as the only independent parameter of the average SpO 2 . Conclusion Our study found that the majority of the participants had some type of SDB with a marked predominance of OSA over CSA, while half of them had nocturnal desaturation. Neither clinical and hemodynamic parameters nor the RDI was a predictor of nocturnal desaturation, except for mPAP measured during a right heart catheterization, which emerged as the only independent and significant predictor of average SpO 2 .