Megan M. Lowery, Nicholas S. Hill, Lu Wang, Erika B. Rosenzweig, Aparna Bhat, Serpil Erzurum, J. Emanuel Finet, Christine L. Jellis, Sunjeet Kaur, Deborah H. Kwon, Rawan Nawabit, Milena Radeva, Gerald J. Beck, Robert P. Frantz, Paul M. Hassoun, Anna Hemnes, Evelyn M. Horn, Jane A. Leopold, Franz P. Rischard, Reena Mehra, Pulmonary Vascular Disease Phenomics Study (PVDOMICS) Group
University of Florida. Tufts Medical Center. Cleveland Clinic. Columbia University Irving Medical Center and NewYork-Presbyterian Hospital. Mayo Clinic. Johns Hopkins University. Vanderbilt University Medical Center. Weill Cornell Medicine. Brigham and Women’s Hospital and Harvard Medical School. University of Arizona.
United States
Journal of the American College of Cardiology
J Am Coll Cardiol 2023; 82: 1989-2005
DOI: 10.1016/j.jacc.2023.09.806
Abstract
Background: Group 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.
Objectives: The 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.
Methods: Pulmonary 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.
Results: Analysis 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.
Conclusions: Sleep-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).
Category
Class III. Pulmonary Hypertension Associated with Airway Disease, Apnea or Hypoventilation
Class III. Pulmonary Hypertension Associated with Alveolar Hypoxia
Right Heart Dysfunction Associated with Pulmonary Vascular Disease
Age Focus: Adult Pulmonary Vascular Disease
Fresh or Filed Publication: Filed (PHiled). Greater than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: No