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HIGH OCCURRENCE OF HYPOXEMIC SLEEP RESPIRATORY DISORDERS IN PRECAPILLARY PULMONARY HYPERTENSION AND MECHANISMS.
MedLine Citation:
PMID:  22878784     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
ABSTRACT BACKGROUND The occurrence and mechanisms of nocturnal hypoxemia (NH) in precapillary pulmonary hypertension (PH) are not clearly defined. METHODS: In an observational prospective and transversal design, we studied 46 clinically stable PH patients with BMI < 35 kg/m2, FEV1 > 60% of predicted and diagnosis of idiopathic pulmonary arterial hypertension (IPAH, n=29) or chronic thrombo-embolic PH (CTEPH, n=17). They underwent nocturnal polysomnography with transcutaneous capnography. RESULTS: Most patients were in NYHA functional class II (69.6%). Mean pulmonary arterial pressure was 44 ± 13 mmHg and cardiac index 3.2 ± 0.6 L/min/m2. The time spent below a saturation of 90% (D90%) was 48.9 ± 35.9% of sleep time and 38 out of 46 (82.6%) patients had NH. Mean apnea hypopnea index (AHI) was 24.9 ± 22.1/ hour and 41 patients (89%) had sleep apnea. The major mechanism of NH was a ventilation/perfusion mismatch alone or associated with obstructive apneic events. Multivariate logistic regression identified both FEV25-75 (odds ratio, 0.9519; 95% CI, 0.9089 to 0.9968; P = 0,036) and mean pulmonary arterial pressure (odds ratio, 1.1068; 95% CI, 1.0062 to 1.2175; P = 0,037) as significant predictors of NH. Clinical symptoms were not predictive of NH. CONCLUSIONS: The occurrence of NH is high in PH and should be systematically screened for. Further studies are needed to determine the impact of NH on the outcome of patients with PH.ClinicalTrials.gov Identifier: NCT013716691-Université Paris-Sud, Faculté de médecine, Le Kremlin-Bicêtre, F-94276, France;2-AP-HP, Unité de Médecine du Sommeil, Hôpital Antoine Béclère, Clamart, F-92140, France;3-AP-HP, Service de Pneumologie et Réanimation Respiratoire, Hôpital Antoine Béclère, Clamart, F-92140, France;4-INSERM U999, Hypertension Artérielle Pulmonaire: Physiopathologie et Innovation Thérapeutique, Le Plessis-Robinson, F-92350, France;5-Université Paris-Sud, EA3544, Faculté de Pharmacie, Châtenay-Malabry, F-92290, France;Corresponding author and reprint requests: Gabriel Roisman, MD, PhD, Unité de Médecine du Sommeil, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92140 Clamart, France, Email: gabriel.roisman@abc.aphp.fr.
Authors:
Fadia Nicolas Jilwan; Pierre Escourrou; Gilles Garcia; Xavier Jaïs; Marc Humbert; Gabriel Roisman
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-1
Journal Detail:
Title:  Chest     Volume:  -     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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