Pulmonary Hypertension and Sleep Apnea

The rare and severe lung disease called pulmonary hypertension (PH) affects the pulmonary arteries, causing high blood pressure. The pulmonary arteries transport the blood from the right heart ventricle to the lungs, but when affected by the disease, they become narrowed and thickened. The hearts of patients with pulmonary hypertension need to work harder to properly pump the blood, which make them enlarged, weakened, and more susceptible to complications that could include right heart failure.

The diagnosis, management, and prognosis of pulmonary hypertension are closely related to the causes of the disease but they are not completely understood. It can develop as consequence of alterations in the cells that line the pulmonary arteries with or without a known reason or as result of another condition.

Sleep apnea, a potentially severe sleep disease that makes patients stop breathing repeatedly for short periods of time while sleeping, is among the most common diseases that cause pulmonary hypertension.

Development and Diagnosis Of Pulmonary Hypertension and Sleep Apnea

Sleep apnea is known to contribute to the development of cardiovascular disease and pulmonary hypertension. It happens because the disease increases the risk of hypertension, pulmonary vascular disease, ischemic heart disease, stroke, congestive heart failure and arrhythmias. A study, “Obstructive sleep apnea and pulmonary hypertension,” concluded that the increase in pulmonary artery pressure is related to repetitive nocturnal arterial oxygen desaturation and hypercapnia, in addition to large intrathoracic negative pressure swings.

Because the disease causes the effects repeatedly, it results in pulmonary vascular remodeling, sustained pulmonary hypertension and right ventricular hypertrophy, as demonstrated in rodent tests. Both conditions share a series of risk factors that include age, gender, obesity, diabetes and hypertension. However, the American College of Chest Physicians (ACCP) does not consider screening for pulmonary hypertension needed for patients with sleep apnea – unless there are suspicions, which can delay diagnosis and treatment, as well as accelerate the development of more severe consequences.

Prognosis and Treatment Of Pulmonary Hypertension and Sleep Apnea

Between 17%  and 53% of patients who suffer from sleep apnea also develop pulmonary hypertension, according to a 2004 American College of Chest Physicians consensus panel. The presence of both conditions makes the patient more susceptible to heart failure, stroke or sudden death. When diagnosed properly and early, treatments can be applied to help reduce the symptoms and the risk of death.

The study “Obstructive Sleep Apnea, Cardiovascular Disease, and Pulmonary Hypertension,” suggests that continuous positive airway pressure (CPAP) is effective in the treatment of patients to significantly improve cardiac function, sympathetic activity and quality of life. The treatment can help reduce pulmonary artery pressure, increase left ventricular function and functional capacity, and decrease norepinephrine levels.