Sleep-Related Hypoxia, Right Ventricular Dysfunction, and Survival in Patients With Group 1 Pulmonary Arterial Hypertension
Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved..
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).
| Errataetall: |
CommentIn: J Am Coll Cardiol. 2023 Nov 21;82(21):2006-2008. - PMID 37968018 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:82 |
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| Enthalten in: |
Journal of the American College of Cardiology - 82(2023), 21 vom: 21. Nov., Seite 1989-2005 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Lowery, Megan M [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 20.02.2024 Date Revised 06.03.2024 published: Print ClinicalTrials.gov: NCT02980887 CommentIn: J Am Coll Cardiol. 2023 Nov 21;82(21):2006-2008. - PMID 37968018 Citation Status MEDLINE |
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| doi: |
10.1016/j.jacc.2023.09.806 |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM364596023 |
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| 100 | 1 | |a Lowery, Megan M |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Sleep-Related Hypoxia, Right Ventricular Dysfunction, and Survival in Patients With Group 1 Pulmonary Arterial Hypertension |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Completed 20.02.2024 | ||
| 500 | |a Date Revised 06.03.2024 | ||
| 500 | |a published: Print | ||
| 500 | |a ClinicalTrials.gov: NCT02980887 | ||
| 500 | |a CommentIn: J Am Coll Cardiol. 2023 Nov 21;82(21):2006-2008. - PMID 37968018 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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) | ||
| 650 | 4 | |a Clinical Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a connective tissue disease–associated pulmonary arterial hypertension | |
| 650 | 4 | |a obstructive sleep apnea | |
| 650 | 4 | |a pulmonary arterial hypertension | |
| 650 | 4 | |a pulmonary hypertension | |
| 650 | 4 | |a right ventricular dysfunction | |
| 650 | 4 | |a sleep-related hypoxia | |
| 650 | 7 | |a Oxygen |2 NLM | |
| 650 | 7 | |a S88TT14065 |2 NLM | |
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| 700 | 1 | |a Rosenzweig, Erika B |e verfasserin |4 aut | |
| 700 | 1 | |a Bhat, Aparna |e verfasserin |4 aut | |
| 700 | 1 | |a Erzurum, Serpil |e verfasserin |4 aut | |
| 700 | 1 | |a Finet, J Emanuel |e verfasserin |4 aut | |
| 700 | 1 | |a Jellis, Christine L |e verfasserin |4 aut | |
| 700 | 1 | |a Kaur, Sunjeet |e verfasserin |4 aut | |
| 700 | 1 | |a Kwon, Deborah H |e verfasserin |4 aut | |
| 700 | 1 | |a Nawabit, Rawan |e verfasserin |4 aut | |
| 700 | 1 | |a Radeva, Milena |e verfasserin |4 aut | |
| 700 | 1 | |a Beck, Gerald J |e verfasserin |4 aut | |
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| 700 | 1 | |a Rischard, Franz P |e verfasserin |4 aut | |
| 700 | 1 | |a Mehra, Reena |e verfasserin |4 aut | |
| 700 | 0 | |a Pulmonary Vascular Disease Phenomics (PVDOMICS) Study Group |e verfasserin |4 aut | |
| 700 | 1 | |a Hill, N |e investigator |4 oth | |
| 700 | 1 | |a Xiao, L |e investigator |4 oth | |
| 700 | 1 | |a Fu, Y-P |e investigator |4 oth | |
| 700 | 1 | |a Postow, L |e investigator |4 oth | |
| 700 | 1 | |a Schmetter, B |e investigator |4 oth | |
| 700 | 1 | |a Stanton, K |e investigator |4 oth | |
| 700 | 1 | |a Tian, X |e investigator |4 oth | |
| 700 | 1 | |a Gray, M |e investigator |4 oth | |
| 700 | 1 | |a Wong, B |e investigator |4 oth | |
| 700 | 1 | |a Leopold, J |e investigator |4 oth | |
| 700 | 1 | |a Waxman, A |e investigator |4 oth | |
| 700 | 1 | |a DiCarli, M |e investigator |4 oth | |
| 700 | 1 | |a Lawler, L |e investigator |4 oth | |
| 700 | 1 | |a Maron, B |e investigator |4 oth | |
| 700 | 1 | |a Segrera, S |e investigator |4 oth | |
| 700 | 1 | |a Systrom, D |e investigator |4 oth | |
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| 700 | 1 | |a Rosenzweig, E B |e investigator |4 oth | |
| 700 | 1 | |a Arcasoy, S |e investigator |4 oth | |
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