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European Heart Journal Advance Access published online on February 23, 2006
European Heart Journal, doi:10.1093/eurheartj/ehi807
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European Heart Journal © The European Society of Cardiology 2006; all rights reserved
Received June 23, 2005
Revised January 10, 2006
Accepted February 3, 2006

Clinical research

Pulmonary hypertension in obstructive sleep apnoea: effects of continuous positive airway pressure A randomized, controlled cross-over study

Miguel A. Arias 1, Francisco García-Río 2 *, Alberto Alonso-Fernández 2, Isabel Martínez 3, and José Villamor 2

1 Servicios de Cardiología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain
2 Neumología, Hospital Universitario La Paz, Universidad Autónoma de Madrid, c/Alfredo Marqueríe 11, izqda-1°A, 28034 Madrid, Spain
3 Laboratorio de Bioquímica, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain

* To whom correspondence should be addressed.
Francisco García-Río, E-mail: fgr01m{at}jazzfree.com


  Abstract

Aims We tested the hypothesis that: (i) obstructive sleep apnoea (OSA) by itself originates pulmonary hypertension (PH); and (ii) the application of continuous positive airway pressure (CPAP) can reduce pulmonary pressure.

Methods and results In this randomized and cross-over trial, 23 middle-aged OSA (apnoea-hypopnoea index, 44.1 ± 29.3 h - 1) and otherwise healthy patients and 10 control subjects were included. OSA patients randomly received either sham or effective CPAP for 12 weeks. Echocardiographic parameters, blood pressure recordings, and urinary catecholamine levels were obtained at baseline and after both treatment modalities. At baseline, OSA patients had higher pulmonary artery systolic pressure than control subjects (29.8 ± 8.8 vs. 23.4 ± 4.1 mmHg, respectively, P = 0.036). Ten out of 23 patients [43%, (95% CI: 23-64%)] and none of the control subjects had PH at baseline (P = 0.012). Two patients were removed from the study because of inadequate CPAP compliance. Effective CPAP induced a significant reduction in the values for pulmonary systolic pressure (from 28.9 ± 8.6 to 24.0 ± 5.8 mmHg, P < 0.0001). The reduction was greatest in patients with either PH or left ventricular diastolic dysfunction at baseline.

Conclusion Severe OSA is independently associated with PH in direct relationship with disease severity and presence of diastolic dysfunction. Application of CPAP reduces pulmonary systolic pressure levels.

Keywords: Obstructive sleep apnoea; Pulmonary hypertension; Continuous positive airway pressure.
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