Pulmonary hypertension and obstructive sleep apnoea syndrome

Authors: Genzor S. 1;  Sova M. 1;  Kolek V. 1;  Hutyra M. 2
Authors‘ workplace: Klinika plicních nemocí a tuberkulózy LF UP a FN Olomouc 1;  I. interní klinika –  kardiologická LF UP a FN Olomouc 2
Published in: Kardiol Rev Int Med 2019, 21(3): 121-124


Obstructive sleep apnoea syndrome (OSAS) is commonly associated with development of pulmonary hypertension (PH). PH is frequently connected with higher cardiovascular morbidity and mortality. In this review, we summarize the main pathophysiological mechanisms leading to higher incidence of PH in OSAS patients, the clinical consequences of the relationship between OSAS and PH, and recommendations for clinical practice. The therapy of OSAS patients has to be complex and it is necessary to include PH diagnostics in diagnostic algorithms for these patients. In cases of clinically significant PH uncontrollable by OSAS therapy, PH-specific therapy is recommended.


sleep apnoea – pulmonary hypertension – positive airway pressure ther­apy


1. Simon­neau G, Montani D, Celermajer DS et al. Haemodynamic definitions and updat­ed clinical clas­sification of pulmonary hypertension. Eur Respir J 2019; 53(1): pii: 1801913. doi: 10.1183/  13993003.01913-2018.

2. Simon­neau G, Gatzoulis MA, Adatia I et al. Updat­ed clinical clas­sification of pulmonary hypertension. J Am Coll Cardiol 2013; 62 (25 Suppl): D34– D41. doi: 10.1016/ j.jacc.2013.10.029.

3. Seeger W, Adir Y, Barbera JA et al. Pulmonary hypertension in chronic lung dis­eases. J Am Coll Cardiol 62 (25 Suppl): D109– D116. doi: 10.1016/ j.jacc.2013.10.036.

4. Chaouat A, Weitzenblum E, Krieger J et al. Pulmonary hemodynamics in the obstructive sleep apnea syndrome. Results in 220 consecutive patients. Chest 1996; 109(2): 380–386. doi: 10.1378/chest.109.2.380.

5. Bady E, Achkar A, Pascal S et al. Pulmonary arterial hypertension in patients with sleep apnoea syndrome. Thorax 2000; 55(11): 934–939. doi: 10.1136/thorax.55.11.934.

6. Sajkov D, Wang T, Saunders NA et al. Daytime pulmonary hemodynamics in patients with obstructive sleep apnea without lung disease. Am J Respir Crit Care Med 1999; 159(5 Pt 1): 1518–1526. doi: 10.1164/ajrccm.159.5.9805086.

7. Hetzel M, Kochs M, Marx N et al. Pulmonary hemodynamics in obstructive sleep apnea: frequency and causes of pulmonary hypertension. Lung 2003; 181(3): 157–166.

8. Dumitrascu R, Tiede H, Eckermann J et al. Sleep apnea in precapillary pulmonary hypertension. Sleep Med 2013; 14(3): 247–251. doi: 10.1016/j.sleep.2012.11.013.

9. Minai OA, Ricaurte B, Kaw R et al. Frequency and impact of pulmonary hypertension in patients with obstructive sleep apnea syndrome. Am J Cardiol 2009; 104(9): 1300–1306. doi: 10.1016/j.amjcard.2009.06.048.

10. Naeije R. Physiology of the pulmonary circulation and the right heart. Curr Hypertens Rep 2013; 15(6): 623–631. doi: 10.1007/s11906-013-0396-6.

11. Bergofsky EH, Haas F, Porcelli R. Determination of the sensitive vascular sites from which hypoxia and hypercapnia elicit rises in pulmonary arterial pres­sure. Fed Proc 1968; 27(6): 1420–1425.

12. Wu W, Platoshyn O, Firth AL et al. Hypoxia divergently regulates production of reactive oxygen species in human pulmonary and coronary artery smooth muscle cells. Am J Physiol Lung Cell Mol Physiol 2007; 293(4): L952–L959.

13. Kholdani C, Fares WH, Mohsenin V. Pulmonary hypertension in obstructive sleep apnea: is it clinically significant? A critical analysis of the association and pathophysiology. Pulm Circ 2015; 5(2): 220–227. doi: 10.1086/679995.

14. International Classification of Sleep Disorders. 3rd Ed. Darien, IL USA: American Academy of Sleep Medicine 2014. Available at: https://aasm.org/.

15. Nisbet RE, Graves AS, Kleinhenz DJ et al. The role of NADPH oxidase in chronic intermittent hypoxiainduced pulmonary hypertension in mice. Am J Resp Cell Mol Biol 2009; 40(5): 601–609. doi: 10.1165/2008-0145OC.

16. Mohsenin V, Urbano F. Circulating antiangiogenic proteins in obstructive sleep apnea and hypertension. Respir Med 2011; 105(5): 801–807. doi: 10.1016/j.rmed.2011.01.001

17. Vatansever E, Surmen-Gur E, Ursavas A et al. Obstructive sleep apnea causes oxidative damage to plasma lipids and proteins and decreases adiponectin levels. Sleep Breath 2011; 15(3): 275–282. doi: 10.1007/s11325-010-0378-8.

18. Launay JM, Herve P, Peoch K et al. Function of the serotonin 5-hydroxytryptamine 2B receptor in pulmonary hypertension. Nat Med 2002; 8(10): 1129–1135. doi: 10.1038/nm764.

19. Takemoto M, Sun J, Hiroki J et al. Rho-kinase mediates hypoxia-induced downregulation of endothelial nitric oxide synthase. Circulation 2002; 106(1): 57–62. doi: 10.1161/01.cir.0000020682.73694.ab.

20. Janda S, Shahidi N, Gin K et al. Diagnostic accuracy of echocardiography for pulmonary hypertension: a systematic review and metaanalysis. Heart 2011; 97(8): 612–622. doi: 10.1136/hrt.2010.212084.

21. Trip P, Nossent EJ, de Man FS et al. Severely reduced diffusion capacity in idiopathic pulmonary arterial hypertension: patient characteristics and treatment responses. Eur Respir J 2013; 42(6): 1575–1585. doi: 10.1183/09031936.00184412.

22. Alchanatis M, Tourkohoriti G, Kakouros S et al. Daytime pulmonary hypertension in patients with obstructive sleep apnea: the effect of continuous positive airway pressure on pulmonary hemodynamics. Respiration 2001; 68(6): 566–572. doi: 10.1159/000050574.

23. Sajkov D, Wang T, Saunders NA et al. Continuous positive airway pressure treatment improves pulmonary hemodynamics in patients with obstructive sleep apnea. Am J Respir Crit Care Med 2002; 165(2): 152–158. doi: 10.1164/ajrccm.165.2.2010092.

24. Arias MA, García-Río F, Alonso-Fernández A et al. Pulmonary hypertension in obstructive sleep apnoea: effects of continuous positive airway pres­sure: a randomized, controlled cross-over study. Eur Heart J 2006; 27(9): 1106–1113. doi: 10.1093/eurheartj/ehi807.

25. Camacho M, Nesbitt NB, Lambert E et al. Laser-assisted uvulopalatoplasty for obstructive sleep apnea: a systematic review and meta-analysis. Sleep 2017; 40(3). doi: 10.1093/sleep/zsx004.

26. Zohar Y, Talmi YP, Frenkel H et al. Cardiac function in obstructive sleep apnea patients fol­lowing uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 1992; 107(3): 390–394. doi: 10.1177/019459989210700308.

27. Ugur MB, Dogan SM, Sogut A et al. Effect of adenoidectomy and/or tonsillectomy on cardiac functions in children with obstructive sleep apnea. ORL J Otorhinolaryngol Relat Spec 2008; 70(3): 202–208. doi: 10.1159/000124295.

28. Leggio M, Fusco A, Limongelli G et al. Exercise training in patients with pulmonary and systemic hypertension: a unique therapy for two different diseases. Eur J Intern Med 2018; 47: 17–24. doi: 10.1016/j.ejim.2017.09.010.

29. Cambon D, Leclercq F. Clinical and echographic characteristics of patients exposed to fenfluramin or its derivatives: Results of a prospective, single-centre, observational study. Arch Cardiovasc Dis 2015; 108(3): 172–180. doi: 10.1016/j.acvd.2014.10.006.

30. Hanipah, ZN, Mulcahy MJ, Sharma G et al. Bariatric surgery in patients with pulmonary hypertension. Surgery Obes Relat Dis 2018; 14(10): 1581–1586. doi: 10.1016/j.soard.2018.07.015.

Paediatric cardiology Internal medicine Cardiac surgery Cardiology
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