Predictors of nocturnal oxygen desaturation in pulmonary arterial hypertension

Omar A. Minai, Chirag M. Pandya, Joseph A. Golish, Jaime F. Avecillas, Kevin McCarthy, Scott Marlow, Alejandro C. Arroliga

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Background: Sleep may be associated with significant respiratory compromise in patients with lung disease and can result in hypoxia. In patients with pulmonary arterial hypertension (PAH), nocturnal desaturation may not be reflected in daytime evaluations of oxygenation and can lead to worsening pulmonary hemodynamics. The study was conducted to determine the prevalence and significance of nocturnal oxygen desaturation in patients with PAH. Methods: A cross-sectional study conducted at the Cleveland Clinic. Patients were followed up at our institution except for the overnight oximetry study done at home. Data regarding degree of nocturnal desaturation, demographics, hemodynamics, pulmonary function, and functional capacity were collected. Results: Forty-three patients (mean age, 47.9 ± 13.5 years [± SD]; 36 women and 7 men) underwent nocturnal oximetry. The etiology of PAH included idiopathic PAH (88%) and PAH associated with connective tissue diseases (12%). The majority of patients were New York Heart Association functional class II (42%) or III (53%). Thirty patients (69.7%) spent > 10% of sleep time with oxygen saturation by pulse oximetry < 90%. Desaturators were older (p = 0.024) and had higher hemoglobin (p = 0.002). Sixteen of 27 patients (59%) without desaturation < 90% during a 6-min walk test were nocturnal desaturators. Nocturnal desaturators had higher brain natriuretic protein (p = 0.004), lower cardiac index (p = 0.03), and higher mean right atrial pressure (p = 0.09), mean pulmonary artery pressure, and pulmonary vascular resistance. On echocardiography, desaturators were more likely to have moderate or severe right ventricular dilation (p = 0.04) and pericardia! effusion. Only one patient had significant sleep apnea. Conclusions: Nocturnal hypoxemia is common in PAH patients and correlates with advanced pulmonary hypertension and right ventricular dysfunction. Approximately 60% patients without exertional hypoxia had nocturnal desaturation. Overnight oximetry should be considered in the routine workup of PAH patients who do not demonstrate exertional desaturation.

Original languageEnglish
Pages (from-to)109-117
Number of pages9
JournalChest
Volume131
Issue number1
DOIs
StatePublished - Jan 1 2007

Fingerprint

Pulmonary Hypertension
Oxygen
Oximetry
Sleep
Hemodynamics
Right Ventricular Dysfunction
Lung
Connective Tissue Diseases
Atrial Pressure
Pericardium
Sleep Apnea Syndromes
Vascular Resistance
Pulmonary Artery
Lung Diseases
Echocardiography
Dilatation
Hemoglobins
Cross-Sectional Studies
Demography
Pressure

Keywords

  • Hypoxia
  • Oxygen
  • Pulmonary hypertension
  • Pulmonary vascular disease
  • Sleep

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Minai, O. A., Pandya, C. M., Golish, J. A., Avecillas, J. F., McCarthy, K., Marlow, S., & Arroliga, A. C. (2007). Predictors of nocturnal oxygen desaturation in pulmonary arterial hypertension. Chest, 131(1), 109-117. https://doi.org/10.1378/chest.06-1378

Predictors of nocturnal oxygen desaturation in pulmonary arterial hypertension. / Minai, Omar A.; Pandya, Chirag M.; Golish, Joseph A.; Avecillas, Jaime F.; McCarthy, Kevin; Marlow, Scott; Arroliga, Alejandro C.

In: Chest, Vol. 131, No. 1, 01.01.2007, p. 109-117.

Research output: Contribution to journalArticle

Minai, OA, Pandya, CM, Golish, JA, Avecillas, JF, McCarthy, K, Marlow, S & Arroliga, AC 2007, 'Predictors of nocturnal oxygen desaturation in pulmonary arterial hypertension', Chest, vol. 131, no. 1, pp. 109-117. https://doi.org/10.1378/chest.06-1378
Minai OA, Pandya CM, Golish JA, Avecillas JF, McCarthy K, Marlow S et al. Predictors of nocturnal oxygen desaturation in pulmonary arterial hypertension. Chest. 2007 Jan 1;131(1):109-117. https://doi.org/10.1378/chest.06-1378
Minai, Omar A. ; Pandya, Chirag M. ; Golish, Joseph A. ; Avecillas, Jaime F. ; McCarthy, Kevin ; Marlow, Scott ; Arroliga, Alejandro C. / Predictors of nocturnal oxygen desaturation in pulmonary arterial hypertension. In: Chest. 2007 ; Vol. 131, No. 1. pp. 109-117.
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abstract = "Background: Sleep may be associated with significant respiratory compromise in patients with lung disease and can result in hypoxia. In patients with pulmonary arterial hypertension (PAH), nocturnal desaturation may not be reflected in daytime evaluations of oxygenation and can lead to worsening pulmonary hemodynamics. The study was conducted to determine the prevalence and significance of nocturnal oxygen desaturation in patients with PAH. Methods: A cross-sectional study conducted at the Cleveland Clinic. Patients were followed up at our institution except for the overnight oximetry study done at home. Data regarding degree of nocturnal desaturation, demographics, hemodynamics, pulmonary function, and functional capacity were collected. Results: Forty-three patients (mean age, 47.9 ± 13.5 years [± SD]; 36 women and 7 men) underwent nocturnal oximetry. The etiology of PAH included idiopathic PAH (88{\%}) and PAH associated with connective tissue diseases (12{\%}). The majority of patients were New York Heart Association functional class II (42{\%}) or III (53{\%}). Thirty patients (69.7{\%}) spent > 10{\%} of sleep time with oxygen saturation by pulse oximetry < 90{\%}. Desaturators were older (p = 0.024) and had higher hemoglobin (p = 0.002). Sixteen of 27 patients (59{\%}) without desaturation < 90{\%} during a 6-min walk test were nocturnal desaturators. Nocturnal desaturators had higher brain natriuretic protein (p = 0.004), lower cardiac index (p = 0.03), and higher mean right atrial pressure (p = 0.09), mean pulmonary artery pressure, and pulmonary vascular resistance. On echocardiography, desaturators were more likely to have moderate or severe right ventricular dilation (p = 0.04) and pericardia! effusion. Only one patient had significant sleep apnea. Conclusions: Nocturnal hypoxemia is common in PAH patients and correlates with advanced pulmonary hypertension and right ventricular dysfunction. Approximately 60{\%} patients without exertional hypoxia had nocturnal desaturation. Overnight oximetry should be considered in the routine workup of PAH patients who do not demonstrate exertional desaturation.",
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N2 - Background: Sleep may be associated with significant respiratory compromise in patients with lung disease and can result in hypoxia. In patients with pulmonary arterial hypertension (PAH), nocturnal desaturation may not be reflected in daytime evaluations of oxygenation and can lead to worsening pulmonary hemodynamics. The study was conducted to determine the prevalence and significance of nocturnal oxygen desaturation in patients with PAH. Methods: A cross-sectional study conducted at the Cleveland Clinic. Patients were followed up at our institution except for the overnight oximetry study done at home. Data regarding degree of nocturnal desaturation, demographics, hemodynamics, pulmonary function, and functional capacity were collected. Results: Forty-three patients (mean age, 47.9 ± 13.5 years [± SD]; 36 women and 7 men) underwent nocturnal oximetry. The etiology of PAH included idiopathic PAH (88%) and PAH associated with connective tissue diseases (12%). The majority of patients were New York Heart Association functional class II (42%) or III (53%). Thirty patients (69.7%) spent > 10% of sleep time with oxygen saturation by pulse oximetry < 90%. Desaturators were older (p = 0.024) and had higher hemoglobin (p = 0.002). Sixteen of 27 patients (59%) without desaturation < 90% during a 6-min walk test were nocturnal desaturators. Nocturnal desaturators had higher brain natriuretic protein (p = 0.004), lower cardiac index (p = 0.03), and higher mean right atrial pressure (p = 0.09), mean pulmonary artery pressure, and pulmonary vascular resistance. On echocardiography, desaturators were more likely to have moderate or severe right ventricular dilation (p = 0.04) and pericardia! effusion. Only one patient had significant sleep apnea. Conclusions: Nocturnal hypoxemia is common in PAH patients and correlates with advanced pulmonary hypertension and right ventricular dysfunction. Approximately 60% patients without exertional hypoxia had nocturnal desaturation. Overnight oximetry should be considered in the routine workup of PAH patients who do not demonstrate exertional desaturation.

AB - Background: Sleep may be associated with significant respiratory compromise in patients with lung disease and can result in hypoxia. In patients with pulmonary arterial hypertension (PAH), nocturnal desaturation may not be reflected in daytime evaluations of oxygenation and can lead to worsening pulmonary hemodynamics. The study was conducted to determine the prevalence and significance of nocturnal oxygen desaturation in patients with PAH. Methods: A cross-sectional study conducted at the Cleveland Clinic. Patients were followed up at our institution except for the overnight oximetry study done at home. Data regarding degree of nocturnal desaturation, demographics, hemodynamics, pulmonary function, and functional capacity were collected. Results: Forty-three patients (mean age, 47.9 ± 13.5 years [± SD]; 36 women and 7 men) underwent nocturnal oximetry. The etiology of PAH included idiopathic PAH (88%) and PAH associated with connective tissue diseases (12%). The majority of patients were New York Heart Association functional class II (42%) or III (53%). Thirty patients (69.7%) spent > 10% of sleep time with oxygen saturation by pulse oximetry < 90%. Desaturators were older (p = 0.024) and had higher hemoglobin (p = 0.002). Sixteen of 27 patients (59%) without desaturation < 90% during a 6-min walk test were nocturnal desaturators. Nocturnal desaturators had higher brain natriuretic protein (p = 0.004), lower cardiac index (p = 0.03), and higher mean right atrial pressure (p = 0.09), mean pulmonary artery pressure, and pulmonary vascular resistance. On echocardiography, desaturators were more likely to have moderate or severe right ventricular dilation (p = 0.04) and pericardia! effusion. Only one patient had significant sleep apnea. Conclusions: Nocturnal hypoxemia is common in PAH patients and correlates with advanced pulmonary hypertension and right ventricular dysfunction. Approximately 60% patients without exertional hypoxia had nocturnal desaturation. Overnight oximetry should be considered in the routine workup of PAH patients who do not demonstrate exertional desaturation.

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