Obstructive Sleep Apnea, Obesity Hypoventilation Syndrome, and Pulmonary Hypertension: A State-of-the-Art Review

Sarah Bjork; Deepanjali Jain; Manuel Hache Marliere; Sanda A Predescu; Babak Mokhlesi

doi:10.1016/j.jsmc.2024.02.009

Obstructive Sleep Apnea, Obesity Hypoventilation Syndrome, and Pulmonary Hypertension: A State-of-the-Art Review

Sleep Med Clin. 2024 Jun;19(2):307-325. doi: 10.1016/j.jsmc.2024.02.009. Epub 2024 Mar 12.

Authors

Sarah Bjork¹, Deepanjali Jain¹, Manuel Hache Marliere¹, Sanda A Predescu¹, Babak Mokhlesi²

Affiliations

¹ Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Rush University Medical Center, 1750 W. Harrison Street, Jelke 297, Chicago, IL 60612, USA.
² Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Rush University Medical Center, 1750 W. Harrison Street, Jelke 297, Chicago, IL 60612, USA. Electronic address: [email protected].

PMID: 38692755
DOI: 10.1016/j.jsmc.2024.02.009

Abstract

The pathophysiological interplay between sleep-disordered breathing (SDB) and pulmonary hypertension (PH) is complex and can involve a variety of mechanisms by which SDB can worsen PH. These mechanistic pathways include wide swings in intrathoracic pressure while breathing against an occluded upper airway, intermittent and/or sustained hypoxemia, acute and/or chronic hypercapnia, and obesity. In this review, we discuss how the downstream consequences of SDB can adversely impact PH, the challenges in accurately diagnosing and classifying PH in the severely obese, and review the limited literature assessing the effect of treating obesity, obstructive sleep apnea, and obesity hypoventilation syndrome on PH.

Keywords: Bilevel PAP; CPAP; Echocardiogram; Hypercapnia; Hypoxemia; Noninvasive ventilation; Obesity hypoventilation syndrome; Obstructive sleep apnea; Positive airway pressure therapy; Pulmonary arterial hypertension; Pulmonary artery systolic pressure; Pulmonary hypertension; Right heart catheterization; Right ventricular systolic pressure; Sleep disordered breathing.

Publication types

Review

MeSH terms

Humans
Hypertension, Pulmonary* / diagnosis
Hypertension, Pulmonary* / physiopathology
Hypertension, Pulmonary* / therapy
Obesity Hypoventilation Syndrome* / diagnosis
Obesity Hypoventilation Syndrome* / physiopathology
Obesity Hypoventilation Syndrome* / therapy
Sleep Apnea, Obstructive* / complications
Sleep Apnea, Obstructive* / diagnosis
Sleep Apnea, Obstructive* / physiopathology
Sleep Apnea, Obstructive* / therapy