The rate of sleep related breathing disorders and its characterstics in pulmonary hypertension patients

Background: Pulmoner hypertension (PH), is a chronic disease that causes right ventriculous insufficiency and causes death when not treated and progresses with progressive pulmoner vascular resistance increase. Many diseases can cause PH. Sleep related breathing disorders can be seen frequently in PH cases. Therefore, it is recommended in guideline that polysomnography and nocturnal oximetry should be applied. In our study; we aimed to determine the frequency, features and other parameters of sleep related breathing disorders observed in PH patients (OSA, CSA, nocturnal desaturation). Methods: 32 patients with PH diagnosis have been included in this study. The antropometric features, smoking histories, PH group, functional classes, ecocardiographic, right heart catetherisation, PFT findings, 6 minute walking test (6 MWT) and blood gas analysis results were recorded. Polysomnography was performed in all the cases and the data was recorded. Results: 25 (%78,1) of the cases were women, and 7 (%21,9) were men. Mean age was found as 58,2±2,5, mean BMI as 30,5±1,2kg/m2. While %40,6 of the cases consisted group 1 PAH cases, the other groups (group 2, 3, 4 ve 5) consisted %59,4. According to the NYHA functional classification of the cases, %50 of the cases consist were class 1-2 and %50 of the cases were class 3-4. AHI value of the cases found as mean 19,6±5,1/h. When we classify the cases according to the severity of sleep related breathing disorders; AHİ>15 was found in 10 (31.2%) of the cases. While the values of these cases were significantly high as weight (p=0,01), BMI (p=0,006), N3 sleep time (p=0,04), the least oxygen saturation in sleep (p=0,01) and 6MWT distance (p=0,05) were found significantly low. AHİ>30 was found in the 7 of the cases. The right ventricular diameter of these cases (RV) (p=0,04) and right atrium pressure (p=0,01) values was significantly high. When the cases were divided in order with the existence of nocturnal desaturation, as cases which were ≤%88 and >%88 mean oxygen saturation in sleep, it was detected that in Group 1 (PAH) cases, the number of cases that had nocturnal desaturation was significantly higher (p=0,01) in comparison with the other groups. In the cases with nocturnal desaturation PAB (p=0,02), right ventrcicular diameter (RV) (p=0,002) were significantly high, 6MWT distance (p=0,03), PaO2 (p=0,007), oxygen saturation in rest (repose) position (p=0,004) was found signficantly low. Conclusions: In our study like the previous studies it has been found that; even though desaturation does not occur during rest position or exercise in PH patients; sleep related breathing disorders like OSA and nocturnal desaturation are found frequently. Therefore, while determining the group of the cases who have PH diagnosis; the result that is reached is that PSG and nocturnal oxymetry research should be applied during the initial diagnosis phase or after diagnosis is made. Key Words: Pulmoner hypertension, sleep related breathing disorders, apnea – hypoapnea index, nocturnal desaturation, polysomnography