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Pulmonary Artery Hypertension and Sleep-Disordered Breathing^*

ACCP Evidence-Based Clinical Practice Guidelines

^* From the Division of Pulmonary, Allergy and Critical Care Medicine (Dr. Atwood), Department of Medicine, University of Pittsburgh Medical Center and the VA Pittsburgh Healthcare System, Pittsburgh, PA; Department of Medicine (Drs. McCrory and Ahearn), Duke Center for Clinical Health Research, Duke University Medical Center, Durham, NC; Division of Pulmonary and Critical Care Medicine (Dr. Garcia), Department of Medicine, Johns Hopkins Hospital, Baltimore, MD; and University of Colorado Health Sciences Center (Dr. Abman), The Children’s Hospital, Denver, CO.

Correspondence to: Charles W. Atwood, Jr., MD, FCCP, UPMC-Montefiore PACCM, MUH, NW 628, Pittsburgh, PA 15213; atwoodcw{at}upmc.edu

The objective of this article is to review the available data on the relationship between sleep-disordered breathing (SDB) and pulmonary arterial hypertension (PAH), with a focus on the prevalence of SDB in patients with idiopathic PAH (IPAH); the prevalence of PAH in patients with SDB; and the effects of SDB treatment on PAH. The evidence to date suggests that PAH may occur in the setting of SDB, although the prevalence is low. However, pulmonary hypertension (PH) in SDB is most strongly associated with other risk factors, such as left-sided heart disease, parenchymal lung disease, nocturnal desaturation, and obesity. The limited data available also suggest that SDB is uncommon in patients with IPAH. Treatment of SDB with continuous positive airway pressure may lower pulmonary artery pressures when the degree of PH is mild.

Key Words: clinical guideline • continuous positive airway pressure therapy • evidenced-based review • hypoxemia • pulmonary arterial hypertension • sleep-disordered breathing

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