Etiopathogenetic mechanisms of pulmonary hypertension in sleep-related breathing disorders

Abstract

Obstructive sleep apnea syndrome is a common disorder with significant health consequences and is on the rise in consonance with the obesity pandemic. In view of the association between sleep-disordered breathing and pulmonary hypertension as depicted by multiple studies, current clinical practice guidelines categorize obstructive sleep apnea as a risk factor for pulmonary hypertension and recommend an assessment for sleep disordered breathing in evaluating patients with pulmonary hypertension. The dysregulatory mechanisms associated with hypoxemic episodes observed in sleep related breathing disorders contribute to the onset of pulmonary hypertension and identification of these potentially treatable factors might help in the reduction of overall cardiovascular mortality.

Figure 1

Pathogenesis of pulmonary hypertension [, –23].

Figure 2

Intermediate mechanisms which potentially increase the risk of developing pulmonary hypertension in obstructive sleep apnea. These intermediate mechanisms in obstructive sleep apnea may contribute to initiating and perpetuating pathologic cardiovascular changes which result in pulmonary hypertension.