Increased right atrial pressure is associated with elevated PLMS and sleep disordered breathing in patients with pulmonary hypertension

M Becker; N Tröster; S Scheidl; G Kovacs; M Dominco; H Olschewski

doi:10.1055/s-0031-1272007

Pneumologie, Table of Contents

Increased right atrial pressure is associated with elevated PLMS and sleep disordered breathing in patients with pulmonary hypertension

M Becker ¹, N Tröster ², S Scheidl ², G Kovacs ², M Dominco ², H Olschewski ²

¹Department of Internal Medicine/Infectious diseases and Respiratory medicine, Charité Medical University Berlin
²Graz

Abstract

In patients with pulmonary hypertension CSR/CSA is common, but also obstructive sleep apnea (OSA) occur¹. Overnight rostral leg fluid displacement and increase in neck circumference may influence severity of central sleep apnea^2/3. Polysomnographic studies demonstrated a synchronisation between periodic leg movements (PLMS) and hyperventilation episodes in patients with CSR. This suggests that PLMS during sleep in patients with CSR may have a different origin, compared with PLMS during sleep in restless legs syndrome⁴. Until now an influence of fluid shift or fluid overloading to PLMS could not shown.

Material and Methods: After a screening with echocardiography 101 patients with suspected pulmonary hypertension different underlying diseases underwent right heart catheterization, polysomnography, a clinical interview to sleep status, blood examination, pulmonary function testing and 6MW.

Results: In our study 53 patients (53.5%) fulfilled the current criterions of pulmonary hypertension (mPAp≥25mmHg) vs. 46 patients (46.5%) without a pulmonary hypertension. 37 patients (37.4%) showed a right atrial pressure above the median (6mmHg) vs. 62 patients (62.6%) under the median. Patients with a right atrial pressure (RAP) above the median were associated with exceeded PLMS (17.0/h vs. 6.7/h; p≤0.005) and decreased S4 (2.3 vs. 4.5; p≤0.05) and SWS (Slow wave sleep) (9.9/h vs. 13.5/h; p≤0.05). RAP was correlated with PLMS (r=0.314; p=0.001). RAP above median was also associated with higher CSA/CSR (4.8/h vs. 1.6; p≤0.05).

Conclusion: Right atrial pressure the upper normal range and above is associated with higher PLMS and a sleep disruption with lower S4 and slow wave sleep. Also higher RAP may influence sleep disordered breathing especially CSA/CSR. This finding suggest that fluid overloading play a previously unrecognized role in the pathogenesis of PLMS in patients with a pulmonary hypertension and also can play a role in pathogenesis of sleep disordered breathing.