Abstract
Obstructive sleep apnea (OSA) is a disease process involving recurrent pharyngeal collapse during sleep, resulting in apneic episodes. Clinically, symptoms can include snoring, sudden awakening with a choking-like sensation, excessive somnolence, non-restorative sleep, difficulty in starting or maintaining sleep, and fatigue. It results in impaired gas exchange, subsequently causing various cardiovascular, metabolic, and neurocognitive pathologies. Historically, OSA has been underdiagnosed and undertreated, especially in women.OSA is associated with WHO (World Health Organization) class III pulmonary hypertension (PH) or PH due to lung disease. PH is a concerning complication of OSA and thought to occur in roughly 20% of individuals with OSA. The pathogenesis of PH in OSA can include pulmonary artery vasoconstriction and remodeling. Patients suffering from OSA who develop PH tend to have worse cardiovascular and pulmonary changes. We present a thorough review of the literature examining the interplay between OSA and PH.
Highlights
BackgroundObstructive sleep apnea (OSA) is characterized by recurrent pharyngeal collapse during sleep [1]
Novel treatments for OSA are actively being investigated in an effort to deliver an effective option that both reduces the deleterious effects of this disease and provides a sustainable method to increase patient satisfaction and adherence
Pulmonary disease has served as exclusionary criteria for many studies, but moving forward we believe that it would be beneficial to include a cohort of OSA patients with pulmonary hypertension (PH) in the investigation of alternative treatment options for OSA
Summary
Obstructive sleep apnea (OSA) is characterized by recurrent pharyngeal collapse during sleep [1]. As stated previously, increased crosssectional area is correlated with a better response; not all patients who received additional tonsillectomy in this study were considered to have a good response Surgeries such as UPPP may initially be beneficial and improve quality of life versus CPAP therapy; recurrence of excessive daytime sleepiness was evident in this cohort after six months postoperatively and at long-term follow-up, which may indicate decreased benefit after an extended post-surgical period. Less invasive treatment modalities that target tongue-based obstruction include mandibular advancement splints and tongue stabilizing devices [31] Both modalities showed a significant reduction in AHI and subjective sleep parameters in a study by Deane et al, but they may have subsequent issues with compliance as seen in CPAP since it requires the user to use an intra-oral device during sleep.
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