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Sleep Breath 2002; 06(4): 181-188
DOI: 10.1055/s-2002-36529
COMMENTARY

Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Pulmonary Hypertension, Sleep-Disordered Breathing, and Beta Blockers in Heart Failure Patients

Robert P. Blankfield1,2
  • 1Department of Family Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
  • 2University Hospitals Primary Care Physician Practice, Berea, Ohio
Further Information

Publication History

Publication Date:
13 January 2003 (online)

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ABSTRACT

Heart failure patients with pulmonary hypertension have a worse prognosis than heart failure patients with normal pulmonary artery pressures. Heart failure is usually considered the cause of the pulmonary hypertension when the two conditions coincide. However, there is evidence that sleep-disordered breathing may be responsible for the pulmonary hypertension in these patients, and the worsened outcomes in heart failure patients with pulmonary hypertension may be due to sleep-disordered breathing. In addition, sleep-disordered breathing may provide an explanation for the beneficial effect of beta-adrenergic antagonists in heart failure patients.

KEYWORD

Heart failure - sleep-disordered breathing - pulmonary hypertension - beta-adrenergic blockers

REFERENCES

  • 1 Abramson S V, Burke J F, Kelly J J. Pulmonary hypertension predicts mortality and morbidity in patients with dilated cardiomyopathy.  Ann Intern Med . 1992;  116 888-895
    PubMedGoogle Scholar
  • 2 Enriquez-Sarano M, Rossi A, Seward J B, Bailey K R, Tajik A J. Determinants of pulmonary hypertension in left ventricular dysfunction.  J Am Coll Cardiol . 1997;  29 153-158
    CrossrefPubMedGoogle Scholar
  • 3 Tribouilloy C M, Enriquez-Sarano M, Rossi A, Tajik A J, Seward J B. Determinants of the pulmonary artery pressure rise in left ventricular dysfunction.  Cardiologia . 1997;  42 1051-1058
    PubMedGoogle Scholar
  • 4 Capomolla S, Febo O, Guazzotti G. Invasive and non-invasive determinants of pulmonary hypertension in patients with chronic heart failure.  J Heart Lung Transplant . 2000;  19 426-438
    PubMedGoogle Scholar
  • 5 Blankfield R P, Tapolyai A A, Zyzanski S J. Left ventricular dysfunction, pulmonary hypertension, obesity and sleep apnea.  Sleep Breath . 2001;  5 57-62
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Rich S, Braunwald E, Grossman W. Pulmonary hypertension. In: Braunwald E, ed. Heart Disease: A Textbook of Cardiovascular Medicine 5th ed. Philadelphia: WB Saunders Co 1997: 780-806
    Google Scholar
  • 7 Rubin L J. Primary pulmonary hypertension: ACCP consensus statement.  Chest . 1993;  104 236-250
    PubMedGoogle Scholar
  • 8 Schroeder J S, Motta J, Guilleminault C. Hemodynamic studies in sleep apnea. In: Guilleminault C, Dement WC, eds. Sleep Apnea Syndromes New York: Alan R Liss 1978: 177-196
    Google Scholar
  • 9 Shepard J W. Hemodynamics in obstructive sleep apnea. In: Fletcher EC, ed. Abnormalities of Respiration During Sleep Orlando, FL: Grune & Stratton 1986: 39-63
    Google Scholar
  • 10 Kessler R, Chaouat A, Weitzenblum E. Pulmonary hypertension in the obstructive sleep apnoea syndrome: prevalence, causes and therapeutic consequences.  Eur Respir J . 1996;  9 787-794
    CrossrefPubMedGoogle Scholar
  • 11 Sanner B M, Doberauer C, Konerman M, Sturm A, Zidek W. Pulmonary hypertension in patients with obstructive sleep apnea.  Arch Intern Med . 1997;  157 2483-2487
    CrossrefPubMedGoogle Scholar
  • 12 Chaouat A, Weitzenblum E, Krieger J, Oswald M, Kessler R. Pulmonary hemodynamics in the obstructive sleep apnea syndrome: results in 220 consecutive patients.  Chest . 1996;  109 380-386
    CrossrefPubMedGoogle Scholar
  • 13 Alchanatis M, Tourkohoriti G, Kakouros S, Kosmas E, Podaras S, Jordanoglou J B. Daytime pulmonary hypertension in patients with obstructive sleep apnea.  Respiration . 2001;  68 566-572
    CrossrefPubMedGoogle Scholar
  • 14 Sajkov D, Wang T, Saunders N A, Bune A J, McEvoy R D. Continuous positive airway pressure treatment improves pulmonary hemodynamics in patients with obstructive sleep apnea.  Am J Respir Crit Care Med . 2002;  165 152-158
    CrossrefPubMedGoogle Scholar
  • 15 McDonnell P J, Toye P A, Hutchins G M. Primary pulmonary hypertension and cirrhosis: are they related?.  Am Rev Respir Dis . 1983;  127 437-441
    PubMedGoogle Scholar
  • 16 Hadengue A, Benhayoun M K, Lebrec D, Benhamou J. Pulmonary hypertension complicating portal hypertension: prevalence and relation to splanchnic hemodynamics.  Gastroenterology . 1991;  100 520-528
    PubMedGoogle Scholar
  • 17 Kleiger R E, Boxer M, Ingham R E, Harrison D C. Pulmonary hypertension in patients using oral contraceptives: a report of six cases.  Chest . 1976;  69 143-147
    CrossrefPubMedGoogle Scholar
  • 18 Masi A T. Pulmonary hypertension and oral contraceptive usage.  Chest . 1976;  69 451-453
    PubMedGoogle Scholar
  • 19 Dawkins K D, Burke C M, Billingham M E, Jamieson S W. Primary pulmonary hypertension and pregnancy.  Chest . 1986;  89 383-388
    PubMedGoogle Scholar
  • 20 Rich S, Dantkzer D R, Ayres S M. Primary pulmonary hypertension: a national prospective study.  Ann Intern Med . 1987;  107 216-223
    CrossrefPubMedGoogle Scholar
  • 21 Shaiberger P H, Kennedy T C, Miller F C, Gal J, Petty T L. Pulmonary hypertension associated with long-term inhalation of ``crank'' methamphetamine.  Chest . 1993;  104 614-616
    PubMedGoogle Scholar
  • 22 Collins E, Hardwick H, Jeffrey H. Perinatal cocaine intoxication.  Med J Aust . 1989;  150 331-332
    PubMedGoogle Scholar
  • 23 Russell L A, Spehlmann J C, Clarke M, Lillington G A. Pulmonary hypertension in female crack users [abstract].  Am Rev Resp Dis . 1992;  145(suppl) A717
    PubMedGoogle Scholar
  • 24 Legoux B, Piette A M, Bouchet P F, Landau J F, Gepner P, Chapman A M. Pulmonary hypertension and HIV infection.  Am J Med . 1990;  89 122
    PubMedGoogle Scholar
  • 25 Petitpretz P, Brenot R, Azarian R. Pulmonary hypertension in patients with human immunodeficiency virus infection: comparison with primary pulmonary hypertension.  Circulation . 1994;  89 2722-2727
    CrossrefPubMedGoogle Scholar
  • 26 Speich R, Jenni M D, Opravil M, Pfab M, Russi E W. Primary pulmonary hypertension in HIV infection.  Chest . 1991;  100 1268-1271
    CrossrefPubMedGoogle Scholar
  • 27 Brenot F, Herve P, Petitpretz P, Parent F, Duroux P, Simonneau G. Primary pulmonary hypertension and fenfluramine use.  Br Heart J . 1993;  70 537-541
    CrossrefPubMedGoogle Scholar
  • 28 Douglas J G, Munro J F, Kitchin A H, Muir A L, Proudfoot A T. Pulmonary hypertension and fenfluramine.  BMJ . 1981;  283 881-883
    CrossrefPubMedGoogle Scholar
  • 29 Gurtner H P. Aminorex and pulmonary hypertension.  Cor Vasa . 1985;  27 160-171
    PubMedGoogle Scholar
  • 30 Abenhaim L, Moride Y, Brenot F. Appetite suppressant drugs and the risk of primary pulmonary hypertension.  N Engl J Med . 1996;  335 609-616
    CrossrefPubMedGoogle Scholar
  • 31 International Primary Pulmonary Hypertension Study Group. The international primary pulmonary hypertension study (IPPHS).  Chest . 1994;  105 37S-41S
    PubMedGoogle Scholar
  • 32 Jahaveri S, Parker T J, Wexler L. Occult sleep-disorder breathing in stable congestive heart failure.  Ann Intern Med . 1995;  122 487-492
    PubMedGoogle Scholar
  • 33 Jahaveri S, Parker T J, Liming J D. Sleep apnea in 81 ambulatory male patients with stable heart failure.  Circulation . 1998;  97 2154-2159
    PubMedGoogle Scholar
  • 34 Chan J, Sanderson J, Chan W. Prevalence of sleep-disordered breathing in diastolic heart failure.  Chest . 1997;  111 1488-1493
    CrossrefPubMedGoogle Scholar
  • 35 Sin D D, Fitzgerald F, Parker J D, Newton G, Floras J S, Bradley T D. Risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure.  Am J Respir Crit Care Med . 1999;  160 1101-1106
    CrossrefPubMedGoogle Scholar
  • 36 Tremel F, Pepin J L, Veale D. High prevalence and persistence of sleep apnoea in patients referred for acute left ventricular failure and medically treated for over 2 months.  Eur Heart J . 1999;  20 1201-1209
    CrossrefPubMedGoogle Scholar
  • 37 Lafaso F, Verschueren P, Rande J LD, Harf A, Goldenberg F. Prevalence of sleep-disordered breathing in patients on a heart transplant waiting list.  Chest . 1994;  106 1689-1694
    PubMedGoogle Scholar
  • 38 Solin P, Bergin P, Richardson M, Kaye D M, Walters E H, Naughton M T. Influence of pulmonary wedge pressure on central apnea in heart failure.  Circulation . 1999;  99 1574-1579
    CrossrefPubMedGoogle Scholar
  • 39 Dark D S, Pingleton S K, Kerby G R. Breathing pattern abnormalities and arterial oxygen desaturation during sleep in the congestive heart failure syndrome.  Chest . 1987;  91 833-836
    CrossrefPubMedGoogle Scholar
  • 40 Walsh J T, Andrews R, Starling R, Cowley A J, Johnston I DA. Effects of captopril and oxygen on sleep apnoea in patients with mild to moderate congestive cardiac failure.  Br Heart J . 1995;  73 237-241
    CrossrefPubMedGoogle Scholar
  • 41 Sin D D, Logan A G, Fitzgerald F S, Liu P P, Bradley T D. Effects of continuous positive airway pressure on cardiovascular outcomes in heart failure patients with and without Cheyne-Stokes respiration.  Circulation . 2000;  102 61-66
    CrossrefPubMedGoogle Scholar
  • 42 Malone S, Liu P P, Holloway R. Obstructive sleep apnea in patients with dilated cardiomyopathy: effects of continuous positive airway pressure.  Lancet . 1991;  338 1480-1484
    CrossrefPubMedGoogle Scholar
  • 43 Takasaki Y, Orr D, Popkin J, Rutherford R. Effect of nasal continuous positive airway pressure on sleep apnea in congestive heart failure.  Am Rev Respir Dis . 1989;  140 1578-1584
    PubMedGoogle Scholar
  • 44 Davies R JO, Harrington K J, Ormerod O JM, Stradling J R. Nasal continuous positive airway pressure in chronic heart failure with sleep-disordered breathing.  Am Rev Respir Dis . 1993;  147 630-634
    PubMedGoogle Scholar
  • 45 Hanly P J, Zuberi-Khokar N S. Increased mortality associated with Cheyne-Stokes respiration in patients with congestive heart failure.  Am J Respir Crit Care Med . 1996;  153 272-276
    CrossrefPubMedGoogle Scholar
  • 46 Lanfranchi P A, Braghiroli A, Bosimini E. Prognostic value of nocturnal Cheyne-Stokes respiration in chronic heart failure.  Circulation . 1999;  99 1435-1440
    CrossrefPubMedGoogle Scholar
  • 47 Andreas S, Hagenah G, Möller C, Werner G S, Kreuzer H. Cheyne-Stokes respiration and prognosis in congestive heart failure.  Am J Cardiol . 1996;  78 1260-1264
    CrossrefPubMedGoogle Scholar
  • 48 Barbé F, Mayorales L R, Duran J. Treatment with continuous positive airway pressure is not effective in patients with sleep apnea but no daytime sleepiness: a randomized, controlled trial.  Ann Intern Med . 2001;  134 1015-1023
    PubMedGoogle Scholar
  • 49 Blankfield R P, Zyzanski S J. Bilateral leg edema, pulmonary hypertension, and obstructive sleep apnea.  J Fam Pract . 2002;  51 561-564
    PubMedGoogle Scholar
  • 50 Caruana L, Petrie M C, Davie A P, McMurray J J. Do patients with suspected heart failure and preserved left ventricular systolic function suffer from ``diastolic heart failure'' or from misdiagnosis?.  <~>A prospective descriptive study. BMJ . 2000;  321 215-218
    PubMedGoogle Scholar
  • 51 Packer M, Bristow M R, Cohn J N. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure.  N Engl J Med . 1996;  334 1349-1355
    CrossrefPubMedGoogle Scholar
  • 52 CIBIS-II Investigators and Committees. The cardiac insufficiency bisoprolol study II (CIBIS-II): a randomised trial.  Lancet . 1999;  353 9-13
    CrossrefPubMedGoogle Scholar
  • 53 MERIT-HF study group. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL randomized intervention trial in congestive heart failure (MERIT-HF).  Lancet . 1999;  353 2001-2007
    CrossrefPubMedGoogle Scholar
  • 54 Packer M, Cohn J N. Consensus recommendations for the management of chronic heart failure.  Am J Cardiol . 1999;  83(suppl) 1A-38A
    CrossrefPubMedGoogle Scholar
  • 55 Bristow M R. Mechanism of action of beta-blocking agents in heart failure.  Am J Cardiol . 1997;  80 26L-46L
    CrossrefPubMedGoogle Scholar
  • 56 Kaye D M, Johnston L, Vaddadi G, Brunner-LaRocca H, Jennings G L, Esler M D. Mechanisms of carvedilol action in human congestive heart failure.  Hypertension . 2001;  37 1216-1221
    PubMedGoogle Scholar
  • 57 Ziegler M G, Nelesen R, Mills P. Sleep apnea, norepinephrine-release rate, and daytime hypertension.  Sleep . 1997;  20 224-231
    PubMedGoogle Scholar
  • 58 Dimsdale J E, Coy T, Ziegler M G. The effect of sleep apnea on plasma and urinary catecholamines.  Sleep . 1995;  18 377-381
    PubMedGoogle Scholar
  • 59 Van de Borne P, Oren R, Abouassaly C, Anderson E, Somers V K. Effect of Cheyne-Stokes respiration on muscle sympathetic nerve activity in severe congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy.  Am J Cardiol . 1998;  81 432-436
    CrossrefPubMedGoogle Scholar
  • 60 Minemura H, Akashiba T, Yamamoto H. Acute effects of nasal continuous positive airway pressure on 24-hour blood pressure and catecholamines in patients with obstructive sleep apnea.  Intern Med . 1998;  37 1009-1013
    CrossrefPubMedGoogle Scholar
  • 61 Bratel T, Wennlund A, Carlstrom K. Pituitary reactivity, androgens and catecholamines in obstructive sleep apnea. Effects of continuous positive airway pressure treatment (CPAP).  Respir Med . 1999;  93 1-7
    CrossrefPubMedGoogle Scholar
  • 62 Fletcher E C, Miller J, Schaaf J W, Fletcher J G. Urinary catecholamines before and after tracheostomy in patients with obstructive sleep apnea and hypertension.  Sleep . 1987;  10 35-44
    PubMedGoogle Scholar
  • 63 Kaye D M, Mansfield D, Aggarwal A, Naughton M T, Esler M D. Acute effects of continuous positive airway pressure on cardiac sympathetic tone in congestive heart failure.  Circulation . 2001;  103 2336-2338
    PubMedGoogle Scholar
  • 64 Kaye D M, Jennings G L, Dart A M, Esler M D. Differential effect of acute baroreceptor unloading on cardiac and systemic tone in congestive heart failure.  J Am Coll Cardiol . 1998;  31 583-587
    CrossrefPubMedGoogle Scholar
  • 65 Bradley T D, Logan A G, Floras J S, The CANPAP Investigators. Rationale and design of the Canadian continuous positive airway pressure trial for congestive heart failure patients with central sleep apnea-CANPAP.  Can J Cardiol . 2001;  17 677-684
    PubMedGoogle Scholar
  • 66 The CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure: results of the Cooperative North Scandinavian Enalapril Survival Study.  N Eng J Med . 1987;  316 1429-1435
    PubMedGoogle Scholar
  • 67 The SOLVD Investigators. Effect of angiotensin-converting enzyme inhibition with enalapril on survival in patients with reduced left ventricular ejection fraction and congestive heart failure: results of the Treatment Trial of the Studies of Left Ventricular Dysfunction (SOLVD): a randomized double blind trial.  N Engl J Med . 1991;  325 293-302
    CrossrefPubMedGoogle Scholar
  • 68 Garg R, Yusuf S. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity of patients with heart failure.  JAMA . 1991;  273 1450-1456
    PubMedGoogle Scholar
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