Sleep-related breathing disorders in patients with Schistosomal cor-pulmonale

ABSTRACT

Schistosmiasis has long been an endemic disease in Egypt and an important cause of pulmonary hypertension. We aimed to investigate the clinical and polysomnographic features of sleep-related breathing disorders [SRBD] in patients with schistosomal cor-pulmonale and to evaluate their effects on pulmonary hemodynamics. We studied 10 stable patients diagnosed with schistosomal pulmonary hypertension [7 males and 3 females their mean age was 43.7 +/- 8.04] and 10 healthy volunteers matched for age, sex and BMI. Patients' exclusion criteria were smoking, morbid obesity, other secondary causes of pulmonary hypertension, systemic hypertension, ischemic or rheumatic heart disease or left heart failure. All patients underwent overnight polysomnography or ambulatory cardiorespiratory sleep studies, spirometry, ECG and echocardiography. Daytime sleepiness was also assessed using the Epworth sleepiness scale [ESS]. The mean AHI in patients group was 20.0 +/- 11.34/h while in the control group it was 2.3 +/- 1.16/h. 80% of the patients were found to have an AHI > 10/h and 60% had moderate to severe sleep apnea [AHI >/= 15/h]. In addition, the majority of the patients [80%] spent > 30% of the night with an arterial oxygen saturation <90%. SRBD were not correlated with anthropometric measures, spirometry nor with the typical symptoms of SA such as excessive sleepiness as assessed by ESS. More importantly, SRBD were significantly associated with measures of pulmonary hypertension severity, and patients with moderate to severe SA had more impaired cardiovascular function as indicated by more severe right ventricular dilatation [p = 0.036] than patients with mild sleep apnea. SRBD are highly prevalent in patients with schistosomal pulmonary hypertension [PH]. Also, the SA severity was correlated with more advanced PH and more severe cardiovascular impairment. Therefore in the evaluation of patients with schistosomal PH, polysomnography or an ambulatory cardiorespiratory sleep study seems justified to identify potentially treatable SRBD that may additionally challenge the already compromised cardiovascular system in these patients