Chest
Volume 95, Issue 4, April 1989, Pages 757-764
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Clinical Investigations
Pulmonary Vascular Hemodynamics in Chronic Lung Disease Patients with and without Oxyhemoglobin Desaturation During Sleep

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Nonapneic, nocturnal oxyhemoglobin desaturation (NOD) during rapid-eye-movement (REM) sleep has been proposed as a predecessor and possible etiologic factor in the development of pulmonary hypertension in patients both with restrictive and obstructive chronic lung disease. The association between abnormal waking cardiopulmonary hemodynamics and NOD has not been established in patients with mild daytime hypoxemia. Gas exchange, pulmonary function, red cell mass, radionuclide gated cardiac ejection fraction, and supine cardiopulmonary hemodynamics were examined in 36 patients with chronic lung disease. All had a daytime PaO2>60 mm Hg and REM sleep-related NOD for >5 minutes, to 85 percent or lower. These data were compared to those from 13 subjects with similar symptoms and objective measures of pulmonary dysfunction but without evidence of NOD. Patients with NOD showed more end organ evidence of hypoxemia and more abnormal cardiopulmonary hemodynamics than patients with similar degrees of lung disease but without NOD. The relative role of daytime vs nocturnal hypoxemia in inducing hemodynamic differences between groups cannot be determined from this study.

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MATERIALS AND METHODS

Forty-nine male veterans with chronic lung disease were recruited from the Houston Veterans Administration Medical Center chest medicine clinics to participate in this study. None had clinical evidence of chronic cor pulmonale. None showed substantial left ventricular dysfunction by gated equilibrium radionuclide ejection fraction (<45 percent = dysfunction). Chronic lung disease was defined by a history of cough, exertional dyspnea, or wheezing, spirometry consistent with irreversible

Pulmonary Function and Gas Exchange

The two groups did not vary with respect to age, percentage of ideal body weight, RVEF, LVEF (Table 1), or parameters of pulmonary function including spirometry, body plethysmographic measurements, and DCO (Table 2). Hemoglobin was significantly higher in the NOD group (15.2 vs 14.4 g/dL). The RBC mass corrected for predicted was normal for both groups. However, when corrected for body weight, the NOD group value was higher.

There were several important differences between the groups with regard

DISCUSSION

The goal of this study was to determine whether there were differences in parameters of cardiopulmonary function between two subsets of patients with chronic lung disease. Since the predominant lung disease pattern was obstructive, FEV1 was chosen as a parameter for matching groups. Numerous studies show that in obstructive lung disease, FEV1 correlates with clinical symptomatology, survival,16, 17, 18 and to some degree, pulmonary hemodynamics.19

Patients who had restrictive components along

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  • Cited by (0)

    Supported by the General Research Service, Veterans Administration and in part by a grant from Oximetrix, Inc, Mountain View, CA. Computational assistance was provided by the CLINFO project, funded by the Division of Research Resources of the NIH under grant No RR-00350.

    Manuscript received August 8; revision accepted October 31.

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