Poor Sleep Quality Associated With Pulmonary Arterial Hypertension

Patients with pulmonary arterial hypertension (PAH) are likely to suffer from poor sleep quality, and thus dyspnea and exercise intolerance, contributing to greater disease burden, according to a study in Acta Cardiologica Sinica.¹

“Poor sleep quality is an overlooked symptom in patients with pulmonary arterial hypertension (PAH), however it may significantly contribute to disease burden,” the authors wrote. “Poor sleep quality was associated with dyspnea and exercise capacity in the enrolled patients, and those with severe dyspnea were at a particularly higher risk of poor sleep quality.”

Of the 45 patients with PAH included in this prospective, cross-sectional study, 64% had poor sleep quality, which was defined as a Pittsburgh Sleep Quality Index (PSQI) score greater than 5. In addition, 86% of the patients experienced severe fatigue. The mean Fatigue Severity Scale score was 59, which was close to the maximum score of the scale, 63, indicating that the patients were very severely fatigued during daily life. The cohort was composed of 35 women and 10 men.

Patients with PAH may experience issues with sleep | image credit: princeoflove - stock.adobe.com

The PSQI score was significantly correlated with the Modified Medical Research Council (MMRC scale; r = -0.561), The University of California, San Diego Shortness of Breath Questionnaire (UCSD-SOBQ; r = 0.497), Baseline Dyspnea Index (BDI; r = -0.468), and the six-minute walk test (6MWT; r = -0.412; P < .05). These correlations suggest that poorer sleep quality was related to worse dyspnea and exercise capacity scores, according to the study.

Patients with severe dyspnea during the day were found to be the most at-risk for sleep disturbance. Dyspnea was found to be a significant predictor of sleep quality, independent of disease severity.

Researchers made an unexpected finding: severe fatigue during the day, a condition most patients reported, was not associated with poor sleep quality. Fatigue levels were evaluated through the Fatigue Severity Scale and Borg Rating of Perceived Exertion.

Dyspnea was a substantially greater variable influencing sleep quality compared with exercise tolerance, according to a regression analysis. Dyspnea was also found to be an independent predictor for sleep quality (P = .005). A univariate model including MMRC as an independent variable, PSQI score as a dependent variable, and The European Society of Cardiology and European Respiratory Society (ESC/ERS) Risk Category as a covariate revealed that MMRC was still an independent predictor for PSQI after controlling for disease severity.

Patients met criteria that included a diagnosis of PAH by right heart catheterization, no changes in medications in the last 3 months, World Health Organization functional class (WHO-FC) IIII status, and were deemed clinically stable. Patients were excluded who had obstructive or restrictive lung diseases, cor pulmonale, left heart failure, ischemic heart disease, cognitive impairment, recent viral infection in the past 6 months, or orthopedic problems.

Most patients (60%) had PAH associated with congenital heart diseases. Comorbidities included obesity (24%), diabetes (22%), hypertension (15%), smoking history (8%), history of myocardial infarction (8%) and hyperlipidemia (6%).

Subjective poor sleep quality has previously been associated with coronary heart disease.²

“Poor sleep quality is common in patients with PAH and is associated with poor exercise capacity and dyspnea. Patients with severe dyspnea are particularly at higher risk of poor sleep quality,” the authors wrote. “Consideration of sleep related complaints and underlying mechanisms when planning symptomatic treatments for these patients may help provide better management for PAH.”

References

1. Ceylan R, Demir R, Zeren M, Sinan UY, Kucukoglu MS. Sleep quality and its predictors among dyspnea, fatigue and exercise capacity in pulmonary arterial hypertension. Acta Cardiol Sin. 2024. doi:10.6515/ACS.202409_40(5).20240712A
2. Kwok CS, Kontopantelis E, Kuligowski G, et al. Self-reported sleep duration and quality and cardiovascular disease and mortality: a dose-response meta-analysis. J AmHeart Assoc. 2018. doi:10.1161/JAHA.118.008552