Evidence map›Paper›PMID 37968017›Full record

Observational studyJournal of the American College of Cardiology2023

Sleep-Related Hypoxia, Right Ventricular Dysfunction, and Survival in Patients With Group 1 Pulmonary Arterial Hypertension.

Megan M Lowery, Nicholas S Hill, Lu Wang, Erika B Rosenzweig, Aparna Bhat, Serpil Erzurum, J Emanuel Finet, Christine L Jellis, Sunjeet Kaur, Deborah H Kwon and 11 more

2 registry-linked trialsOpen access · greenAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Journal of the American College of Cardiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 17 papers.

0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed
6.5field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02980887 active not recruitingnot on this map

Redefining Pulmonary Hypertension Through Pulmonary Vascular Disease Phenomics (PVDOMICS)

TypeobservationalSponsorThe Cleveland ClinicRan2016 to 2029Enrolled1,195ConditionsPulmonary Arterial HypertensionArmsNo Intervention
NCT04071327 recruitingnot on this map

Pulmonary Hypertension Association Registry

Typeobservational_patient_registrySponsorPulmonary Hypertension Association, Inc.Ran2015 to 2025Enrolled3,000ConditionsPulmonary Arterial Hypertension, Chronic Thromboembolic Pulmonary Hypertension, Pulmonary Hypertension
3 · Its place in the literature

Who cites it

17 citing papers in PubMed, 25 citations in OpenAlex.

  1. Review
  2. Nocturnal Hypoxaemia in PAH Patients Living at High Altitude Relocated to Low Altitude.Respiration; international review of thoracic diseases · 2026
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

21 authors at 11 institutions in 1 country.

Megan M LoweryDivision of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, Florida, USA.
Nicholas S HillDivision of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, Massachusetts, USA.
Lu WangLerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Erika B RosenzweigDivision of Pediatric Cardiology, Department of Pediatrics and Medicine, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA.
Aparna BhatNeurologic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Serpil ErzurumNeurologic Institute, Cleveland Clinic, Cleveland, Ohio, USA; Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA.
J Emanuel FinetHeart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Christine L JellisDepartment of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.
Sunjeet KaurNeurologic Institute, Cleveland Clinic, Cleveland, Ohio, USA; Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Deborah H KwonHeart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Rawan NawabitNeurologic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Milena RadevaLerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Gerald J BeckDepartment of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.
Robert P FrantzDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Paul M HassounDivision of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
Anna R HemnesDivision of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Evelyn M HornPerkin Heart Failure Center, Division of Cardiology, Weill Cornell Medicine, New York, New York, USA.
Jane A LeopoldDivision of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Franz P RischardDivision of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona, Tucson, Arizona, USA.
Reena MehraLerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA; Neurologic Institute, Cleveland Clinic, Cleveland, Ohio, USA; Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA; Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA. Electronic address: mehrar@ccf.org.
Pulmonary Vascular Disease Phenomics (PVDOMICS) Study Group
Cleveland Clinic · USBrigham and Women's Hospital · USUniversity of Arizona · USMayo Clinic · USCleveland Clinic Lerner College of Medicine · USCornell University · USJohns Hopkins University · USNewYork–Presbyterian Hospital · USTufts Medical Center · USVanderbilt University Medical Center · USUniversity of Florida · US

Funding

Pulmonary Vascular Disease Phenomics Program (PVDOMICS) Data Coordinating CenterU01HL125177 · NHLBI · CLEVELAND CLINIC LERNER COM-CWRU · PI BECK, GERALD J, ERZURUM, SERPIL C. · 2014 to 2020
$20.0M
Improving Phenotypic Classification and Prediction of Treatment Outcomes in Patients with Non-ischemic Cardiomyopathy and Functional Mitral RegurgitationR01HL170090 · NHLBI · CLEVELAND CLINIC LERNER COM-CWRU · PI DEBORAH KWON · 2023 to 2026
$3.1M
Intergrated Endothelial Phenotyping to Redefine Pulmonary HypertensionU01HL125215 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI LEOPOLD, JANE A, WAXMAN, AARON B · 2014 to 2018
$1.7M
Profibrotic Mechanisms of the TRPV4-PI3K-gamma Protein ComplexR01HL158746 · NHLBI · CLEVELAND CLINIC LERNER COM-CWRU · PI OLMAN, MITCHELL ALAN · 2021 to 2024
$1.6M
PVDOMICS Defining the Future Fingerprints of Pulmonary Vascular DiseaseU01HL125218 · NHLBI · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI BERMAN-ROSENZWEIG, ERIKA S., HORN, EVELYN · 2014 to 2018
$1.6M
Redefining Pulmonary Hypertension through Pulmonary Vascular Disease Phenomics: Clinical Centers (CC) (U01).U01HL125205 · NHLBI · MAYO CLINIC ROCHESTER · PI FRANTZ, ROBERT PAUL · 2014 to 2018
$1.5M
A molecular phenotype of combined pulmonary hypertensionU01HL125212 · NHLBI · VANDERBILT UNIVERSITY MEDICAL CENTER · PI HEMNES, ANNA R, NEWMAN, JOHN HUGHES · 2014 to 2018
$1.5M
Phenomic and genomic study to subphenotype Hispanics with pulmonary hypertensionU01HL125208 · NHLBI · UNIVERSITY OF ARIZONA · PI GARCIA, JOE G. N., RISCHARD, FRANZ P · 2014 to 2018
$1.5M
Hopkins Clinical Center for Pulmonary Vascular Disease Phenomics ProgramU01HL125175 · NHLBI · JOHNS HOPKINS UNIVERSITY · PI HASSOUN, PAUL M., MATHAI, STEPHEN C · 2015 to 2019
$1.1M
FDA HHS R01 FD007627NHLBI NIH HHS R01 HL158746NHLBI NIH HHS R01 HL170090NHLBI NIH HHS U01 HL125175NHLBI NIH HHS U01 HL125177NHLBI NIH HHS U01 HL125205NHLBI NIH HHS U01 HL125208NHLBI NIH HHS U01 HL125212NHLBI NIH HHS U01 HL125215NHLBI NIH HHS U01 HL125218
6 · The paper itself

Abstract

backgroundGroup 1 pulmonary arterial hypertension (PAH) is a progressive fatal condition characterized by right ventricular (RV) failure with worse outcomes in connective tissue disease (CTD). Obstructive sleep apnea and sleep-related hypoxia may contribute to RV dysfunction, though the relationship remains unclear.

objectivesThe aim of this study was to prospectively evaluate the association of the apnea-hypopnea index (AHI) and sleep-related hypoxia with RV function and survival.

methodsPulmonary Vascular Disease Phenomics (National Heart, Lung, and Blood Institute) cohort participants (patients with group 1 PAH, comparators, and healthy control participants) with sleep studies were included. Multimodal RV functional measures were examined in association with AHI and percentage of recording time with oxygen saturation <90% (T90) per 10-unit increment. Linear models, adjusted for demographics, oxygen, diffusing capacity of the lungs for carbon monoxide, pulmonary hypertension medications, assessed AHI and T90, and RV measures. Log-rank test/Cox proportional hazards models adjusted for demographics, oxygen, and positive airway pressure were constructed for transplantation-free survival analyses.

resultsAnalysis included 186 participants with group 1 PAH with a mean age of 52.6 ± 14.1 years; 71.5% were women, 80.8% were Caucasian, and there were 43 events (transplantation or death). AHI and T90 were associated with decreased RV ejection fraction (on magnetic resonance imaging), by 2.18% (-2.18; 95% CI: -4.00 to -0.36; P = 0.019) and 0.93% (-0.93; 95% CI: -1.47 to -0.40; P < 0.001), respectively. T90 was associated with increased RV systolic pressure (on echocardiography), by 2.52 mm Hg (2.52; 95% CI: 1.61 to 3.43; P < 0.001); increased mean pulmonary artery pressure (on right heart catheterization), by 0.27 mm Hg (0.27; 95% CI: 0.05 to 0.49; P = 0.019); and RV hypertrophy (on electrocardiography), 1.24 mm (1.24; 95% CI: 1.10 to 1.40; P < 0.001). T90, but not AHI, was associated with a 17% increased 5-year risk for transplantation or death (HR: 1.17; 95% CI: 1.07 to 1.28). In non-CTD-associated PAH, T90 was associated with a 21% increased risk for transplantation or death (HR: 1.21; 95% CI: 1.08 to 1.34). In CTD-associated PAH, T90 was associated with RV dysfunction, but not death or transplantation.

conclusionsSleep-related hypoxia was more strongly associated than AHI with measures of RV dysfunction, death, or transplantation overall and in group 1 non-CTD-associated PAH but only with RV dysfunction in CTD-associated PAH. (Pulmonary Vascular Disease Phenomics Program [PVDOMICS]; NCT02980887).

Indexed as

Heart FailureHypertension, PulmonaryPulmonary Arterial HypertensionVentricular Dysfunction, RightAdultAgedFemaleHumansHypoxiaMaleMiddle AgedOxygenSleepVentricular Function, RightOxygenconnective tissue disease–associated pulmonary arterial hypertensionobstructive sleep apneapulmonary arterial hypertensionpulmonary hypertensionright ventricular dysfunctionsleep-related hypoxia

Identifiers

PMID37968017
PMCPMC11060475
OpenAlexW4388623071

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.