ArticleAnnals of the American Thoracic Society2026
Morning Larks and Night Owls: Considering Chronotype in Evaluation of Patients with Pulmonary Hypertension.
Article in Annals of the American Thoracic Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
rationalePulmonary hypertension (PH) is a systemic illness with increasingly subtle disease manifestations, including sleep disruption. Patients with PH are at increased risk for disturbances in circadian biology, although, to date, there are no data on "morningness" or "eveningness" in pulmonary vascular disease.
objectivesOur group studied circadian rhythms in patients with PH, on the basis of chronotype analysis, to explore whether there is a link between circadian parameters and physiological risk-stratifying factors to inform novel treatment strategies in patients with PH.
methodsWe serially recruited participants from July 2022 to March 2024 by administering the Munich Chronotype Questionnaire in clinic. We then compared free-day sleep measurements in patients with PH and bed-partner control subjects (BPCs), investigating associations with survival predictors. In exploratory analysis, we looked for associations between known single-nucleotide polymorphism (SNP) variants of core clock genes and cardiopulmonary hemodynamics. Finally, we performed circadian analysis of time-stamped heart rate variation from a PH cohort compared with control subjects.
resultsIn this pilot study, we recruited 103 patients with PH and 38 BPCs, ages 20 to 86 years. Compared with BPCs, patients with PH had longer sleep duration and less social jet lag (SJL), with no clear difference in chronotype. Within the PH cohort, sleep duration was associated with worse functional class, whereas SJL was associated with a low risk for disease progression and more severe signs of right ventricular dysfunction. However, a later chronotype was associated with a decrease in mean pulmonary artery pressure. In an independent cohort of patients with PH, there was a relationship between functionally distinct core clock gene SNP variants and relevant hemodynamic parameters. Patients with PH exhibited a distinct delayed phase shift in circadian HR variation.
conclusionsPH in adults is associated with significant changes in sleep duration and SJL, corroborated by both genomic and physiologic data. Dependence between circadian variables, SNP data, and disease characteristics suggest that findings may directly relate to disease pathogenesis through derangement in the molecular core clock.
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