<Kingman Strohl M.D.> Hello there, I'm getting settled.

<Moderator> *** May I have your attention please. ***
<Moderator> *** Welcome to the Guest Expert Chat. ***
<Moderator> *** The guest speaker today is Dr. Kingman Strohl, Pulmonalogist, specializing in sleep disorders and PH. ***
<Moderator> *** Topic: PH and Sleep Disorders ***
<Moderator> *** My name is Michael and I will be the moderator for this chat. ***
<Moderator> *** The guidelines for this chat are: ***
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<Moderator> *** OK, let's begin. If you have a question for Dr. Strohl, please send a "?"

<Norman A> Is there a connection between upper respiratory distress syndrome and ph?

<Kingman Strohl M.D.> Would you clarify the term "upper respiratory distress syndrome"?

<Norman A> Yes, I was told in the sleep clinic it is a"cousin" of apnea in that I wake up 24x per hour without knowing it.

<Kingman Strohl M.D.> There is a condition called upper airway resistance syndrome that is a "cousin" of sleep apnea. In this case, there is no complete cessation of airflow (apnea) but there is a reduction in airflow with a high grade resistacne (obstruction) in the upper airway (nose and/or throat)...

<Norman A> What can be done and does it likely lead to moderate hp?

<Kingman Strohl M.D.> This produces arousals during sleep so that your sleep is fragmented. This usually is not associated with PH, or at least there are no case series showing PH andthe entity.

<Bev b> Is there a correlation between pulmonary hypertension and sleep apnea. I read in the Chest Journal that people taking fenfluramines got not only PPH but SPH at 11.4% rate/ Could you comment?

<Kingman Strohl M.D.> PH can and does produce SPH, but the incidence is unknown. More commonly people are sleepy or have hypertension. Sorry OSA (sleep apnea) can cause PH. The issue to me seems that sleep apnea is common, and so it will occur in any case sewries of people that expsosed to a drug that might cause PH.

<Bev b> Can you build up carbon dioxide in you system by using the CPAP?

<Kingman Strohl M.D.> The systems are not designed to build up CO2, there is a controlled leak at the mask.

<lynnzs> I have the hoarse voice often associated with PPH--from the enlarged pulmonary artery. Could this possibly cause my sleep apnea? The apnea is apparently not the cause of my PH.

<Kingman Strohl M.D.> I guess that the enlarged pulmonary artery on the right caused a stretch injury to the recurrent laryngeal nerve. Usually, laryngeal problems do not cause sleepapnea but awakenings from saliva gettinginto the airway.

<lynnzs> Ahh...How often should one be retested with a sleep test?

<Kingman Strohl M.D.> (Probably the artery on the left rather)

<alex> refering to Bev's question : so than regardless if you have ph, it is common to have apnea? or is it that those with ph just happen to have apnea? thank you Dr. Strohl

<Kingman Strohl M.D.> PPH and SPH are considered distinctly different. PPH is a diagnosis of exclusion whereas if you have sleep apnea and have an elevated pulmonary artery pressure one presumes that the PH follows the sleep apnea.

<Kathleen> Did I understand you to say that apnea causes HTN? and possibly PH as well?

<Kingman Strohl M.D.> Sleep apnea is associated with systemic hypertension, stroke, and nocturnal angina, possibly more commonly than with PH.

<Bev b> If you have been diagnosed with apnea will you see a significant change in your oxygen levels and how soon?

<Kingman Strohl M.D.> Sleep apnea is accompanied by a fall in oxygen levels and an increase in carbon dioxide levels with each apnea. After treatment there may occur an improvement in arterial blood gases but it may take some time.

<Kingman Strohl M.D.> Sleep apnea leads to hypoxemia at night which leads to changes in breathing and gas exchange during the day. Treatment unravels the daytime problems but more slowly than you might think.

<Kyle> I am a heavy duty snorer,would this mean I have sleep apnea?

<Kingman Strohl M.D.> It is not snoring per se but the type of snoring with pauses and snorts and being heard in the next room. Heavy snorers do have an increased chance of obstructive sleep apnea, but it really is heralded by the loudness, frequency and the presence of pauses.

<Carol L.> Has there been any progress made on doing a formal study using nitric oxide in adults?

<Kingman Strohl M.D.> I hear rumors that there is interest now that the FDA has approved NO use in the intensive care unit.

<Pat KL> This is for Martha, who can't get back in the room. She would like to know how long it take for PH to reverse, if it's going to, after you get on a cpap?

<Moderator> 2 studies show that PH pressures fall after 18 months of therapy

<Cindy in NJ> Are there any lung diseases that could cause someone to look like they have sleep apnea during testing in the sleep lab?

<Kingman Strohl> Patients with lung disease like COPD will have falls in oxygen like those with sleep apnea, but the indicator for sleep apnea is the reduction or absence of airflow. Sleep apnea can occur in people with or without all types of lung and heart problems.

<Norman A> Sorry error. does long term hypertension lead to hp?

<Kingman Strohl> Systemic hypertension and sleep apnea are associated, but you can have one without the other. If the hypertension was easily controlled, and your heart is not enlarged it might be that the sleepapnea came on by itself. Possibly the PH came on by itself. By all accounts, the most common cause for pulmonary hypertension is beleived to be left heart failure. Inthose with PPH, there should be no evidence for left heart failure.

<Bev b> What if you are in a room with another snorer does that effect the test?

<Kingman Strohl> Sure. there would be more arousals and more disturbed sleep. More chance to be falling asleep and having respiratory variations.

<Bev b> So it would be better to take the test in a hospital in a private room?

<Kingman Strohl> Better for whom?

<Kingman Strohl> The reuslts are all relative. If that is what one usually does, then it would be valid.

<Emilia> How come I have had a problem falling asleep I am not tired and I keep staring at the alarm clock for later hours eache night?
<Emilia> I have SPH taking Phenobarbital since birth for a Seizure Disorder caused by Atrial Fibrilation which I was born with.

<Kingman Strohl> Difficulty in falling asleep is fairly common...

<Kingman Strohl> One thing to think about is how you get ready for sleep. Do you unwind? Do you have a quiet safe palce to sleep? If you are not tired, get out of bed an d read until you are ready to go to sleep. If the problem persists, keep track of it with a sleep diary.

<Emilia> What do you mean unwind? I listen to the walkman I don't feel sleepy. I can't get up although I would love too my family gets mad and fights with me.

<Kingman Strohl> Sounds like the family needs to get together on this one. It is not uncommon for one member to have a different sleep-wake pattern than another.

<Fay/NC> My CPAP is set at 13..is this unusually high? Will I ever be able to get off CPAP? Dr. said I have PH

<Kingman Strohl>A CPAP of 13 is in the high but reasonable range. One usually needs it for a long time. It may take some time for the pulmonary artery pressure start to fall.

<sharon(on)> Hello Dr. Strohl, I have Sph due from asd, right side heart enlargement, I sometimes can't sleep because I can't breath and get arrhythmias together, is this a cause from the pa pressures rising or sleep apnea? what could I do to help myself breath better so I can sleep?

<Kingman Strohl> There are a couple of issues here. One is the possibility to reduce pulmoanry artery pressures more. Another is to use oxygen. It is difficult for me to be more specific without sorting out the phsyiologic from the catherizations and taking a sleep history.

<Kingman Strohl> Sharon, do you talk to your cardiologist about sleep?

<sharon(on)> Not yet, I've just been started on new meds. I haven't seen the card. in awhile

<Kingman Strohl> When starting any new med, ask about sleep effects, or the optimal time of day to take the med.

<Kathleen> I know there is a connection between obesity and apnea. What % of obese people have apnea? Is there a family connection with apnea, other than obesity?

<Kingman Strohl> About a third of people who are obese (a BMI >29) will have a good number of apneas during sleep and will have disturbed sleep. There are three or four patterns of familial apnea besides obesity. One is jaw length. And of course there can be more than one thing operating in the family- i.e obesity and jaw length.

<mcats> My CPAP is set at 13 also. What is the 'normal' range for a CPAP and do your PH symptoms get worse before getting better? What is average time before obtaining relief?

<Kingman Strohl> Our survey in Cleveland had pressures raning from 5-18cmH2O, with an average of 11 and 75% of the values between 8-14. The CPAP may feel a bit uncomfortaable, but things should get better. Often besides CPAP I have people watch their diet, salt, and food, and increase water.

<mcats> I did not have sleep apnea prior to taking Redux, do you believe diet drugs can cause sleep apnea?

<Kingman Strohl> No data.

<Cindy in NJ> Is it common to get extreme nasal congestion and then a runny nose as a result of using the Bipap machine with oxygen also. Do you have any suggestions on how to reduce the amount of congestion and /or mucous secretion.

<Kingman Strohl> The things to try first are humidification and medications (like atrovent nasal) to dry out the nose. Usually I try nasal steroids. Some people I have evaluated by ENT.

<Moderator> Thanks, Everyone!

<Moderator> Thank You Dr. Strohl!