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March 10, 2020

Prevalence and Predictors of Elevated Central Venous Pressure and Obstructive Sleep Apnea Evaluated in Patients With Lower Extremity Chronic Venous Disease

March 10, 2020—Online in Journal of Vascular Surgery: Venous & Lymphatic Disorders (JVS-VL) , Raghu Kolluri, MD, et al published findings from a study of the prevalence and predictors of elevated central venous pressure (CVP) and obstructive sleep apnea (OSA) in patients with lower extremity chronic venous disease (CVD).

This single-center, retrospective, descriptive study was composed of patients referred to the investigators' tertiary care center (OhioHealth Riverside Methodist Hospital in Columbus, Ohio) with a diagnosis of CVD. Each patient was evaluated by a simultaneous venous duplex ultrasound to assess venous reflux and limited echocardiography of the right side of the heart to assess elevated CVP. The prevalence and predictors of elevated CVP in this cohort were assessed using multivariate logistic regression.

As summarized in JVS-VL, a total of 264 patients with CVD were evaluated; of these, 22.7% had elevated CVP and 26.9% had OSA.

The investigators reported that there was no significant difference in the prevalence of OSA or elevated body mass index in the group with elevated CVP compared with patients with normal CVP.

Additionally, the findings demonstrated that the predictors of elevated CVP were > 64.6 years old (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.003–1.05; P = .026), diabetes mellitus (OR, 2.19; 95% CI, 1.05–4.5; P = .035), and right lower extremity Venous Clinical Severity Score of ≥ 8.5 (OR, 1.098; 95% CI, 1.01–11.193; P = .026). Other predictors included a history of pulmonary embolism and renal insufficiency.

The investigators concluded that the prevalence of elevated CVP and OSA is significant in this cohort of patients compared with the general population and that age, diabetes, and right lower extremity chronic venous insufficiency symptoms seem to be predictors of elevated CVP.

Larger, population-based prevalence studies are needed to confirm these findings, noted the investigators in JVS-VL.

Discussing the findings with Endovascular Today, Dr. Kolluri commented, "All venous specialists encounter patients that present with symptoms that mimic venous disease but do not respond to venous therapies. Very little was known about the role of elevated CVPs and peripheral venous hypertension. In our study at the OhioHealth/Riverside Methodist Hospital, we noted significant prevalence of both CVP and OSA in patients who were referred to us for chronic venous insufficiency. We hope that our paper sheds some light on elevated CVP and its potential role in patients presenting with chronic venous insufficiency symptoms."

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