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Original Investigation
August 14/28, 2000

Bilateral Leg Edema, Obesity, Pulmonary Hypertension, and Obstructive Sleep Apnea

Author Affiliations

From the Departments of Family Medicine (Drs Blankfield and Zyzanski and Ms Tapolyai) and Medicine (Dr Hudgel), Case Western Reserve University School of Medicine, and the Division of Pulmonary and Critical Care Medicine, Department of Medicine, The MetroHealth Medical Center (Dr Hudgel), Cleveland, Ohio; and University Hospitals Primary Care Physician Practice, Berea, Ohio (Dr Blankfield). Dr Blankfield owns stock in Respironics, Inc, Pittsburgh, Pa.

Arch Intern Med. 2000;160(15):2357-2362. doi:10.1001/archinte.160.15.2357

Background  Pulmonary hypertension is usually due to an underlying cardiac or pulmonary condition. An association between unexplained pulmonary hypertension and bilateral leg edema in primary care patients was found previously. We undertook this study to identify the frequency of obstructive sleep apnea (OSA) in ambulatory, adult patients with pulmonary hypertension who initially presented with bilateral leg edema.

Methods  Twenty ambulatory adults with bilateral leg edema, with echocardiocardiographic evidence of pulmonary hypertension (estimated pulmonary artery systolic pressure >30 mm Hg), and without left ventricular dysfunction or with no clinically apparent pulmonary disease were enrolled from a suburban family practice and an inner-city family practice during a 3-year period. Spirometric assessment, pulse oximetry, rheumatologic evaluation, polysomnography, and questionnaire information regarding risk factors for pulmonary hypertension were obtained for each subject.

Results  Fifteen patients (75%) completed the study. Almost all of the subjects were obese. Nine (60%) of the 15 had OSA. None of the subjects demonstrated an obstructive pattern on spirometric evaluation results, but 9 (60%) had a restrictive spirometry pattern, consistent with their obesity. None of the subjects had daytime hypoxemia. Systemic hypertension was present in two-thirds of the subjects with OSA, and was absent in all of the subjects who lacked OSA.

Conclusions  Bilateral leg edema in obese primary care patients is associated with both OSA and modest pulmonary hypertension. If these findings are generalizable, then bilateral leg edema may be an important clinical marker for underlying OSA.