Orthopnea

Orthopnea is a form of dyspnea that is relieved by an upright posture and worsened when lying flat. Patients commonly report needing to sleep propped up on multiple pillows or in a chair to ease breathing, and the symptom may be more noticeable at night.

The condition is most often linked to congestive heart failure, particularly left-sided heart failure with pulmonary edema. When a person lies supine, shifts of fluid from the legs into the central circulation increase venous return and pulmonary capillary pressure, promoting fluid leakage into the lungs and shortness of breath.

Other cardiac and non-cardiac conditions can cause orthopnea, including valvular heart disease, cardiomyopathy, obesity hypoventilation, chronic obstructive pulmonary disease with coexisting heart disease, severe anemia, and ascites. Orthopnea must be distinguished from platypnea, which is dyspnea that occurs when upright and improves lying down.

Evaluation typically includes a focused history and physical examination, assessment of heart failure symptoms, and investigations such as chest imaging and measurement of natriuretic peptides. Echocardiography and ECG assess structural heart disease, while sleep studies may be considered if sleep-disordered breathing is suspected.

Management centers on treating the underlying condition and relieving pulmonary congestion. In acute settings, sitting upright, supplemental oxygen, and diuretics are common. Long-term management may involve optimization of heart failure therapy, management of anemia or obesity, and addressing sleep apnea; positioning devices and gradual fluid balance can help in selected patients.