Blood pressure increase detected by ambulatory monitoring correlates with hypoxemia reflecting sleep apnea severity

• Autorzy: Soňa Grešová , Zoltán Tomori , Martin Kurpas , Alexander Marossy , Adela Vrbenská , Martin Kundrík , Viliam Donič
• Języki publikacji: EN

Abstrakty

EN

Ambulatory blood pressure monitoring and parallel polysomnographic study were performed in 116 adult males divided into 6 groups. Thirty blood-pressure (BP) and polysomnographic variables were measured to test their usefulness for screening for both arterial hypertension and sleep apnea-hypopnea syndrome (SAHS). The development of severe breathing disorders and hypoxemia during sleep was attributed to SAHS, when compared with measurements in healthy controls and in patients with arterial hypertension. Such disorders manifested as an increased apnea-hypopnea index, apnea index, duration of arterial oxygen saturation of less than 85%, and decrease of average arterial oxygen saturation that correlated with nocturnal average diastolic BP (p=0.0049, p=0.0027, p=0.049 and p=0.0457, respectively). These respiratory disorders resulted in various nocturnal, rather than diurnal, and diastolic and systolic BP variables. The acute antihypertensive effect of continuous positive airway pressure therapy for SAHS significantly reduced the episodes of apnea and hypopnea and the secondary component of hypertension caused by excessive sympathetic stimulation. For the SAHS-induced, dose-dependent component of hypertension that responded to continuous positive airway pressure, the following variables, in decreasing significance, were useful: nocturnal average systolic and diastolic BP and 24-hour average systolic and diastolic BP, as well as percent time elevation and mean blood pressure load. The monitoring of these variables could contribute to early diagnostic and prognostic stratification of complications and adequate therapy of the secondary component of hypertension caused by SAHS.

Słowa kluczowe

EN

Blood pressure monitoring; Hypertension; Hypoxemia; Sleep apnea; Screening

• Czasopismo: Open Medicine
• Rocznik: 2009
• Tom: 4
• Numer: 2
• Strony: 222-232

Daty

wydano

2009-06-01

online

2009-03-27

Twórcy

autor

Soňa Grešová

• Department of Physiology, Medical Faculty, Safarik University, 040 66, Kosice, Slovak Republic,

autor

Zoltán Tomori

• Department of Physiology, Medical Faculty, Safarik University, 040 66, Kosice, Slovak Republic

autor

Martin Kurpas

• Department of Pathological Physiology, Medical Faculty, Safarik University, 040 66, Kosice, Slovak Republic

autor

Alexander Marossy

• Department of Physiology, Medical Faculty, Safarik University, 040 66, Kosice, Slovak Republic

autor

Adela Vrbenská

• Department of Pathology, Medical Faculty, Safarik University, 040 66, Kosice, Slovak Republic

autor

Martin Kundrík

• Department of Physiology, Medical Faculty, Safarik University, 040 66, Kosice, Slovak Republic

autor

Viliam Donič

• Department of Physiology, Medical Faculty, Safarik University, 040 66, Kosice, Slovak Republic

Bibliografia

• [1] Young T., Palta M., Dempsey J., Skatrud J., Weber S., Badr S., The occurrence of sleep-disordered breathing among middle-aged adults, N. Engl. J. Med., 1993, 328, 1230–1235 http://dx.doi.org/10.1056/NEJM199304293281704[Crossref]
• [2] Peppard P., Young T., Palta M., Skatrud J., Prospective study of the association between sleepdisordered breathing and hypertension, N. Engl. J. Med., 2000, 342, 1378–1384 http://dx.doi.org/10.1056/NEJM200005113421901[Crossref]
• [3] Morgan B.J., Crabtree D.C., Palta M., Skatrud J.B., Combined hypoxia and hypecapnia evoked longlasting sympatetic activation in humans, J. Appl. Physiol., 1995, 79, 205–213
• [4] Xie A., Skatrud J.B., Crabtree D.C., Puleo D.S., Goodman B.M., Morgan B.J., Neurocirculatory consequences of intermittent asphyxia in humans, J. Appl. Physiol., 2000, 89, 1333–1339
• [5] Hla K.M., Skatrud J.B., Finn L., Palta M., Young T., The effect of correction of sleep-disordered breathing on BP in untreated hypertension. Chest, 2002, 122(4), 1125–1132 http://dx.doi.org/10.1378/chest.122.4.1125[Crossref]
• [6] Bradley T.D., Tkacova R., Hall M.J., Ando S., Floras J.S., Augmented sympathetic neural response to simulated obstructive apnoea in human heart failure, Clin. Sci., 2003, 104, 231–238 http://dx.doi.org/10.1042/CS20020157[Crossref]
• [7] Shamsuzzaman A.S., Gersh B.J., Sommers V.V., Obstructive sleep apnoea complications and cardiovascular disease, 2003, JAMA, 290, 1906–1914 http://dx.doi.org/10.1001/jama.290.14.1906[Crossref]
• [8] Young T., Peppard P., Palta M., Hla K.M., Finn L., Morgan B., et al., Population-based study of sleepdisordered breathing as a risk factor for hypertension, Arch. Intern. Med., 1997, 157, 1746–1752 http://dx.doi.org/10.1001/archinte.157.15.1746[Crossref]
• [9] Singh J., Larson M., Manolio T., O’Donnell C., Lauer M., Evans J., et al., Blood pressure response during treadmill testing as a risk factor for new-onset hypertension (Framingham Heart Study), Circulation, 1999, 99, 1831–1836
• [10] Davies C.W., Crosby J.H., Mullins R.L., Barbour C., Davies R.J., Stradling J.R., Case-control study of 24 h ambulatory blood pressure in patients with obstructive sleep apnoea and normal matched control subjects, Thorax, 2000, 55, 736–740 http://dx.doi.org/10.1136/thorax.55.9.736[Crossref]
• [11] Nieto F.J., Young T., Lind B.K., Sharar E., Samet J.M., Redline S., et al., Association of sleep apnea and hypertension in a large community-based study. JAMA, 2000, 283, 1829–1836 http://dx.doi.org/10.1001/jama.283.14.1829[Crossref]
• [12] Haas D.C., Foster G.L., Nieto F.J., Redline S., Resnick H.E., Robbins J.A., et al., Age-dependent associations between sleep-disordered breathing and hypertension, Circulation, 2005, 111, 614–621 http://dx.doi.org/10.1161/01.CIR.0000154540.62381.CF[Crossref]
• [13] Pepin J.L., Baguet J.P., Hammer L., Pierre H., Levy P., Mallion J.M., Diastolic diurnal hypertension is a common and underestimated situation in patients with unknown hypertension at time of sleep apnea diagnosis. Sleep Medicine, 2003, 4Suppl, 1, S1–S56
• [14] Baguet J.P., Hammer L., Levy P., Pierre H., Rossini E., Mouret S., et al., Night-time and diastolic hypertension are common and underestimated conditions in newly diagnosed apnoeic patients, J. Hypertens, 2005, 23(3), 521–527 http://dx.doi.org/10.1097/01.hjh.0000160207.58781.4e[Crossref]
• [15] Lavie P., Herer P., Peled R., Berger I., Yoffe N., Zomer J., et al., Mortality in sleep apnea patients: a multivariate analysis of risk factors, Sleep., 1995, 18(3), 149–157
• [16] Staessen J.A., Fagard R., Thijs L., Celis H., Arabidze G.G., Birkenhäger W.H., et al., Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension, The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators, Lancet, 1997, 13, 350(9080), 757–764 http://dx.doi.org/10.1016/S0140-6736(97)05381-6[Crossref]
• [17] Donic V., Donicová V., Lesko R., Tomori Z., Screening of sleep apnea from values obtained by monitoring of blood pressure and heart rate variability. Monitorovanie TK a frekvencie srdca ako metóda zis’ovania výskytu spánkového apnoe, Sb. Lek., 2002, 103(1), 85–90, (in Slovak)
• [18] Logan A.G., Tkacova R., Perlikowski S.M., Leung R.S., Tisler A., Floras J.S., et al., Refractory hypertension and sleep apnoea: effect of CPAP on blood pressure and baroreflex. Eur Respir J., 2003, 21(2), 241–247 http://dx.doi.org/10.1183/09031936.03.00035402[Crossref]
• [19] Yaggi H.K., Concato J., Kernan W.N., Lichtman J.H., Brass L.M., Mohsenin V., Obstructive sleep apnea as a risk factor for stroke and death, N Engl J Med., 2005, 10, 353(19), 2034–2041 http://dx.doi.org/10.1056/NEJMoa043104[Crossref]
• [20] Szaboová E., Tomori Z., Donič V., Petrovičová J., Szabó P., Sleep apnoea inducing hypoxemia is associated with early sign of carotid atherosclerosis in males, Respir. Physiol. & Neurobiol., 2007, 155, 121–127 http://dx.doi.org/10.1016/j.resp.2006.05.004[Crossref]
• [21] Nagata K., Osada N., Shimazaki M., Kida K., Yoneyama K., Tsuchiya A., et al., Diurnal blood pressure variation in patients with sleep apnea syndrome, Hypertens Res., 2008, 31(2), 185–191 http://dx.doi.org/10.1291/hypres.31.185[Crossref]
• [22] Grote L., Hedner J., Peter J.H., Sleep-related breathing disorder is an independent risk factor for uncontrolled hypertension., J Hypertens. 2000, 18, 679–685 http://dx.doi.org/10.1097/00004872-200018060-00004[Crossref]
• [23] Grote L., Hedner J., Peter J.H., Mean blood pressure, pulse pressure and grade of hypertension in untreated hypertensive patients with sleeprelated breathing disorders, J. Hypertens., 2001, 19, 683–690 http://dx.doi.org/10.1097/00004872-200104000-00004[Crossref]
• [24] Martinez-Garcia M.A., Gomez-Aldaravi R., Soler-Cataluna J.J., Martinez T.G., Bernacer-Alpera B., Roman-Sanchez P., Positive effect of CPAP treatment on the control of difficult-totreat hypertension. Eur. Respir. J., 2007, 29(5), 951–957 http://dx.doi.org/10.1183/09031936.00048606[Crossref]
• [25] Penzel T., Mayer J., Peter J.H., Podszus T., Voigt K.H., von Wichert P., Continuous non-invasive blood pressure monitoring in patients with sleep disorders, Physiol. Res., 1992, 41(1), 11–17
• [26] Penáz J: Criteria for set point estimation in the volume clamp method of blood pressure measurement. Physiol Res 41(1): 1992. 5–10
• [27] Sharabi Y., Scope A., Chorney N., Grotto I., Dagan Y., Diastolic blood pressure is the first to rise in association with early subclinical obstructive sleep apnea: lessons from periodic examination screening, Am. J. Hypertens., 2003, 16(3), 236–239 http://dx.doi.org/10.1016/S0895-7061(02)03250-8[Crossref]
• [28] Hermida R.C., Zamarrón C., Ayala D.E., Calvo C., Effect of continuous positive airway pressure on ambulatory blood pressure in patients with obstructive sleep apnoea, Blood Press Monit., 2004, 9(4), 193–202 http://dx.doi.org/10.1097/00126097-200408000-00004[Crossref]
• [29] Guidelines 1999 World Health Organization- International Society of Hypertension Guidelines for the Management of Hypertension. Guidelines Subcommittee, J. Hypertens., 1999, 17, 151–183
• [30] Verdecchia P., Porcellati C., Schillaci G., Borgioni C., Ciucci A., Battistelli M., et al., Ambulatory blood pressure, An independent predictor of prognosis in essential hypertension, Hypertension, 1994, 24(6), 793–801 [Crossref]
• [31] Duchna H.W., Guilleminault C., Stoohs R.A., Vascular reactivity in obstructive sleep apnea syndrome. Am. J. Respir., Crit. Care Med., 2000, 161, 187–191
• [32] Kraiczi H., Hedner J., Peker Y., Carlson J., Increased vasoconstrictor sensitivity in obstructive sleep apnea, J. App. Physiol., 2000, 89, 193–498
• [33] Morell M., Finn L., Kim H., Peppard P., Badr S., Young T., Sleep fragmentation, awake blood pressure. and sleep-disordered breathing in a population-based study, Am. J. Respir. Crit. Care. Med., 2000, 162, 2091–2096
• [34] Parati G., Di Rienzo M., Omboni S., Ulian L., Mancia G., Blood presure variability over 24 hours: its different cemponents and relationship to the arterial baroreflex, J. Sleep Res., 1995, 4, 21–29 http://dx.doi.org/10.1111/j.1365-2869.1995.tb00181.x[Crossref]
• [35] Phillips B.G., Narkiewicz K., Pesek C.A., Haynes W.G., Dyken M.E., Somers V.K., Effect of obstructive sleep apnea on endothelin-1 and blood pressure, J. Hypertens, 1999, 17, 61–66 [Crossref]
• [36] Tomori Z., Widdicombe J.G., Muscular, bronchomotor and cardiovascular reflexes elicited by mechanical stimulation of the respiratory tract. J Physiol., 1969, 200, 25–49
• [37] Švorc P., Beňačka R., Petrašová D., Bračoková I., Kujaník S., Effect of systemic hypoxia and reoxygenation on electrical stability of the rat myocardium: Chronophysiological study, Physiol. Res., 2005, 54, 319–325
• [38] Gus M., Goncalves S.C., Martinez D., de Abreu Silva E.O., Moreira L.B., Fuchs S.C., et al., Risk for Obstructive Sleep Apnea by Berlin Questionnaire, but not daytime sleepiness, is associated with resistant hypertension: a case-control study, Am J Hypertens., 2008, 21(7), 832–835 http://dx.doi.org/10.1038/ajh.2008.184[Crossref]
• [39] Selcoki Y., Uz B., Baybek N., Akcay A., Eryonucu B., The effects of nocturnal dipping on cardiovascular outcomes and proteinuria in essential hypertensive patients, Cent. Eur. J. Med., 2008, 3(3), 279–286 http://dx.doi.org/10.2478/s11536-008-0009-y[Crossref][WoS]
• [40] Kohler M., Pepperell J.C., Casadei B., Craig S., Crosthwaite N., Stradling J.R., et al., CPAP and measures of cardiovascular risk in males with OSAS, Eur Respir J., 2008, 32(6), 1488–1496 http://dx.doi.org/10.1183/09031936.00026608[Crossref][WoS]
• [41] Fagard R.H., Thijs L., Staessen J.A., Clement D.L., Buyzere M.L., De Bacquer D.A., Prognostic significance of ambulatory blood pressure in hypertensive patients with history of cardiovascular disease, Blood Press Monitor., 2008, 13(6), 325–332 http://dx.doi.org/10.1097/MBP.0b013e32831054f5[Crossref]
• [42] Atanassova P.A., Chalakova N.T., Dimitrov B.D., Diastolic blood pressure cut-off predicts major cerebrovascular events after minor ischaemic stroke: a post-hoc modelling study, Cent. Eur. J. Med., 2008, 3(4), 430–437 http://dx.doi.org/10.2478/s11536-008-0064-4[Crossref][WoS]

Identyfikatory

DOI

10.2478/s11536-009-0011-z