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Blood pressure responsiveness to obstructive events during sleep after chronic CPAP

Institute of Biomedicine and Molecular Immunology, Section of Respiratory Pathophysiology, National Research Council, Palermo, Italy

CORRESPONDENCE: O. Marrone, Consiglio Nazionale delle Ricerche, IBIM, Fisiopatologia Respiratoria, Via Ugo La Malfa, 153, 90146, Palermo, Italy. Fax: 39 916809122. E-mail: marrone@ifr.pa.cnr.it

Keywords: blood pressure, continuous positive airway pressure, hypoxaemia, obstructive sleep apnoea

Received: May 14, 2002
Accepted October 23, 2002

This study was performed for the "Protocollo d'intesa della Ricerca Finalizzata 2000", developed with Fondazione don Carlo Gnocchi Onlus, Convenzione ICS 030.7/RF 00.80.

The aim of this study was to investigate whether chronic continuous positive airway pressure (CPAP) affects blood pressure (BP) responsiveness to obstructive events occurring on the first night of CPAP withdrawal in obstructive sleep apnoea (OSA) after chronic treatment.

Thirteen male subjects with severe OSA underwent nocturnal polysomnography with beat­by­beat BP monitoring before treatment and after 4.9±3.4 months of home CPAP (mean daily use 5.1±1.7 h). Variations in oxyhaemoglobin saturation (S_a,O2), systolic (P_s), and diastolic (P_d) BP within nonrapid eye movement apnoeas and hypopnoeas were measured on a sample of pre­ and post­treatment events. In addition, a pretreatment sample was selected for S_a,O2 to match post­treatment events.

The higher the mean S_a,O2 was in the full pretreatment sample, the more S_a,O2, P_s and P_d were attenuated after treatment. Mean P_s decreased from 47.3±8.5 in the full pretreatment sample to 42.2±6.9 in the selected pretreatment sample, to 31.5±5.9 mmHg in the post­treatment sample. The post­treatment value differed significantly from both the pretreatment values. The corresponding values for mean P_d were 27.0±3.5, 24.0±3.1 and 19.6±3.7 mmHg, with all values differing significantly from each other.

Chronic continuous positive airway pressure is followed by a decrease in apnoea/hypopnoea­related blood pressure swings, possibly secondary to both reduced severity of event­related hypoxaemia and decreased responsiveness to obstructive events secondary to chronic prevention of nocturnal intermittent hypoxaemia.

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