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1 Sleep Laboratory, Division of Pulmonary Diseases, Dept of Internal Medicine, and 2 Dept of Physiology, Marburg University, Germany. 3 Dept of Pulmonary Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
CORRESPONDENCE: J. Heitmann, Klinik für Innere Medizin, SP Pneumologie, Schlafmedizinisches Labor, Klinikum der Philipps-Universität Marburg, Baldingerstrasse D-35033, Marburg, Germany. Fax: 49 6421284958. E-mail: heitmanj@med.uni-marburg.de
Keywords: continuous positive airways pressure treatment, hypertension, sleep apnoea, sympathetic activity
Received: February 12, 2003
Accepted September 22, 2003
This study was supported by a scientific grant from the Deutsche Forschungs gemeinschaft (Eh 149/1-1).
There is increasing evidence that nasal continuous positive airway pressure (nCPAP) lowers blood pressure in obstructive sleep apnoea (OSA) patients, not only during sleep but also in the daytime. However, both the mechanisms of blood pressure reduction and the considerable differences in the magnitude of the effect in the studies presented to date are not fully understood.
Therefore, the authors prospectively studied the effect of nCPAP on noradrenaline plasma levels (NApl), blood pressure and heart rate (HR) in 10 normotensive and eight hypertensive OSA patients before and after 41.6±16.9 days of nCPAP therapy. Polysomnography and invasive blood pressure were continuously monitored over 24 h in the supine position before and with nCPAP. NApl were analysed every 15 min.
In hypertensives, nCPAP reduced NApl by 36±25%, lowered mean arterial blood pressure substantially (night-time: –8.89±14.09 mmHg; daytime: –7.94±10.47 mmHg) and decreased HR by 6.6±5.4 beats·min–1, whereas in normotensives there were only minor changes.
The decrease in heart rate was associated with a decrease in mean arterial blood pressure and noradrenaline plasma levels, suggesting a causal effect of nasal continuous positive airway pressure therapy. This nasal continuous positive airway pressure effect occurs mainly in hypertensive obstructive sleep apnoea patients, whereas the effect is small in normotensives. This may explain, at least in part, some of the discrepant results in previous treatment studies.
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