Skip to main content
SpringerLink
Log in

Cardiovascular autonomic dysfunction in normotensive awake subjects with obstructive sleep apnoea syndrome

  • Research Paper
  • Published:
Clinical Autonomic Research Aims and scope Submit manuscript

Abstract

Cardiovascular autonomic function in normotensive awake patients with obstructive sleep apnoea syndrome was studied in 21 normotensive (mean age 48 ± 14 years), drug-free men with obstructive sleep apnoea syndrome. Cardiovascular reflex tests with continuous blood pressure monitoring and biochemical indices were performed the morning after a standard polygraphic sleep recording. A group of 20 agematched (mean age 49 ± 19 years) normal subjects was used as controls. The obstructive sleep apnoea syndrome patients showed higher heart rate and noradrenaline plasma levels (p < 0.05) at rest and a higher blood pressure response to head-up tilt (p < 0.01), suggesting sympathetic overactivity. Respiratory arrhythmia, baroreflex sensitivity index and Valsalva ratio were significantly lower in the obstructive sleep apnoea syndrome group (p < 0.01) whereas the decrease in heart rate induced by the cold face test was significantly higher (p < 0.05) showing a blunting of reflexes dependent on baroreceptor or pulmonary afferents with normal or increased cardiac vagal efferent activity. These abnormalities in autonomic regulation may predispose obstructive sleep apnoea syndrome patients to cardiovascular complications like hypertension and cardiac arrhythmias.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Coccagna G, Mantovani M, Brignani F, Parchi C, Lugaresi E. Continuous recording of the pulmonary and systemic arterial pressure during sleep in syndromes of hypersomnia with periodic breathing.Bull Physiopathol Respir 1972;8: 1159–1172.

    Google Scholar 

  2. Parish JM, Shepard JW, Jr. Cardiovascular effects of sleep disorders.Chest 1990;97: 1220–1226.

    PubMed  Google Scholar 

  3. Mondini S, Zucconi M, Cirignotta F, Aguglia U, Lenzi PL, Zauli C, Lugaresi E. Snoring as a risk factor for cardiac and circulatory problems. An epidemiological study. In: Guilleminault C, Lugaresi E, eds.Sleep/Wake Disorders: Natural History, Epidemiology and Long Term Evolution. New York: Raven Press, 1983; 99–105.

    Google Scholar 

  4. Hoffstein V, Chan CK, Slutsky AS, Sleep apnea and systemic hypertension: a causal association review.Am J Med 1991;91: 190–196.

    PubMed  Google Scholar 

  5. Milman RP, Redline S, Carlisle CC, Assaf AR, Levinson PD. Daytime hypertension in obstructive sleep apnea.Chest 1991;99: 861–866.

    PubMed  Google Scholar 

  6. Lavie P, Yoffe N, Berger I, Peled R. The relationship between the severity of sleep apnea syndrome and 24-h blood pressure values in patients with obstructive sleep apnea.Chest 1993;103: 717–721.

    PubMed  Google Scholar 

  7. Stradling JR. Sleep apnea and systemic hypertension.Thorax 1989;44: 984–989.

    PubMed  Google Scholar 

  8. Guilleminault C, Connolly SJ, Dement WC. Cardiac arrhythmias and conduction disturbances during sleep in 400 patients with sleep apnea syndrome.Am J Cardiol 1983;52: 490–494.

    PubMed  Google Scholar 

  9. Shepard WJ, Jr, Garrison MW, Grither DA, Dolan GF. Relationship to ventricular ectopy to oxyhaemoglobin desaturation in patients with obstructive sleep apnea.Chest 1985;88: 335–340.

    PubMed  Google Scholar 

  10. Eisenberg E, Zimlichman R, Lavie P. Plasma norepinephrine in patients with sleep apnea syndrome.New Engl J Med 1990;322: 13, 932–933.

    PubMed  Google Scholar 

  11. Ehlenz K, Kohler U, Mayer J, Peter JH, von Wichert P, Kaffarnik H. Plasma levels of catecholamines and cardiovascular parameters during sleep in patients with sleep apnea syndrome. In: Peter JH, Podszus T, von Wichert P, eds.Sleep Related Disorders and Internal Diseases. New York: Springer Verlag, 1987; 321–325.

    Google Scholar 

  12. Fletcher EC, Miller J, Schaaf JW, Fletcher JG. Urinary catecholamines before and after tracheostomy in patients with obstructive sleep apnea and hypertension.Sleep 1987;10: 35–44.

    Google Scholar 

  13. Baruzzi A, Riva R, Cirignotta F, Zucconi M, Cappelli M, Lugaresi E. Atrial natriuretic peptide and catecholamines in obstructive sleep apnea syndrome.Sleep 1991;14: 83–86.

    PubMed  Google Scholar 

  14. Ehlenz K, Peter J, Kaffarnik H, Wichert PV. Disturbances in volume regulating hormone system—a key to the pathogenesis of hypertension in obstructive sleep apnea syndrome?Pneumologie 1991;45(S1): 239–245.

    PubMed  Google Scholar 

  15. Hedner J, Ejnell H, Sellgren J, Hedner T, Wallin G. Is high and fluctuating muscle nerve sympathetic activity in the sleep apnea syndrome of pathogenetic importance for the development of hypertension?J Hypertension 1988;6: S529-S531.

    Google Scholar 

  16. Hedner J, Ejnell H, Wallin G, Carlsson J, Caidahl K. Consequences of increased sympathetic activity in sleep apnea. A pathogenetic mechanism for cardiovascular complications? In: Horne J, ed.Sleep 90. Bochum: Pontenagel Press, 1990; 435–439.

    Google Scholar 

  17. Carlson JT, Hedner J, Elam M, Ejnell H, Sellgren J, Wallin G. Augmented resting sympathetic activity in awake patients with obstructive sleep apnea.Chest 1993;103: 1763–1768.

    PubMed  Google Scholar 

  18. Tafil-Klawe M, Raschke F, Becker H, Hein H, Stoohs R, Kublik A, Peter JH, Penzel T, Podszus T, von Wichert P. Investigation of arterial baro- and chemoreflexes in patients with arterial hypertension and obstructive sleep apnea. In: Peter JH, Penzel T, Podszus T, von Wichert P, eds.Sleep and Health Risk. Berlin: Springer-Verlag, 1991; 319–334.

    Google Scholar 

  19. Somers VK, Dyken ME, Mark AL, Abboud FM. Parasympathetic hyperresponsiveness and bradyarrhythmias during apnoea in hypertension.Clin Auton Res 1992;2: 171–176.

    PubMed  Google Scholar 

  20. Coccagna G, Mantovani M, Brignani F, Parchi C, Lugaresi E. Tracheostomy in hypersomnia with periodic breathing.Bull Physiopathol Respir 1972;8: 1217–1227.

    Google Scholar 

  21. Krieger J, Follenius M, Sforza E, Brandenberger B. Water and electrolite metabolism in obstructive sleep apnea. In: Horne J, ed.Sleep 90. Bochum: Pontenagel Press, 1990; 429–434.

    Google Scholar 

  22. Hanly PJ, George CF, Millar TW, Kryger MH. Heart rate response to breath-hold, Valsalva and Mueller maneuvers in obstructive sleep apnea.Chest 1989;95: 735–739.

    PubMed  Google Scholar 

  23. Svanborg E, Carlsson-Nordlander B, Larsson H, Sachs C, Kaijser L. Autonomic nervous system function in patients with primary obstructive sleep apnoea syndrome.Clin Auton Res 1991;1: 125–130.

    PubMed  Google Scholar 

  24. Veale D, Pepin JL, Levy PA. Autonomic stress tests in the obstructive sleep apnoea syndrome and snoring.Sleep 1992;15: 505–513.

    PubMed  Google Scholar 

  25. Bannister R, Mathias CJ, Investigation of autonomic disorders. In: Bannister R, Mathias CJ, eds.Autonomic Failure. A Textbook of Clinical Disorders of the Autonomic Nervous System. 3rd edition. Oxford: Oxford University Press, 1992; 255–290.

    Google Scholar 

  26. Khurana RK, Watabiki S, Hebel JR, Toro R, Nelson E. Cold face test in the assessment of trigeminal-brainstem-vagal function in humans.Ann Neurol 1980;7: 144–149.

    PubMed  Google Scholar 

  27. Heath ME, Downey JA. The cold face test (diving reflex) in clinical autonomic assessment: methodological considerations and repeatability of responses.Clin Sci 1990;78: 139–147.

    PubMed  Google Scholar 

  28. Anton AH, Sayre DF. A study of the factors affecting the aluminum oxidetrihyndole procedure for the analysis of catecholamines.J Pharmacol Exp Ther 1962;138: 360–375.

    PubMed  Google Scholar 

  29. Goldstein DS, Horwitz D, Keiser HR. Comparison of techniques for measuring baroreflex sensitivity in man.Circulation 1982;66: 432–439.

    PubMed  Google Scholar 

  30. Rechtschaffen A, Kales A.A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. US Department of Health, Education and Welfare. Publication (NIH) 204, National Institutes of Health, 1968.

  31. Bristow JD Honour AJ, Pickering GW, Sleight P, Smyth HS. Diminished baroreflex sensitivity in high blood pressure.Circulation 1969;39: 48–55.

    PubMed  Google Scholar 

  32. Mancia G, Ferrari A, Gregorini L, Zanchetti A. Baroreceptor reflexes in human hypertension.Circ Res 1978;43: 170–176.

    PubMed  Google Scholar 

  33. Ewing DJ. Cardiovascular reflexes and autonomic neuropathy.Clin Sci Molec Med 1978;55: 321–327.

    Google Scholar 

  34. Ewing DJ, Borsey DQ, Bellavere F, Clarke BF. Cardiac autonomic neuropathy in diabetes: comparison of measure of r–r interval variation.Diabetologia 1981;21: 18–24.

    PubMed  Google Scholar 

  35. Peterson HR, Rothschild MD, Weinberg CR, Fell RD, McLeish KR, Pfeifer MA. Body fat and the activity of the autonomic nervous system.N Engl J Med 1988;318: 1077–1083.

    PubMed  Google Scholar 

  36. Goldstein DS, McCarty R, Polinsky RJ, Kopin IJ. Relationship between plasma norepinephrine and sympathetic neural activity.Hypertension 1983;5: 552–559.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Neurological Institute, University of Bologna, Via Ugo Foscolo 7, 40123, Bologna, Italy

    P. Cortelli, P. Parchi, E. Sforza, M. Contin, G. Pierangeli, G. Barletta & E. Lugaresi

Authors
  1. P. Cortelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Parchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Sforza
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Contin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Pierangeli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. Barletta
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. E. Lugaresi
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cortelli, P., Parchi, P., Sforza, E. et al. Cardiovascular autonomic dysfunction in normotensive awake subjects with obstructive sleep apnoea syndrome. Clinical Autonomic Research 4, 57–62 (1994). https://doi.org/10.1007/BF01828839

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01828839

Key words

Search

Navigation