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. 1994 Apr;49(4):335–339. doi: 10.1136/thx.49.4.335

Non-invasive beat to beat arterial blood pressure during non-REM sleep in obstructive sleep apnoea and snoring.

R J Davies 1, J Crosby 1, K Vardi-Visy 1, M Clarke 1, J R Stradling 1
PMCID: PMC475366  PMID: 8202903

Abstract

BACKGROUND--Obstructive sleep apnoea, and possibly snoring, are associated with a poorly understood increase in cardiovascular mortality which may be explained by their effects on systemic blood pressure during sleep. This study compares changes in mean blood pressure during obstructive sleep apnoea and snoring without apnoeas with those in matched control subjects during non-REM sleep. METHODS--Eighteen men with obstructive sleep apnoea, 16 men who snored without apnoeas, and 34 control subjects matched for age, sex, obesity, smoking, and alcohol intake were studied. During polysomnography non-invasive mean blood pressure (Finapres) was recorded from each cardiac cycle during non-REM sleep and averaged over a 10 minute period. This was compared with the blood pressure during 10 minutes before sleep onset. The changes in the patients' sleeping blood pressure were compared with those in their individually matched control subjects. RESULTS--Compared with the control subjects the change in mean (SD) arterial blood pressure between being awake and asleep was higher during obstructive sleep apnoea (+6.5 (9) mm Hg v-2 (6.5), difference 8.5 (11)), and the rise from wakefulness to sleep in the obstructive sleep apnoea group was itself significant. The average mean arterial pressure was not raised in those who snored without apnoeas compared with either the control subjects or during wakefulness. CONCLUSIONS--Average mean arterial pressure is higher during obstructive sleep apnoea than it is during wakefulness, while normal subjects show a fall in blood pressure at sleep onset. This sleep related rise in blood pressure may contribute to the excess cardiovascular morbidity and mortality experienced by patients with this condition.

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Selected References

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  1. Ali N. J., Davies R. J., Fleetham J. A., Stradling J. R. The acute effects of continuous positive airway pressure and oxygen administration on blood pressure during obstructive sleep apnea. Chest. 1992 Jun;101(6):1526–1532. doi: 10.1378/chest.101.6.1526. [DOI] [PubMed] [Google Scholar]
  2. Davies R. J., Ali N. J., Stradling J. R. Neck circumference and other clinical features in the diagnosis of the obstructive sleep apnoea syndrome. Thorax. 1992 Feb;47(2):101–105. doi: 10.1136/thx.47.2.101. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Davies R. J., Stradling J. R. Acute effects of obstructive sleep apnoea. Br J Anaesth. 1993 Nov;71(5):725–729. doi: 10.1093/bja/71.5.725. [DOI] [PubMed] [Google Scholar]
  4. Davies R. J., Vardi-Visy K., Clarke M., Stradling J. R. Identification of sleep disruption and sleep disordered breathing from the systolic blood pressure profile. Thorax. 1993 Dec;48(12):1242–1247. doi: 10.1136/thx.48.12.1242. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Garpestad E., Katayama H., Parker J. A., Ringler J., Lilly J., Yasuda T., Moore R. H., Strauss H. W., Weiss J. W. Stroke volume and cardiac output decrease at termination of obstructive apneas. J Appl Physiol (1985) 1992 Nov;73(5):1743–1748. doi: 10.1152/jappl.1992.73.5.1743. [DOI] [PubMed] [Google Scholar]
  6. Gleeson K., Zwillich C. W., White D. P. The influence of increasing ventilatory effort on arousal from sleep. Am Rev Respir Dis. 1990 Aug;142(2):295–300. doi: 10.1164/ajrccm/142.2.295. [DOI] [PubMed] [Google Scholar]
  7. Guilleminault C., Stoohs R., Duncan S. Snoring (I). Daytime sleepiness in regular heavy snorers. Chest. 1991 Jan;99(1):40–48. doi: 10.1378/chest.99.1.40. [DOI] [PubMed] [Google Scholar]
  8. Jennum P., Hein H. O., Suadicani P., Gyntelberg F. Cardiovascular risk factors in snorers. A cross-sectional study of 3,323 men aged 54 to 74 years: the Copenhagen Male Study. Chest. 1992 Nov;102(5):1371–1376. doi: 10.1378/chest.102.5.1371. [DOI] [PubMed] [Google Scholar]
  9. MacMahon S., Peto R., Cutler J., Collins R., Sorlie P., Neaton J., Abbott R., Godwin J., Dyer A., Stamler J. Blood pressure, stroke, and coronary heart disease. Part 1, Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet. 1990 Mar 31;335(8692):765–774. doi: 10.1016/0140-6736(90)90878-9. [DOI] [PubMed] [Google Scholar]
  10. Mateika J. H., Mateika S., Slutsky A. S., Hoffstein V. The effect of snoring on mean arterial blood pressure during non-REM sleep. Am Rev Respir Dis. 1992 Jan;145(1):141–146. doi: 10.1164/ajrccm/145.1.141. [DOI] [PubMed] [Google Scholar]
  11. Mayer J., Becker H., Brandenburg U., Penzel T., Peter J. H., von Wichert P. Blood pressure and sleep apnea: results of long-term nasal continuous positive airway pressure therapy. Cardiology. 1991;79(2):84–92. doi: 10.1159/000174864. [DOI] [PubMed] [Google Scholar]
  12. O'Brien E., Sheridan J., O'Malley K. Dippers and non-dippers. Lancet. 1988 Aug 13;2(8607):397–397. doi: 10.1016/s0140-6736(88)92867-x. [DOI] [PubMed] [Google Scholar]
  13. Obstructive sleep apnea and blood pressure elevation: what is the relationship? Working Group on OSA and Hypertension. Blood Press. 1993 Sep;2(3):166–182. doi: 10.3109/08037059309077548. [DOI] [PubMed] [Google Scholar]
  14. Parati G., Casadei R., Groppelli A., Di Rienzo M., Mancia G. Comparison of finger and intra-arterial blood pressure monitoring at rest and during laboratory testing. Hypertension. 1989 Jun;13(6 Pt 1):647–655. doi: 10.1161/01.hyp.13.6.647. [DOI] [PubMed] [Google Scholar]
  15. Parish J. M., Shepard J. W., Jr Cardiovascular effects of sleep disorders. Chest. 1990 May;97(5):1220–1226. doi: 10.1378/chest.97.5.1220. [DOI] [PubMed] [Google Scholar]
  16. Partinen M., Guilleminault C. Daytime sleepiness and vascular morbidity at seven-year follow-up in obstructive sleep apnea patients. Chest. 1990 Jan;97(1):27–32. doi: 10.1378/chest.97.1.27. [DOI] [PubMed] [Google Scholar]
  17. Partinen M., Jamieson A., Guilleminault C. Long-term outcome for obstructive sleep apnea syndrome patients. Mortality. Chest. 1988 Dec;94(6):1200–1204. doi: 10.1378/chest.94.6.1200. [DOI] [PubMed] [Google Scholar]
  18. Ringler J., Basner R. C., Shannon R., Schwartzstein R., Manning H., Weinberger S. E., Weiss J. W. Hypoxemia alone does not explain blood pressure elevations after obstructive apneas. J Appl Physiol (1985) 1990 Dec;69(6):2143–2148. doi: 10.1152/jappl.1990.69.6.2143. [DOI] [PubMed] [Google Scholar]
  19. Saumon G., Basset G. Electrolyte and fluid transport across the mature alveolar epithelium. J Appl Physiol (1985) 1993 Jan;74(1):1–15. doi: 10.1152/jappl.1993.74.1.1. [DOI] [PubMed] [Google Scholar]
  20. Shepard J. W., Jr Gas exchange and hemodynamics during sleep. Med Clin North Am. 1985 Nov;69(6):1243–1264. doi: 10.1016/s0025-7125(16)30985-3. [DOI] [PubMed] [Google Scholar]
  21. Smith N. T., Wesseling K. H., de Wit B. Evaluation of two prototype devices producing noninvasive, pulsatile, calibrated blood pressure measurement from a finger. J Clin Monit. 1985 Jan;1(1):17–29. doi: 10.1007/BF02832685. [DOI] [PubMed] [Google Scholar]
  22. Stradling J. R., Crosby J. H. Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men. Thorax. 1991 Feb;46(2):85–90. doi: 10.1136/thx.46.2.85. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Stradling J. R. Sleep apnoea and systemic hypertension. Thorax. 1989 Dec;44(12):984–989. doi: 10.1136/thx.44.12.984. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Tilkian A. G., Guilleminault C., Schroeder J. S., Lehrman K. L., Simmons F. B., Dement W. C. Hemodynamics in sleep-induced apnea. Studies during wakefulness and sleep. Ann Intern Med. 1976 Dec;85(6):714–719. doi: 10.7326/0003-4819-85-6-714. [DOI] [PubMed] [Google Scholar]
  25. Waller P. C., Bhopal R. S. Is snoring a cause of vascular disease? An epidemiological review. Lancet. 1989 Jan 21;1(8630):143–146. doi: 10.1016/s0140-6736(89)91153-7. [DOI] [PubMed] [Google Scholar]
  26. Warley A. R., Mitchell J. H., Stradling J. R. Evaluation of the Ohmeda 3700 pulse oximeter. Thorax. 1987 Nov;42(11):892–896. doi: 10.1136/thx.42.11.892. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Wesseling K. H., Settels J. J., van der Hoeven G. M., Nijboer J. A., Butijn M. W., Dorlas J. C. Effects of peripheral vasoconstriction on the measurement of blood pressure in a finger. Cardiovasc Res. 1985 Mar;19(3):139–145. doi: 10.1093/cvr/19.3.139. [DOI] [PubMed] [Google Scholar]

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