Abstract
Background: Obstructive sleep apnea syndrome (OSAS) is related to diurnal sympathetic hyperactivity and increased blood pressure, both factors that are likely to lead to the development of cardiovascular disease.
Hypothesis: The study investigated whether 24‐h urinary catecholamines would reflect the effect of obstructive sleep apnea on autonomic activity.
Methods: Standard poly somnography was performed in 17 patients with OSAS (age 53.7 ± 13.5 years, mean ± standard deviation). The number of apnea/hypopnea episodes per hour of sleep (apnea/hypopnea index [AHI]); number of oxygen desaturation episodes per hour (desaturation index [DSI]); arousals per hour (arousal index); lowest oxygen saturation (lowest SpO2); and percentages of stages 1, 2, 3/4, and rapid eye movement sleep (% stage 1, −2, and ‐ 3/4, and % REM, respectively) were measured. Overnight continuous positive airway pressure (CPAP) titration was performed the night after the baseline sleep measurements had been taken. Twenty‐four‐hour urinary adrenaline and noradrenaline were also examined.
Results: During the CPAP treatment, both 24‐h urinary adrenaline and noradrenaline were significantly lower compared with natural sleep. Continuous positive airway pressure significantly decreased the AHI, DSI, % stage 1, and arousal index and significantly increased the lowest SpO2. There were no significant differences in % stage 2, % stage 3/4, and % REM between before and during CPAP treatment. Multiple analysis of covariance tests revealed that lowest SpO2 was the most important factor for increasing 24‐h urinary noradrenaline levels (F = 4.75, p = 0.048).
Conclusions: One night CPAP treatment could improve autonomic dysfunction. The assessment of 24‐h urinary noradrenaline would provide important information for evaluating the effect of CPAP treatment.
Keywords: catecholamine, adrenaline, noradrenaline, obstructive sleep apnea syndrome, autonomic activity, continuous positive airway pressure, lowest oxygen saturation
Full Text
The Full Text of this article is available as a PDF (34.1 KB).
References
- 1. Fletcher EC: Obstructive sleep apnea and cardiovascular morbidity. Monaldi Arch Chest Dis 1996; 51: 77–80 [PubMed] [Google Scholar]
- 2. Brooks D, Horner RL, Kozar LF, Render‐Teixeira CL, Phillipson EA: Obstructive sleep apnea as a cause of systemic hypertension: Evidence from a canine model. J Clin Invest 1997; 99: 106–109 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Somers VK, Dyken ME, Mark AL: Parasympathetic hyperresponsiveness and bradyarrhythmias during apnea in hypertension. Clin Auton Res 1992; 2: 171–176 [DOI] [PubMed] [Google Scholar]
- 4. Somers VK, Dyken ME, Clary MP, Abboud FM: Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest 1995; 96: 1897–1904 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. Levinson PD, Millman RP: Causes and consequences of blood pressure alterations in obstructive sleep apnea. Arch Intern Med 1991; 151: 455–462 [PubMed] [Google Scholar]
- 6. Noda A, Yasuma F, Okada T, Yokota M: Circadian rhythm of autonomic activity in patients with obstructive sleep apnea syndrome. Clin Cardiol 1998; 21: 271–276 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7. Kansanen M, Vanninen E, Tuunainen A, Pesonen P, Tuononen V, Hartikainen J, Mussalo H, Uusitupa M: The effect of a very low‐calorie diet‐induced weight loss on the severity of obstructive sleep apnea and autonomic nervous function in obese patients with obstructive sleep apnea syndrome. Clin Physiol 1998; 18: 377–385 [DOI] [PubMed] [Google Scholar]
- 8. Khoo MCK, Kim TS, Berry RB: Spectral indices of cardiac autonomic function in obstructive sleep apnea. Sleep 1999; 22: 443–451 [DOI] [PubMed] [Google Scholar]
- 9. Svanborg E, Carlsson‐Nordlander B, Larsson H: Autonomic nervous system function in patients with primary obstructive sleep apnea syndrome. Clin Auton Res 1991; 1: 125–130 [DOI] [PubMed] [Google Scholar]
- 10. He J, Kryger MH, Zorick FJ, Conway W, Roth T: Mortality and apnea index in obstructive sleep apnea. Experience in 385 male patients. Chest 1988; 94: 9–14 [PubMed] [Google Scholar]
- 11. Noda A, Okada T, Hayashi H, Yasuma F, Yokota M: 24‐hour ambulatory blood pressure variability in obstructive sleep apnea syndrome. Chest 1993; 103: 1343–1347 [DOI] [PubMed] [Google Scholar]
- 12. Noda A, Okada T, Yasuma F, Sobue T, Nakashima N, Yokota M: Cardiac hypertrophy in obstructive sleep apnea syndrome. Chest 1995; 107: 1538–1544 [DOI] [PubMed] [Google Scholar]
- 13. Noda A, Okada T, Yasuma F: Prognosis of the middle‐aged and aged patients with obstructive sleep apnea syndrome. Psychiat Clin Neurosci 1998; 52: 79–85 [DOI] [PubMed] [Google Scholar]
- 14. Narkiewicz K, Montano N, Cogliati C, Borne PJH, Dyken ME, Somers VK: Altered cardiovascular variability in obstructive sleep apnea. Circulation 1998; 98: 1071–1077 [DOI] [PubMed] [Google Scholar]
- 15. Luft R, Ulf S, Von Euler US: Two cases of postural hypotension showing a deficiency in release of norepinephrine and epinephrine. J Clin Invest 1953; 32: 1065–1069 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16. Rechtschaffen A, Kales A: A Manual of Standardized Techniques and Scoring System for Sleep Stages of Human Subjects. Washington, D. C.: US Government Printing Office, 1968. [Google Scholar]
- 17. The Report of an American Academy of Sleep Medicine Task Force : American Academy of Sleep Medicine: Sleep‐related breathing disorders in adults. Recommendations for syndrome definition and measurement techniques in clinical research. Sleep 1999; 22: 667–689 [PubMed] [Google Scholar]
- 18. Macdonald IA, Lake DM: An improved technique for extracting catecholamines from body fluids. J Neurosci Meth 1985; 13: 239–248 [DOI] [PubMed] [Google Scholar]
- 19. Laederach K, Weidmann P: Plasma and urinary catecholamines as related to renal function in man. Kidney Inc 1987; 31: 107–111 [DOI] [PubMed] [Google Scholar]
- 20. Phillipson EA: Sleep apnea. A major public health problem. N Engl J Med 1993; 328: 1271–1273 [DOI] [PubMed] [Google Scholar]
- 21. Marrone O, Ricobono L, Salvaggio A, Mirabella A, Bonaao A, Bonsignore MR: Catecholamines and blood pressure in obstructive sleep apnea syndrome. Chest 1993; 103: 722–727 [DOI] [PubMed] [Google Scholar]
- 22. 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 [DOI] [PubMed] [Google Scholar]
- 23. Eisensehr I, Ehrenberg BL, Noachtar S, Korbett K, Byrne A, McAuley A, Palabrica T: Platelet activation, epinephrine, and blood pressure in obstructive sleep apnea syndrome. Neurology 1998; 51: 188–195 [DOI] [PubMed] [Google Scholar]
- 24. Waravdekar NV, Sinoway LI, Zwillich CW, Leuenberger UA: Influence of treatment on sympathetic nerve activity in sleep apnea. Am J Respir Crit Care Med 1996; 153: 1333–1338 [DOI] [PubMed] [Google Scholar]
- 25. Minemura H, Akashiba T, Yamamoto H, Akahoshi T, Kosaka N, Horie T: Acute effects of nasal continuous positive airway pressure on 24‐hour blood pressure and catecholamines in patients with obstructive sleep apnea. Intern Med 1998; 37: 1009–1013 [DOI] [PubMed] [Google Scholar]
- 26. Davidson L, Baum A: Chronic stress and posttraumatic stress disorders. J Consult Clin Psychol 1986; 54: 303–308 [DOI] [PubMed] [Google Scholar]
- 27. Dimsdale J, Moss J: Short‐term catecholamine response to psychologic stress. Psychosom Med 1980; 42: 493–497 [DOI] [PubMed] [Google Scholar]
- 28. Esler M, Jennings G, Korner P: Assessment of human sympathetic nervous system activity from measurements of norepinephrine turnover. Hypertension 1988; 11: 3–20 [DOI] [PubMed] [Google Scholar]