CPAP-therapy changes of hemodynamic response to physical load in osas patients
Abstract
Cardiovascular consequences of obstructive sleep apnea-hypopnea syndrome are known to be one of the main causes of increased morbidity and mortality associated with this disease. Pathophysiological mechanisms underlying hemodynamic abnormalities in OSAS, the role of increased sympathetic tonus are being discussed. The CPAP efficiency for correction of OSAS hemodynamic consequences has not been established yet. The aim of the current study was to assess cardiovascular response to physical load and the short-term effects of CPAP-therapy on hemodynamics in OSAS patients. Ten severe OSAS patients were examined. A bicycle exercise test dynamic stress-echocardiography was performed to study cardiovascular response to physical load. Tests were performed before and 5 days after the starting of CPAP therapy. The results of study showed that hyperdynamic B P response to physical load was common for severe OSAS patients and associated with the initial decrease of left ventricular stroke volume. Short-term CPAP course improved the central hemodynamic pattern and the blood pressure response. One of the possible involved mechanisms could be the reduction of sympathetic nervous activity due to the CPAP effects on nocturnal hypoxemia and sleep fragmentation. Conclusion: short-term CPAP-therapy produces positive changes in hemodynamic response to physical load in OSAS patients.
About the Authors
A. M. Belov
НИИ пульмонологии М3 РФ
Russian Federation
Russian Federation
D. U. Kallistov
НИИ пульмонологии М3 РФ
Russian Federation
Russian Federation
E. R. Yashina
НИИ пульмонологии М3 РФ
Russian Federation
Russian Federation
A. G. Chuchalin
НИИ пульмонологии М3 РФ
Russian Federation
Russian Federation
References
1. American College of Sports Medicine: Guidelines for Exercise Testing and Prescription. 4-th Ed.— Philadelphia: Len & Febiger, 1991.
2. ASDA report EEG arousals: scoring rules and examples / / Sleep.— 1992.— Vol.15, № 2.— P. 173—184.
3. Blumberg H., Oberle J. Effects of systemic hypoxia and hypercapnia n skin and muscle sympathetic activity in humans / / Pflugers Arch.— 1998.— Vol.403, Suppl.— P.R51.
4. Butkov N. Atlas of Clinical Polysomnography.— Ashland: Synapse Media Inc., 1996.
5. Crabtree D., Morgan B., Skatrud J. Chemoreflex sensitisation augments symphathettic vasomotor outfloff in awake humans / / Am. Rev. Respir. Dis.— Vol.147.— P.A1015.
6. Daly M.D. Interactions between respirations and circulation / / Handbook of Physiology: the Cardiovascular System. Peripheral Circulation and Organ Blood Flow / Eds. J.T.Shepard, F.M.Abboud.— Baltimore: Williams and Wilkins, 1983.— Vol.3.— P.529—592.
7. Engletnan H.M., Gough K., Martin S.E. et at. Ambulatory blood pressure on and of continuous positive airway pressure therapy for the sleep apnea/hypopnea syndrome: effects in “ non-dippers” / / Sleep.— 1996,— Vol.19, № 5.— P.378—381.
8. Fletcher E.C., Miller J., Schaaf J.W., Fletcher J.G. Urinary catecholamines before and after ttracheostomy in OSA and hypertension / / Ibid.— 1987.— Vol.10.— P.35—44.
9. Garpestad E.E., Ringler J., Parker J.A. et al. Sleep stage influences thee hemodynamic response to obstructive apneas / / Am. J. Respir. Crit. Care Med.— 1995.— Vol.152.— P .199—203.
10. Grote L., Mayer J., Penzel T. et al. Nocturnal hhypertension and cardiovasscular risk: Consegueenses for diagnosis and treatment / / J. Cardiovasc. Pharmacol.— 1994.— Vol.24., Suppl.2.— P.S26-S38.
11. He J., Kryger M.N., Zorick F.J. et al. Mortality and apnea index in obstructive sleep apnea. Expierence in 385 male patients / / Chest.— 1988.— Vol.94.— P.9-14.
12. Hedner J., Ejnell H., Sellgren J. et al. Is high and fluctuating musvle nerve sympathetic activity in the sleep apnea syndrome of pathogenetic importance for the development of hypertension? / / J.Hypertens.— 1988.— Vol.6, Suppl.4.— P.S529—S531.
13. Palotnaki H., Patinen M., Juvela S. et al. Snoring as a risk of sllep related brain infraction / / Stroke.— 1989.— Vol.20.— P.1311—1315.
14. Partinen M ., Jamieson A., Guilleminault C. Long—term outcome for obstructive sleep apnea patients; mortality / / Chest.— 1988.— Vol.94.— P. 1200-1204.
15. Rechtschaffen A., Kales A.A. Eds. A Manual of Standardized Therminology, Techniques, and Scoring System for Sleep Atagges of Human Subjects (NIH publ. № 204).— Washington, DC.: U.S. Goverment Printing Office, 1986.
16. Ringler J., Basner R.C., Sharnon R. et al. Hypoxemia alone does not explain blood pressure elevations after obstructive apneas / / J. Appl. Physiol. 1990.— Vol.69.— P.2143-2148.
17. Shepard J.W. Hypertension, cardiac arrythmias, myocardial infraction and stroke in relation to obstructive sllep apnea / / Clin. Chest Med.— 1992.— Vol.3., № 3.— P.737—758.
18. Somers V., Zavala D.C., Marc A.L., Abboud F.M. Sympathetic nerve responses to hypoxia during breathing and apnea in normal humans / / Circulation.— 1987.— Vol.76, Suppl.IV.— P.48.
19. Sullivan C.E., Issa E.G., Berthon-Jones M., Eves L. Reversal of obstructive sleep apnea by continuous positive airway pressure applied through the nares / / Lancet.— 1981.— Vol.l.— P.862—865.
20. Trzebsky A. Arterial hemoreceptor reflex and hypertension / / Hypertension.— 1992.— Vol. 19.— P.562—566.
21. Weiss J.W ., Remsburg S., Gaperstad E. et al. Hemodynamic consequences of obstructive sllep apnea / / Sleep.— 1996.— Vol. 19, № 5.— P.388—397.
22. Weisman I.M., Zebalos R.J. Eds. C linical expense testing / / Clin. Chest. M ed.— 1 9 9 4 .- Vol.15.— P.173-450.
Review
For citations:
Belov A.M., Kallistov D.U., Yashina E.R., Chuchalin A.G. CPAP-therapy changes of hemodynamic response to physical load in osas patients. PULMONOLOGIYA. 1998;(3):33-39. (In Russ.)
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