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Sleep and Breathing

, Volume 17, Issue 1, pp 289–296 | Cite as

The effect of continuous positive airway pressure on total cerebral blood flow in healthy awake volunteers

  • Theresia I. YiallourouEmail author
  • Céline Odier
  • Raphael Heinzer
  • Lorenz Hirt
  • Bryn A. Martin
  • Nikolaos Stergiopulos
  • José Haba-Rubio
Original Article

Abstract

Purpose

Continuous positive airway pressure (CPAP) is the gold standard treatment for obstructive sleep apnea. However, the physiologic impact of CPAP on cerebral blood flow (CBF) is not well established. Ultrasound can be used to estimate CBF, but there is no widespread accepted protocol. We studied the physiologic influence of CPAP on CBF using a method integrating arterial diameter and flow velocity (FV) measurements obtained for each vessel supplying blood to the brain.

Methods

FV and lumen diameter of the left and right internal carotid, vertebral, and middle cerebral arteries were measured using duplex Doppler ultrasound with and without CPAP at 15 cm H2O, applied in a random order. Transcutaneous carbon dioxide (PtcCO2), heart rate (HR), blood pressure (BP), and oxygen saturation were monitored. Results were compared with a theoretical prediction of CBF change based on the effect of partial pressure of carbon dioxide on CBF.

Results

Data were obtained from 23 healthy volunteers (mean ± SD; 12 male, age 25.1 ± 2.6 years, body mass index 21.8 ± 2.0 kg/m2). The mean experimental and theoretical CBF decrease under CPAP was 12.5 % (p < 0.001) and 11.9 % (p < 0.001), respectively. The difference between experimental and theoretical CBF reduction was not statistically significant (3.84 ± 79 ml/min, p = 0.40). There was a significant reduction in PtcCO2 with CPAP (p = <0.001) and a significant increase in mean BP (p = 0.0017). No significant change was observed in SaO2 (p = 0.21) and HR (p = 0.62).

Conclusion

Duplex Doppler ultrasound measurements of arterial diameter and FV allow for a noninvasive bedside estimation of CBF. CPAP at 15 cm H2O significantly decreased CBF in healthy awake volunteers. This effect appeared to be mediated predominately through the hypocapnic vasoconstriction coinciding with PCO2 level reduction. The results suggest that CPAP should be used cautiously in patients with unstable cerebral hemodynamics.

Keywords

Continuous positive airway pressure Cerebral blood flow PCO2 Ultrasound 

Notes

Acknowledgments

The authors are indebted to all volunteers whose participation made this study possible. This study was funded by the Swiss National Science Foundation Grant 205321_132695/1.

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Theresia I. Yiallourou
    • 1
    Email author
  • Céline Odier
    • 2
  • Raphael Heinzer
    • 3
  • Lorenz Hirt
    • 2
  • Bryn A. Martin
    • 1
  • Nikolaos Stergiopulos
    • 1
  • José Haba-Rubio
    • 3
  1. 1.Ecole Polytechnique Fédérale de Lausanne (EPFL)Laboratory of Hemodynamics and Cardiovascular Technology (LHTC)LausanneSwitzerland
  2. 2.Neurosciences DepartmentCentre Hospitalier Universitaire Vaudois Lausanne(CHUV)LausanneSwitzerland
  3. 3.CHUVCenter for Investigation and Research in Sleep (CIRS)LausanneSwitzerland

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