Nocturnal blood pressure fluctuations measured by using pulse transit time in patients with severe obstructive sleep apnea syndrome
- 338 Downloads
Obstructive sleep apnea syndrome (OSAS) is related to arterial hypertension. In the present study, we test the hypothesis that patients with severe OSAS have excessive apnea induced blood pressure (BP).
We investigated 97 patients with an apnea/hypopnea index (AHI) greater than 30. Systolic BP (SBP) was continuously determined by using the pulse transit time (PTT). Apnea/hypopnea induced nocturnal BP fluctuations (NBPFs) were detected and showed phenomena of continuous increases of the SBP baseline. Such periods of SBP baseline elevations ≥ 10 mmHg were called superposition. Respiratory and cardiac parameters were obtained from the polysomnographic investigation.
Eighty-four periods of superposition were detected in 48 patients. They occurred mainly during REM sleep (76%). Apnea duration was increased and the time in respiration was reduced in periods of superposition compared to non-superposition periods. In superposition periods mean oxygen saturation (SpO2) and the minimal SpO2 were lower, desaturations were more pronounced, and the mean heart rate (HR) was increased. The maximum SBP during superposition was significantly increased (204 ± 32 vs.171 ± 28 mmHg). The clinic BP was higher in patients with superposition (SBP 149.2 ± 17.5 vs. 140 ± 19.1, DBP 91.5 ± 11.5 vs. 86.3 ± 11.8).
The study reveals that patients with severe OSAS can have periods of BP superposition during night with extremely high SBP and very low oxygen saturation, which may add to a high risk for cardiovascular events during the night.
KeywordsObstructive sleep apnea Blood pressure Nocturnal blood pressure fluctuations Pulse transit time Hypertension
The authors thank Dr. A. Göhler and Mrs. Rebecca Müller for their help in preparing the manuscript.
No funding was received for this research.
Compliance with ethical standards
Conflict of interest
J.G. is an employee and G.K. is the CEO of SOMNOmedics GmbH. A.P. advices SOMNOmedics in methods of BP measurement and received travel support. The authors certify that they have no other affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, nor other equity interest; and expert testimony or patent-licensing arrangements) or no non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
- 1.Somers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A et al (2008) Sleep apnea and cardiovascular disease: an American Heart Association/american College Of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council On Cardiovascular Nursing. In collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health). Circulation 118(10):1080–1111CrossRefPubMedGoogle Scholar
- 2.Jenner R, Fatureto-Borges F, Costa-Hong V, Lopes HF, Teixeira SH, Marum E, et al. (2017) Association of obstructive sleep apnea with arterial stiffness and nondipping blood pressure in patients with hypertension. J Clin Hypertens (Greenwich). https://doi.org/10.1111/jch.13008
- 3.Crinion SJ, Ryan S, McNicholas WT (2017) Obstructive sleep apnoea as a cause of nocturnal nondipping blood pressure: recent evidence regarding clinical importance and underlying mechanisms. Eur Respir J:49(1). https://doi.org/10.1183/13993003.01818-2016
- 4.Parati G, Lombardi C, Hedner J, Bonsignore MR, Grote L, Tkacova R et al (2012) Position paper on the management of patients with obstructive sleep apnea and hypertension: joint recommendations by the European Society of Hypertension, by the European Respiratory Society and by the members of European COST (COoperation in Scientific and Technological research) ACTION B26 on obstructive sleep apnea. J Hypertens 30(4):633–646CrossRefPubMedGoogle Scholar
- 10.Carpagnano GE, Kharitonov SA, Resta O, Foschino-Barbaro MP, Gramiccioni E, Barnes PJ (2003) 8-Isoprostane, a marker of oxidative stress, is increased in exhaled breath condensate of patients with obstructive sleep apnea after night and is reduced by continuous positive airway pressure therapy. Chest 124(4):1386–1392CrossRefPubMedGoogle Scholar
- 15.Bartsch S, Ostojic D, Schmalgemeier H, Bitter T, Westerheide N, Eckert S et al (2010) Validation of continuous blood pressure measurements by pulse transit time: a comparison with invasive measurements in a cardiac intensive care unit. Dtsch Med Wochenschr 135(48):2406–2412CrossRefPubMedGoogle Scholar
- 17.The AASM manual for the scoring of sleep and associated events: rules, terminology, and technical specification. 1st ed. ed. Westchester, IL: American Academy of Sleep Medicine; 2007Google Scholar
- 20.Sega R, Facchetti R, Bombelli M, Cesana G, Corrao G, Grassi G et al (2005) Prognostic value of ambulatory and home blood pressures compared with office blood pressure in the general population: follow-up results from the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study. Circulation 111(14):1777–1783CrossRefPubMedGoogle Scholar
- 27.Bilo G, Zorzi C, Ochoa Munera JE, Torlasco C, Giuli V, Parati G (2015) Validation of the Somnotouch-NIBP noninvasive continuous blood pressure monitor according to the European Society of Hypertension International Protocol revision 2010. Blood Press Monit 20(5):291–294CrossRefPubMedPubMedCentralGoogle Scholar