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Voluntary apnea evokes diving responses in obstructive sleep apnea patients

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Abstract

Purpose

Two potentially protective responses to apnea were studied in obstructive sleep apnea (OSA) patients; the diving response and the increase in Hb concentration [Hb] via spleen contraction.

Methods

Eight OSA patients and ten healthy controls performed apneas in air (A) and apneas with facial immersion in 15 °C water (FIA) after inspiration and without prior hyperventilation. In each condition, subjects performed three apneas of maximal voluntary duration spaced by 2 min of rest. Cardiorespiratory parameters were measured non-invasively, and venous blood samples for [Hb] analysis were drawn before and after apneas.

Result

Mean (SD) apnea durations were similar between groups (NS). In controls, the heart rate (HR) reduction was 10 ± 10 % at apnea and 19 ± 10 % in FIA (P < 0.05). In OSA patients, however, the fall in HR was the same in both conditions, 13 ± 10 and 14 ± 8 % for A and FIA, respectively (NS). In controls, the [Hb] increase was the same in A and FIA (2.2 ± 2.9 and 2.1 ± 2.2 %), while in OSA the [Hb] increase was greater during FIA compared to A (3.3 ± 2.2 and 1.4 ± 0.9 %; P < 0.05).

Conclusion

Apnea induces a diving response and [Hb] increase in both groups. OSA patients did not show the typical training effect of the diving response seen in apnea divers despite their frequent nocturnal apneas. However, they also deviated from normal controls in response pattern; face immersion enhanced the cardiovascular diving response in controls but not in OSA, while the hematological response was enhanced by face immersion only in OSA patients.

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Abbreviations

A:

Apnea without face immersion

AHI:

Apnea/hyponea index

AT:

Apneic time

BMI:

Body mass index

EP:

Easy phase

ETCO2 :

Tension for end-tidal carbon dioxide

FIA:

Apnea with face immersion

[Hb]:

Blood concentration of hemoglobin

HR:

Heart rate

IBM:

Involuntary breathing movements

MAP:

Mean arterial blood pressure

ODI:

Oxygen desaturation index

OSA:

Obstructive sleep apnea

PaCO2 :

Partial pressure carbon dioxide

SaO2 :

Blood hemoglobin oxygen saturation

SD:

Standard deviation

SkBf:

Skin blood flow

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Acknowledgments

We are grateful to all patients and control subjects for participating in the study. We also thank Dr. Matt Richardson, Dr. Sofia Pettersson, and M.Sc Torborg Jonsson, for technical assistance and B.A. Stephen Haughey for linguistic revision. This study was supported by Mid Sweden’s Research and Development Center, Sundsvall Hospital, Landstinget Västernorrland and by Capio St Görans Hospital, Stockholm, Sweden.

Conflict of interest

The authors have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Health Sciences, Mid Sweden University, Campus Östersund, 831 25, Östersund, Sweden

    Helena Vigetun-Haughey, Tomas Forsberg, Magnus Kaldensjö & Erika Schagatay

  2. Department of Research and Development, Sundsvall Hospital, Västernorrland County Council, Sundsvall, Sweden

    Jonas Appelberg

  3. Department of Clinical Physiology, Sundsvall Hospital, Västernorrland County Council, Sundsvall, Sweden

    Jonas Appelberg

  4. Swedish Winter Sports Research Center, Mid Sweden University, Östersund, Sweden

    Erika Schagatay

  5. Department of Clinical Physiology, Capio St Görans Hospital, Stockholm, Sweden

    Helena Vigetun-Haughey

Authors
  1. Helena Vigetun-Haughey
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  2. Jonas Appelberg
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  3. Tomas Forsberg
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  4. Magnus Kaldensjö
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  5. Erika Schagatay
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Corresponding author

Correspondence to Helena Vigetun-Haughey.

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Communicated by Carsten Lundby.

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Vigetun-Haughey, H., Appelberg, J., Forsberg, T. et al. Voluntary apnea evokes diving responses in obstructive sleep apnea patients. Eur J Appl Physiol 115, 1029–1036 (2015). https://doi.org/10.1007/s00421-014-3083-7

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  • DOI: https://doi.org/10.1007/s00421-014-3083-7

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