[Obstructive sleep apnea syndrome. A probably cause of therapy refractory hypertension in intracerebral hemorrhage].
There is clear evidence for obstructive sleep apnea as an independent cause of arterial hypertension. We report a case of intracranial hemorrhage with systemic hypertension resistant to antihypertensive medication, which could only be adjusted after effective treatment of coexisting sleep-disordered breathing. The 36 year old male (body mass index 31 kg/m2) was admitted to hospital three weeks before for intracranial bleeding at the left external capsule. Diagnosis of primary hypertension was made after extensive work-up in the acute hospital. Blood pressure was adjusted with five-fold antihypertensive medication at the time of admission to neurological rehabilitation, but was still elevated with "non-dipping" as determined by long-term measurement despite medications above the recommended dosages. Polysomnography confirmed the diagnosis of obstructive sleep apnea. 10 days after initiation of treatment with nasal CPAP blood pressure control was easier with normal dipping at night. Medication could be reduced during rehabilitation with further reduction after discharge. Moderate obstructive sleep apnea appears to be the cause of severe hypertension resistant to pharmacological therapy in this patient. The case underlines the impact of diagnosis and treatment of sleep-disordered breathing for the secondary prevention of stroke.
Wessendorf
T E
TE
Neurologische Abteilung, Fachklinik Rhein/Ruhr, Essen-Kettwig.
Teschler
H
H
Wang
Y M
YM
Sorgenfrei
U
U
Thilmann
A F
AF
D000959:Antihypertensive Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000628:therapy; D020300:Intracranial Hemorrhages / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011175:Positive-Pressure Respiration; D012891:Sleep Apnea Syndromes / Q000175:diagnosis* / Q000628:therapy
D000959:Antihypertensive Agents