title: Obstructive apnea during sleep is associated with peripheral vasoconstriction.
abstract: Obstructive apnea during sleep is associated with a substantial transient blood pressure elevation. The mechanism of this pressor response is unclear. In this study we measured muscle sympathetic nerve activity (MSNA), mean arterial pressure (Psa), and mean limb blood velocity as an index of blood flow (MBV, Doppler) and calculated changes in limb vascular resistance during and after apneas during both wakefulness and sleep in patients with the obstructive sleep apnea syndrome. Immediately postapnea during sleep Psa increased significantly compared with the earlier stages of apnea and this was preceded by a rise of MSNA (n = 5). In contrast to blood pressure, MBV remained unchanged. Because resistance = blood pressure/blood flow, limb vascular resistance increased by 29 +/- 8% from late apnea to postapnea (n = 7, p < 0.002). Voluntary breathhold maneuvers during room air exposure evoked similar responses (n = 10). Supplemental oxygen administered via nonrebreather face mask attenuated the MSNA and vasoconstrictor responses to obstructive (n = 2) and voluntary apneas (n = 10). Our data suggest that obstructive apneas in patients with the obstructive apnea syndrome are accompanied by transient limb vasoconstriction. This vasoconstrictor response appears to be, at least in part, mediated by the sympathetic nervous system and may be linked to hypoxia.
authors.affiliation: Division of Pulmonary, Allergy and Critical Care, Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033, USA. vimadojemu@psu.edu
authors.forename: Virginia A
authors.initials: VA
authors.lastname: Imadojemu
authors.forename: Kevin
authors.initials: K
authors.lastname: Gleeson
authors.forename: Kristen S
authors.initials: KS
authors.lastname: Gray
authors.forename: Lawrence I
authors.initials: LI
authors.lastname: Sinoway
authors.forename: Urs A
authors.initials: UA
authors.lastname: Leuenberger
mesh_terms: D000320:Adrenergic Fibers; D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D001794:Blood Pressure; D001916:Brachial Artery / Q000503:physiopathology*; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005263:Femoral Artery / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D009131:Muscle, Smooth, Vascular / Q000294:innervation / Q000503:physiopathology; D010102:Oxygen Inhalation Therapy; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000378:metabolism / Q000503:physiopathology* / Q000628:therapy; D018608:Ultrasonography, Doppler; D014655:Vascular Resistance; D014851:Wakefulness