title: Effect of intensified diuretic therapy on overnight rostral fluid shift and obstructive sleep apnoea in patients with uncontrolled hypertension.
abstract: OBJECTIVE
  Fluid displacement from the lower extremities to the upper body during sleep is strongly associated with obstructive sleep apnoea in hypertensive patients. The present pathophysiological study tests the hypothesis that intensified diuretic therapy will reduce the apnoea-hypopnoea index and blood pressure of uncontrolled hypertensive patients with obstructive sleep apnoea in proportion to the reduction in overnight change in leg fluid volume.
  
  
  METHODS
  Uncontrolled treated hypertensive patients underwent overnight polysomnography and measurement of overnight changes in leg fluid volume and neck circumference. Those with an apnoea-hypopnoea index at least 20 events per hour (n=16) received metolazone 2.5 mg and spironolactone 25 mg daily for 7 days after which the daily dose was doubled for 7 additional days. Baseline testing was again repeated.
  
  
  RESULTS
  Intensified diuretic therapy reduced the apnoea-hypopnoea index from 57.7 ± 33.0 to 48.5 ± 28.2 events per hour (P=0.005), overnight change in leg fluid volume from -418.1 ± 177.5 to -307.5 ± 161.9 ml (P<0.001) and overnight change in neck circumference from 1.2 ± 0.6 to 0.7 ± 0.4 cm (P<0.001). There was an inverse correlation between the reduction in overnight change in leg fluid volume and decrease in apnoea-hypopnoea index (r=-0.734, P=0.001). The reduction in overnight change in leg fluid volume was also significantly correlated with the change in morning blood pressure (r=0.708, P=0.002 for SBP; r=0.512, P=0.043 for DBP).
  
  
  CONCLUSIONS
  The findings provide further evidence that fluid redistribution from the legs to the neck during sleep contributes to the severity of obstructive sleep apnoea in hypertension and may be an important link between these two conditions.
authors.affiliation: aSleep Research Laboratories of the University Health Network Toronto Rehabilitation Institute and Toronto General Hospital bCentre for Sleep Medicine and Circadian Biology, University of Toronto cDepartment of Medicine, Mount Sinai Hospital, New York, New York, USA dProsserman Centre for Health Research, Samuel Lunenfeld Research Institute of the Mount Sinai Hospital eDepartment of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Kasai
authors.forename: T Douglas
authors.initials: TD
authors.lastname: Bradley
authors.forename: Oded
authors.initials: O
authors.lastname: Friedman
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Logan
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D004232:Diuretics / Q000008:administration & dosage / Q000627:therapeutic use*; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D045604:Extracellular Fluid / Q000187:drug effects / Q000502:physiology; D005260:Female; D018495:Fluid Shifts / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D007866:Leg; D008297:Male; D008788:Metolazone / Q000008:administration & dosage; D008875:Middle Aged; D009333:Neck; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D013148:Spironolactone / Q000008:administration & dosage
chemical_list: D004232:Diuretics; D013148:Spironolactone; D008788:Metolazone