title: Theophylline therapy for Cheyne-Stokes respiration during sleep in a 41-year-old man with refractory arterial hypertension.
abstract: We report a case of a 41-year-old man who was noted to have position-dependent Cheyne-Stokes respiration with central sleep apnea (CSA) during sleep. The patient had multiple cardiovascular risk factors and target organ damages, including a history of two myocardial infarctions, transient ischemic attack, and chronic kidney disease. His hypertension was refractory to a number of antihypertensive medicines, however, a complete elimination of sleep-disordered breathing with oral theophylline treatment was paralleled by a significant BP fall with a subsequent need for reduction of antihypertensive drugs. Following these surprising observations we decided to withdraw theophylline from treatment (in-clinic). Theophylline discontinuation resulted in a gradual increase in BP and an urgent call for antihypertensive treatment modification. These observations suggest a potent hypotensive action of oral theophylline via Cheyne-Stokes respiration with CSA elimination. Our data suggest that CSA may be a mechanism that raises BP even during the daytime.
authors.affiliation: Department of Hypertension and Diabetology Medical University of Gdańsk, Gdańsk, Poland; Department of Cardiovascular Diseases, International Clinical Research Center, St. Anne's University Hospital in Brno (FNUSA), Brno, Czech Republic. Electronic address: lupus@gumed.edu.pl.
authors.forename: Jacek
authors.initials: J
authors.lastname: Wolf
authors.affiliation: Department of Hypertension and Diabetology Medical University of Gdańsk, Gdańsk, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Świerblewska
authors.affiliation: Department of Hypertension and Diabetology Medical University of Gdańsk, Gdańsk, Poland.
authors.forename: Hanna
authors.initials: H
authors.lastname: Jasiel-Wojculewicz
authors.affiliation: Department of Hypertension and Diabetology Medical University of Gdańsk, Gdańsk, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Gockowski
authors.affiliation: Department of Hypertension and Diabetology Medical University of Gdańsk, Gdańsk, Poland.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Wyrzykowski
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester MN.
authors.forename: Virend K
authors.initials: VK
authors.lastname: Somers
authors.affiliation: Department of Hypertension and Diabetology Medical University of Gdańsk, Gdańsk, Poland; Department of Cardiovascular Diseases, International Clinical Research Center, St. Anne's University Hospital in Brno (FNUSA), Brno, Czech Republic.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Narkiewicz
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002639:Cheyne-Stokes Respiration / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D004361:Drug Tolerance; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D012890:Sleep; D020182:Sleep Apnea, Central / Q000150:complications* / Q000503:physiopathology; D013806:Theophylline / Q000008:administration & dosage / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000959:Antihypertensive Agents; D014665:Vasodilator Agents; D013806:Theophylline