Changes in left ventricular ejection fraction during REM sleep and exercise in chronic obstructive pulmonary disease and sleep apnoea syndrome

• Published in: The European respiratory journal Vol. 4; no. 3; pp. 347 - 352
• Main Authors: Levy, PA, Guilleminault, C, Fagret, D, Gaio, JM, Romand, P, Bonnet, C, Pison, CM, Wolf, JE, Paramelle, B
• Format: Journal Article
• Language: English
• Published: Leeds Eur Respiratory Soc 01.03.1991; Maney
• Subjects: Adult; Aged; Biological and medical sciences; Circadian Rhythm; Exercise; Female; Heart Rate; Humans; Lung Diseases, Obstructive - diagnostic imaging; Lung Diseases, Obstructive - physiopathology; Male; Medical sciences; Middle Aged; Monitoring, Physiologic; Oxygen - blood; Pneumology; Radionuclide Imaging; Sleep Apnea Syndromes - diagnostic imaging; Sleep Apnea Syndromes - physiopathology; Sleep, REM - physiology; Stroke Volume - physiology; Wakefulness - physiology; Physical exercise; Human; Apnea; Sleep; Respiratory disease; Exploration; Obstructive pulmonary disease; Scintigraphy; Rapid eye movement sleep; Left ventricle; Ejection fraction
• ISSN: 0903-1936; 1399-3003
• DOI: 10.1183/09031936.93.04030347

Nine patients, 4 with chronic obstructive pulmonary disease (COPD) and 5 with obstructive sleep apnoea syndrome (OSAS) were monitored during sleep, rest and exercise. Left ventricular ejection fraction (LVEF) was investigated using gated equilibrium 99mtechnetium ventricular scintigraphy during rapid eye movement (REM) sleep, during exercise, and during wakeful rest. Control wakeful rest periods used for comparison with a study state (either REM sleep or exercise) were always selected during the same circadian segment as that state. Myocardial stress thallium-201 scintigraphy was performed during, and 4 h after, exercise, and results were compared to a daytime rest period. Several patients had myocardial hypoperfusion despite a normal electrocardiographic (ECG) treadmill test. During REM sleep, all patients exhibited a significant change in LVEF (greater than 5%) compared to wakefulness. During exercise, 5 subjects increased their LVEF normally (greater than 5%) and 4 (1 COPD, 3 OSAS) decreased it. All patients had a similar change (increase or decrease) during REM and at maximal exercise. Our results suggest that REM sleep in COPD and in OSAS can produce a myocardial stress as great as that produced by exercise. We conclude that REM sleep, like exercise, is a state in which morbidity may become higher and that it may account for mortality in COPD and OSAS patients with compromised myocardial circulation.