Acute Effects of Nasal Continuous Positive Airway Pressure on 24-Hour Blood Pressure and Catecholamines in Patients with Obstructive Sleep Apnea

• Published in: Internal Medicine Vol. 37; no. 12; pp. 1009 - 1013
• Main Authors: MINEMURA, Hiroshi, AKASHIBA, Tsuneto, YAMAMOTO, Hitoshi, AKAHOSHI, Toshiki, KOSAKA, Naoko, HORIE, Takashi
• Format: Journal Article
• Language: English
• Published: Tokyo The Japanese Society of Internal Medicine 1998; Japanese Society of Internal Medicine
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Biomarkers - blood; Biomarkers - urine; Blood Pressure - physiology; Blood Pressure Monitoring, Ambulatory; Catecholamines - blood; Catecholamines - urine; Chromatography, High Pressure Liquid; Circadian Rhythm; daytime blood pressure; Emergency and intensive respiratory care; Humans; Hypertension - blood; Hypertension - physiopathology; Hypertension - urine; Intensive care medicine; Male; Medical sciences; Middle Aged; nighttime blood pressure; plasma catecholamine; Polysomnography; Positive-Pressure Respiration; Sleep Apnea Syndromes - blood; Sleep Apnea Syndromes - physiopathology; Sleep Apnea Syndromes - urine; Treatment Outcome; urinary catecholamine; Epinephrine; Human; Nervous system diseases; Sleep apnea syndrome; Night; Respiratory disease; Continuous; Secretion; Instrumentation therapy; Catecholamine; Positive end expiratory pressure; Treatment; Diseases of the autonomic nervous system; Blood pressure; Biological effect; Day; Comparative study
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.37.1009

To assess the acute effects of nasal continuous positive airway pressure (CPAP) on the 24-hour blood pressure and the secretion of catecholamines in urine and plasma, we investigated the changes in the 24-hour blood pressure and urinary and plasma concentrations of epinephrine (E) and norepinephrine (NE) in 26 men with obstructive sleep apnea (OSA) with and without nasal CPAP. Nasal CPAP resulted in significant decreases in the daytime diastolic pressure (from 86 ± 16 mmHg to 83 ± 12 mmHg), the nighttime diastolic pressure (from 81 ± 12 mmHg to 77 ± 9 mmHg) and the nighttime systolic pressures (from 125 ± 15 mmHg to 120 ± 10 mmHg). There was no significant difference between patients with and without CPAP in the daytime or nighttime urinary E level, but patients who received CPAP showed a significant decrease in daytime urinary NE level (from 156 ± 112 μg/14h to 119 ± 101 μg/14h) and nighttime urinary NE level (from 143 ± 91 μg/10h to 112 ± 65 μg/10h). The morning plasma level of NE also decreased (from 371 ± 181 pg/ml to 273 ± 148 pg/ml) in patients who received nasal CPAP (p<0.02), but the plasma level of E remained unchanged. There were no correlations between PSG parameters and the reductions in blood pressure and the catecholamine levels induced by nasal CPAP. These findings suggest that OSA contributes, at least in part, to the development of systemic hypertension by increasing sympathetic nervous activity. (Internal Medicine 37: 1009-1013, 1998)