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Upper airway resistance syndrome, nocturnal blood pressure monitoring, & borderline hypertension

  [ 36 votes ]   [ Discuss This Article ] • April 15, 1996

Upper airway resistance syndrome (UARS) is a sleep-disordered
breathing syndrome characterized by complaints of daytime
fatigue and/or sleepiness, increased upper airway resistance
during sleep, frequent transient arousals, and no significant
hypoxemia. Of a population of 110 subjects (58 men) diagnosed
as having UARS, we investigated acute systolic and diastolic
BP changes seen during sleep in two different samples. First,
six patients from the original subject pool were found to
have untreated chronic borderline high BP, and were subjected
to 48 h of continuous ambulatory BP monitoring before
treatment and another 48 h of BP monitoring 1 month after the
start of nasal-continuous positive airway pressure (N-CPAP)
treatment. Five of six subjects used their equipment on a
regular basis and had their chronic borderline high BP
completely controlled. No change in BP values was seen in the
last subject, who discontinued N-CPAP after 3 days . A second
protocol investigated seven normotensive subjects drawn from
the initial subject pool. Continuous radial artery BP
recording was performed during nocturnal sleep with
simultaneous polygraphic recording of sleep/wake variables
and respiration. BP changes were studied during periods of
increased respiratory efforts and at the time of alpha EEG
arousals. Increases in systolic and diastolic BP were noted
during the breaths with the greatest inspiratory efforts
without significant hypoxemia. A further increase in BP was
noted in association with arousals. Three of these subjects
also underwent echocardiography during sleep, which
demonstrated a leftward shift of the interventricular septum
with pulsus paradoxus in association with peak
end-inspiratory esophageal pressure more negative than -35 cm
H2O. Our study indicates that, in the absence of classic
apneas, hypopneas, and repetitive significant drops in oxygen
saturation (below 90%), repetitive increases in BP can occur
as a result of increased airway resistance during sleep. It
also shows that, in some patients with both UARS and
borderline high BP, high BP can be controlled with treatment
of UARS. We conclude that abnormal upper airway resistance
during sleep, often associated with snoring, can play a role
in the development of hypertension.

Guilleminault C, Stoohs R, Shiomi T, Kushida C, Schnittger I

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