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

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.


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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