Autonomic regulation of blood circulation in hypertensive patients with obstructive sleep apnea syndrome

Objective. To assess autonomic regulation in hypertensive patients with and without obstructive sleep apnea syndrome and in relation to the severity of sleep-disordered breathing. Design and methods. We included 107 subjects, mean age 53,0 ± 8,4 years, 85 males and 22 females. The main group included 77 hypertensive patients who were divided into 2 groups based on the results of sleep study: 37 patients with obstructive sleep apnea syndrome and 40 subjects without sleep=breathing disorders. Control group included 30 normotensive subjects without sleep apnea. All patients underwent clinical examination, 24-hour blood pressure monitoring (SpaceLabs 90207, USA), cardiorespiratory study (Embletta Pds, MedCare Flaga, Iceland), assessment of autonomic regulation of blood circulation by Finometer (FMS, Amsterdam) and vasomotor reactivity by occlusion plethysmography according to Dohn. Results. Sleep apnea patients and hypertensives without sleep-breathing disorders had lower autonomic baroreflex than controls (5,6 ± 2,8; 6,7 ± 1,6 and 9,8 ± 2,4 ms/mmHg, p < 0,005 and p < 0,01, respectively). Subjects with more severe sleep apnea demonstrated lower parameters of spontaneous arterial baroreflex. Valsalva index was reduced in sleep apnea patients (1,45 ± 0,22) compared to hypertensive patients without sleep-breathing disorders (1,71 ± 0,31, p < 0,01) and controls (1,72 ± 0,25, p < 0,01). Forearm cutaneous-muscular blood flow velocity was decreased in patients with obstructive sleep apnea syndrome (3,7 ± 1,7 ml/min×100 cm²) compared to controls (5,8 ± 2,2 ml/min×100 cm², p < 0,05) and subjects without sleep apnea (6,5 ± 2,6 ml/min×100 cm², p < 0,01). Conclusions. Lower control of arterial hypertension in hypertensive patients with sleep apnea is associated with the impairment of baroreflex and non-specific cardiochronotropic heart regulation, increased tone of resistant vessels and non-soecific vasomotor reactivity.

autonomic regulation of circulation, obstructive sleep apnea syndrome, arterial hypertension

1. Parati G., Lombardi C., Hedner J. et. al. Position paper on the management of patients with obstructive sleep apnea and hypertension: Joint recommendations by the European Society of Hypertension, by the European Respiratory Society and by the members of European COST (COoperation in Scientific and Technological research) ACTION B26 on Obstructive Sleep Apnea // J. Hypertens. – 2012. – Vol. 30, № 4. - Р. 633-646.

2. Grunstein R.R., Wilcox I., Yang T. Snoring and sleep apnea in men: association with central obesity and hypertension // Int. J. Obesity. – 1993. – Vol. 17, № 9. – P. 533-540.

3. Levinson P.D., McGarvey S.T., Carlisle C.C., Eveloff S.E., Herbert P.N., Millman R.P. Adiposity and cardiovascular risk factors in men with obstructive sleep apnea // Chest. – 1993. – Vol. 103, № 5. – P. 1336-1342.

4. Pei D., Chen Y.D., Hollenbeck C.B. et al. Relationship between insulin-mediated glucose disposal by muscle and adipose tissue lipolysis in healthy volunteers // J. Clin. Endocrinol. Metab. – 1995. – Vol. 80, № 11. – P. 3368-3372.

5. Ip M.S., Lam B., Ng M.M., Lam W.K., Tsang K.W., Lam K.S. Obstructive sleep apnea is independently associated with insulin resistance // Am. J. Respir. Crit. Care Med. – 2002. – Vol. 165, № 5. – P. 670-676.

6. Coughlin S.R., Mawdsley L., Mugarza J.A., Calverley P.M., Wilding J.P. Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome // Eur. Heart J. – 2004. – Vol. 25, № 9. – P. 735-741.

7. Wilcox I., Stephen G., Fiona L. Collins, Grunstein R., Sullivan C. «Syndrom Z»: the interaction of sleep apnoe, vascular risk factors and heart diseases // Thorax. - 1998. - Vol. 53, Suppl. 3. - P. 25-28.

8. Bixler E.O., Vgontzas A.N., Papanicolaou D.A. et al. Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance, and hypercytokinemia // J. Clin. Endocrinol. Metab. – 2000. – Vol. 85, № 3. – P. 1151-1158.

9. Goodfriend T.L. Obesity, sleep apnea, aldosterone, and hypertension // Curr. Hypertens. Rep. – 2008. – Vol. 10, № 3. –Р. 222-226.

10. Nieto F.J., Young T.B., Lind B.K. et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study // J. Am. Med. Assoc. – 2000. – Vol. 283, № 14. – P. 1829-1836.

11. Olmetti F., La Rovere M.T., Robbi E., Taurino A.E., Fanfulla F. Nocturnal cardiac arrhythmia in patients with obstructive sleep apnea // Sleep Med. – 2008. – Vol. 9, № 5. – Р. 475-480.

12. Pimenta E., Calhoun D.A., Oparil S. Sleep apnea, aldosterone, and resistant hypertension // Prog. Cardiovasc. Dis. – 2009. – Vol. 51, № 5. – Р. 371-380.

13. Chobanian A.V., Bakris G.L., Black H.R. et al. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure // Hypertension. – 2003. – Vol. 42, № 6. – Р. 1206-1252.

14. Mancia G., Backer G., Dominiczak A. et al. The Task Force for the management of arterial hypertension of the European Society of Hypertension and of the European Society of Cardiology. 2007 Guidelines for the management of arterial hypertension // Eur. Heart J. – 2007. – Vol. 28, № 12. – P. 1462–1536.

15. Звартау Н.Э., Свиряев Ю.В., Коростовцева Л.С., Конради А.О. Механизмы развития резистентности к антигипертензивной терапии прии синдроме обструктивного апноэ во время сна // Артериальная гипертензия. - 2012. – Т. 18, № 3. – С. 184-190.

16. Галицин П.В., Литвин А.Ю., Чазова И.Е. Синдром обструктивного апноэ во время сна и дисфункция эндотелия // Кардиологич. вестн. – 2007. - Т. II (XIV), № 2. – С. 71-76.

17. Narkiewicz K., Montano N., Cogliati C., van de Borne P.J., Dyken M.E., Somers V.K. Altered cardiovascular variability in obstructive sleep apnea // Circulation. – 1998. – Vol. 98, № 11. – Р. 1071-1077.

18. Narkiewicz K., Somers V.K. Sympathetic nerve activity in obstructive sleep apnoea // Acta Physiologica Scandinavica. – 2003. – Vol. 177, № 3. – Р. 385-390.

19. Phillips C.L., Cistulli P.A. Obstructive sleep apnea and hypertension: epidemiology, mechanisms and treatment effects // Minerva Med. – 2006. – Vol. 97, № 4. – Р. 299-312.

20. Емельянов И.В., Конради А.О., Багров А.Я. Спонтанный барорефлекс у пациентов с резистентной артериальной гипертензией: изменения во время теста с солевой нагрузкой // Артериальная гипертензия. – 2012. – Т. 18, № 4. – С. 292-297.

21. Pack A.I., Gislason T. Obstructive sleep apnea and cardiovascular disease: a perspective and future directions // Prog. Cardiovasc. Dis. – 2009. – Vol. 51, № 5. – Р. 434-451.

22. Ryan S., Ward S., Heneghan C., McNicholas W.T. Predictors of decreased spontaneous baroreflex sensitivity in obstructive sleep apnea syndrome // Chest. – 2007. – Vol. 131, № 4. – Р. 1100-1107.

23. Carlson J.T., Hedner J.A., Sellgren J., Elam M., Wallin B.G. Depressed baroreflex sensitivity in patients with obstructive sleep apnea // Am. J. Respir. Crit. Care Med. – 1996. – Vol. 154, № 5. – Р. 1490-1496.