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(Hypertension. 1996;28:937-943.)
© 1996 American Heart Association, Inc.

Articles

Short-term Variability of Blood Pressure During Sleep in Snorers With or Without Apnea

Michel Leroy; Catherine Van Surell; Remi Pilliere; Marie-Pascale Hagenmuller; Philippe Aegerter; Bernadette Raffestin; Arlette Foucher

Service d'Exploration Fonctionnelle Multidisciplinaire, Hopital Ambroise Pare, Universite Rene Descartes, Boulogne, France.

Correspondence to Dr Michel Leroy, Service d'Exploration Fonctionnelle, Hopital Ambroise Pare, 92100 Boulogne, France.

In normal subjects, the level and variability of blood pressure decrease during non–rapid eye movement (non-REM) sleep. In contrast, sleep apnea is associated with large swings in nocturnal pressure. In this study, we evaluated a computer-derived index of all-night blood pressure variability in normotensive snorers with or without sleep apnea. We also examined this index in snorers receiving medical treatment for coexistent ischemic heart disease. Beat-to-beat blood pressure was recorded with a photoplethysmographic device (Finapres) throughout polysomnography. Subjects were categorized into four groups: those without cardiovascular disease without or with sleep apnea (15 apnea plus hypopnea per hour of sleep), and those with ischemic heart disease without or with sleep apnea. A frequency distribution histogram of all increases and decreases of blood pressure according to their amplitudes was drawn and the SD of the distribution used as an estimation of variability. Mean systolic and diastolic pressures during the total sleep time were not different among the four groups. In contrast, the SD of the distribution of systolic and diastolic pressure variations that were higher in the apneic than in the nonapneic groups (P<.05) correlated with apnea plus hypopnea (P<.0001) and transient electroencephalographic arousal number per hour of sleep (P<.0001). In both apneic and nonapneic subjects, blood pressure variability as assessed by SD decreased during stages 3 and 4 of non-REM sleep compared with stages 1 and 2 and REM sleep (P<.001). Blood pressure variability was similarly increased in apneic subjects with or without ischemic heart disease. We speculate that in apneic individuals with coexistent ischemic heart disease, pressure variability that is increased despite treatment with ß-blockers or calcium antagonists may be a risk factor for acute coronary events.

Key Words: blood pressure • sleep • sleep apnea syndromes

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