(Hypertension. 1998;32:1039-1043.)
© 1998 American Heart Association, Inc.
Scientific Contributions |
Baroreflex Control of Sympathetic Nerve Activity and Heart Rate in Obstructive Sleep Apnea
From the Cardiovascular Division, Department of Internal Medicine (K.N., C.A.P., M.K., D.E.D., V.K.S.), University of Iowa College of Medicine, and Division of Clinical and Administrative Pharmacy (B.G.P.), University of Iowa College of Pharmacy, Iowa City.
Correspondence to Virend Somers, MD, PhD, Cardiovascular Division, Department of Internal Medicine, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242. E-mail virend-somers{at}uiowa.edu
Abstract—Patients with
obstructive sleep apnea are at increased risk for hypertension. The
mechanisms underlying this increased risk are not known. We tested the
hypothesis that obstructive sleep apnea, independent of factors such as
hypertension, obesity, and age, is characterized by impairment of
baroreflex sensitivity. We measured muscle sympathetic nerve activity
(MSNA) and heart rate responses to activation and deactivation of
baroreceptors in newly diagnosed, never treated, normotensive patients
with obstructive sleep apnea. These responses were compared with those
obtained in healthy control subjects closely matched for age, body mass
index, and blood pressure. Heart rate and MSNA changes during infusion
of phenylephrine (baroreceptor activation) were similar in
the control subjects and patients with sleep apnea. Infusion of
nitroprusside (baroreceptor deactivation) elicited similar decreases in
mean arterial pressure (MAP) but lesser MSNA increases in
patients with sleep apnea than in control subjects. Calculation of
MSNA/MAP ratio revealed that baroreflex regulation of sympathetic
activity for similar blood pressure changes was diminished in patients
with sleep apnea in comparison to normal control subjects
(P=0.01). However, increases in heart rate during
nitroprusside infusion were comparable in both groups. Sympathetic,
blood pressure and heart rate responses to the cold pressor test were
also similar in the 2 groups. Our results indicate that normotensive
patients with sleep apnea have a selective impairment of the
sympathetic response to baroreceptor deactivation but not to
baroreceptor activation or to the cold pressor test. The impairment of
baroreflex sympathetic modulation in patients with sleep apnea is not
accompanied by any impairment of baroreflex control of heart rate.
Key Words: autonomic nervous system • sympathetic nervous system • sleep apnea • blood pressure • heart rate • baroreceptors
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