From the Cardiovascular Division, Department of Internal Medicine (K.N.,
P.J.H.v.d.B., V.K.S.), Department of Neurology (M.E.D.), and Division of
Clinical and Administrative Pharmacy (B.G.P.), University of Iowa, Iowa City,
and Centro Ricerche Cardiovascolari, CNR, Medicina Interna II, Ospedale L.
Sacco, Università di Milano (Italy) (N.M.).
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
Background—Muscle sympathetic nerve
activity (MSNA) is increased in patients with obstructive sleep apnea
(OSA). We tested the hypothesis that tonic activation of excitatory
chemoreceptor afferents contributes to the elevated sympathetic
activity in OSA.
Methods and Results—Using a double-blind, randomized,
vehicle-controlled design, we examined the effects of chemoreflex
deactivation (by comparing effects of breathing 100% oxygen for 15
minutes with effects of breathing room air for 15 minutes) on MSNA,
heart rate, blood pressure, and minute ventilation in 14 untreated
patients with OSA and in 12 normal subjects matched for age and body
mass index. All control subjects underwent overnight polysomnography to
exclude the existence of occult OSA. Baseline MSNA was markedly
elevated in the patients with OSA compared with the control subjects
(44±4 versus 30±3 bursts per minute; P=.01). In both
control subjects and patients with OSA, heart rate decreased during
administration of 100% oxygen but did not change during administration
of room air. By contrast, both MSNA (P=.008) and mean
arterial pressure (P=.02) were significantly
reduced during chemoreflex deactivation by 100% oxygen only in
patients with OSA but not in control subjects.
Conclusions—Tonic activation of excitatory chemoreflex afferents
may contribute to increased efferent sympathetic activity to muscle
circulation in patients with OSA.
© 1998 American Heart Association, Inc.
Brief Rapid Communications
Contribution of Tonic Chemoreflex Activation to Sympathetic Activity and Blood Pressure in Patients With Obstructive Sleep Apnea
Key Words: nervous system, autonomic • nervous system, sympathetic • apnea, sleep • blood pressure • heart rate
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