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
This article has been cited by other articles:
 |
|
 |
|
  V. K. Somers, D. P. White, R. Amin, W. T. Abraham, F. Costa, A. Culebras, S. Daniels, J. S. Floras, C. E. Hunt, L. J. Olson, et al. Sleep Apnea and Cardiovascular Disease: An American Heart Association/American College of Cardiology Foundation Scientific Statement From the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing In Collaboration With the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health) Circulation, September 2, 2008; 118(10): 1080 - 1111. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Rey, M. P. Tarvainen, P. A. Karjalainen, and R. Iturriaga Dynamic time-varying analysis of heart rate and blood pressure variability in cats exposed to short-term chronic intermittent hypoxia Am J Physiol Regulatory Integrative Comp Physiol, July 1, 2008; 295(1): R28 - R37. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. V. Serebrovskaya, E. B. Manukhina, M. L. Smith, H. F. Downey, and R. T. Mallet Intermittent Hypoxia: Cause of or Therapy for Systemic Hypertension? Experimental Biology and Medicine, June 1, 2008; 233(6): 627 - 650. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Lopez-Jimenez, F. H. Sert Kuniyoshi, A. Gami, and V. K. Somers Obstructive Sleep Apnea: Implications for Cardiac and Vascular Disease Chest, March 1, 2008; 133(3): 793 - 804. [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Golbin, V. K. Somers, and S. M. Caples Obstructive Sleep Apnea, Cardiovascular Disease, and Pulmonary Hypertension Proceedings of the ATS, February 15, 2008; 5(2): 200 - 206. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Buyse, J. Hedner, and the participants of working group 2 Sleep apnoea, hypertension and vascular disease: where are we now? Eur. Respir. Rev., December 1, 2007; 16(106): 169 - 182. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Parati, C. Lombardi, and K. Narkiewicz Sleep apnea: epidemiology, pathophysiology, and relation to cardiovascular risk Am J Physiol Regulatory Integrative Comp Physiol, October 1, 2007; 293(4): R1671 - R1683. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 U. A. Leuenberger, C. S. Hogeman, S. Quraishi, L. Linton-Frazier, and K. S. Gray Short-term intermittent hypoxia enhances sympathetic responses to continuous hypoxia in humans J Appl Physiol, September 1, 2007; 103(3): 835 - 842. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. M. de Paula, G. Tolstykh, and S. Mifflin Chronic intermittent hypoxia alters NMDA and AMPA-evoked currents in NTS neurons receiving carotid body chemoreceptor inputs Am J Physiol Regulatory Integrative Comp Physiol, June 1, 2007; 292(6): R2259 - R2265. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Haentjens, A. Van Meerhaeghe, A. Moscariello, S. De Weerdt, K. Poppe, A. Dupont, and B. Velkeniers The Impact of Continuous Positive Airway Pressure on Blood Pressure in Patients With Obstructive Sleep Apnea Syndrome: Evidence From a Meta-analysis of Placebo-Controlled Randomized Trials Arch Intern Med, April 23, 2007; 167(8): 757 - 764. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Wolk and V. K. Somers Sleep Apnoea & Hypertension: Physiological bases for a causal relation: Sleep and the metabolic syndrome Exp Physiol, January 1, 2007; 92(1): 67 - 78. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. L. Smith and C. F. Pacchia Sleep Apnoea & Hypertension: Physiological bases for a causal relation: Sleep apnoea and hypertension: role of chemoreflexes in humans Exp Physiol, January 1, 2007; 92(1): 45 - 50. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. E. Foster, M. J. Poulin, and P. J. Hanly Sleep Apnoea & Hypertension: Physiological bases for a causal relation: Intermittent hypoxia and vascular function: implications for obstructive sleep apnoea Exp Physiol, January 1, 2007; 92(1): 51 - 65. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. W. Weiss, M. D. Y. Liu, and J. Huang Sleep Apnoea & Hypertension: Physiological bases for a causal relation: Physiological basis for a causal relationship of obstructive sleep apnoea to hypertension Exp Physiol, January 1, 2007; 92(1): 21 - 26. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Houssiere, B. Najem, N. Cuylits, S. Cuypers, R. Naeije, and P. van de Borne Hyperoxia enhances metaboreflex sensitivity during static exercise in humans Am J Physiol Heart Circ Physiol, July 1, 2006; 291(1): H210 - H215. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. J. Lai, C. C. H. Yang, Y. Y. Hsu, Y. N. Lin, and T. B. J. Kuo Enhanced sympathetic outflow and decreased baroreflex sensitivity are associated with intermittent hypoxia-induced systemic hypertension in conscious rats J Appl Physiol, June 1, 2006; 100(6): 1974 - 1982. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Yinon, L. Lowenstein, S. Suraya, R. Beloosesky, O. Zmora, A. Malhotra, and G. Pillar Pre-eclampsia is associated with sleep-disordered breathing and endothelial dysfunction Eur. Respir. J., February 1, 2006; 27(2): 328 - 333. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Spaak, Z. J. Egri, T. Kubo, E. Yu, S.-I. Ando, Y. Kaneko, K. Usui, T. D. Bradley, and J. S. Floras Muscle Sympathetic Nerve Activity During Wakefulness in Heart Failure Patients With and Without Sleep Apnea Hypertension, December 1, 2005; 46(6): 1327 - 1332. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. M. Caples, A. S. Gami, and V. K. Somers Obstructive Sleep Apnea Focus, October 1, 2005; 3(4): 557 - 567. [Full Text] [PDF]
|
|
|
|
|
|
C. N. Joseph, C. Porta, G. Casucci, N. Casiraghi, M. Maffeis, M. Rossi, and L. Bernardi Slow Breathing Improves Arterial Baroreflex Sensitivity and Decreases Blood Pressure in Essential Hypertension Hypertension, October 1, 2005; 46(4): 714 - 718. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Ciarka, B. Najem, N. Cuylits, M. Leeman, O. Xhaet, K. Narkiewicz, M. Antoine, J.-P. Degaute, and P. van de Borne Effects of Peripheral Chemoreceptors Deactivation on Sympathetic Activity in Heart Transplant Recipients Hypertension, May 1, 2005; 45(5): 894 - 900. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. M. Caples, A. S. Gami, and V. K. Somers Obstructive Sleep Apnea Ann Intern Med, February 1, 2005; 142(3): 187 - 197. [Full Text] [PDF]
|
|
|
|
 |
|
 P Gordon and M H Sanders Sleep {middle dot} 7: Positive airway pressure therapy for obstructive sleep apnoea/hypopnoea syndrome Thorax, January 1, 2005; 60(1): 68 - 75. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Cutler, N. M. Swift, D. M. Keller, W. L. Wasmund, J. R. Burk, and M. L. Smith Periods of intermittent hypoxic apnea can alter chemoreflex control of sympathetic nerve activity in humans Am J Physiol Heart Circ Physiol, November 1, 2004; 287(5): H2054 - H2060. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Rey, R. Del Rio, J. Alcayaga, and R. Iturriaga Chronic intermittent hypoxia enhances cat chemosensory and ventilatory responses to hypoxia J. Physiol., October 15, 2004; 560(2): 577 - 586. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Velez-Roa, A. Ciarka, B. Najem, J.-L. Vachiery, R. Naeije, and P. van de Borne Increased Sympathetic Nerve Activity in Pulmonary Artery Hypertension Circulation, September 7, 2004; 110(10): 1308 - 1312. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Whitsett, C. J. Bachurski, K. C. Barnes, P. A. Bunn Jr., L. M. Case, D. N. Cook, D. Crooks, M. W. Duncan, L. Dwyer-Nield, R. C. Elston, et al. Functional Genomics of Lung Disease Am. J. Respir. Cell Mol. Biol., August 1, 2004; 31(2/S1): S1 - S81. [Full Text] [PDF]
|
|
|
|
|
|
V. L. Cooper, C. M. Bowker, S. B. Pearson, M. W. Elliott, and R. Hainsworth Effects of simulated obstructive sleep apnoea on the human carotid baroreceptor-vascular resistance reflex J. Physiol., June 15, 2004; 557(3): 1055 - 1065. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Cutler, N. M. Swift, D. M. Keller, W. L. Wasmund, and M. L. Smith Hypoxia-mediated prolonged elevation of sympathetic nerve activity after periods of intermittent hypoxic apnea J Appl Physiol, February 1, 2004; 96(2): 754 - 761. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Grassi, G. Seravalle, F. Quarti-Trevano, R. Dell'Oro, G. Bolla, and G. Mancia Effects of Hypertension and Obesity on the Sympathetic Activation of Heart Failure Patients Hypertension, November 1, 2003; 42(5): 873 - 877. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. S. M. Shamsuzzaman, B. J. Gersh, and V. K. Somers Obstructive Sleep Apnea: Implications for Cardiac and Vascular Disease JAMA, October 8, 2003; 290(14): 1906 - 1914. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Velez-Roa, B. Kojonazarov, A. Ciarka, P. Godart, R. Naeije, V. K. Somers, and P. van de Borne Dobutamine potentiates arterial chemoreflex sensitivity in healthy normal humans Am J Physiol Heart Circ Physiol, August 7, 2003; 285(3): H1356 - H1361. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Spicuzza, L. Bernardi, A. Calciati, and G. U. Di Maria Autonomic Modulation of Heart Rate during Obstructive versus Central Apneas in Patients with Sleep-disordered Breathing Am. J. Respir. Crit. Care Med., March 15, 2003; 167(6): 902 - 910. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Elam, D. McKenzie, and V. Macefield Mechanisms of sympathoexcitation: single-unit analysis of muscle vasoconstrictor neurons in awake OSAS subjects J Appl Physiol, July 1, 2002; 93(1): 297 - 303. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K Otake, K Delaive, R Walld, J Manfreda, and M H Kryger Cardiovascular medication use in patients with undiagnosed obstructive sleep apnoea Thorax, May 1, 2002; 57(5): 417 - 422. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. S. T. LEUNG and T. DOUGLAS BRADLEY Sleep Apnea and Cardiovascular Disease Am. J. Respir. Crit. Care Med., December 15, 2001; 164(12): 2147 - 2165. [Full Text] [PDF]
|
|
|
|
|
|
S. HEINDL, M. LEHNERT, C.-P. CRIEE, G. HASENFUSS, and S. ANDREAS Marked Sympathetic Activation in Patients with Chronic Respiratory Failure Am. J. Respir. Crit. Care Med., August 15, 2001; 164(4): 597 - 601. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Narkiewicz, M. Kato, B. G. Phillips, C. A. Pesek, D. E. Davison, and V. K. Somers Nocturnal Continuous Positive Airway Pressure Decreases Daytime Sympathetic Traffic in Obstructive Sleep Apnea Circulation, December 7, 1999; 100(23): 2332 - 2335. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Narkiewicz, P. J. H. van de Borne, C. A. Pesek, M. E. Dyken, N. Montano, and V. K. Somers Selective Potentiation of Peripheral Chemoreflex Sensitivity in Obstructive Sleep Apnea Circulation, March 9, 1999; 99(9): 1183 - 1189. [Abstract] [Full Text] [PDF]
|
|