snoring, obesity and frequent cessation of breathing during sleep.―2Neurologic problems in SAS patients

have been reported in sleep apnea syndrome (SAS), but such studies have been limited due to lack of a reliable noninvasive study method. We determined the systolic (Vs), diastolic (VD), and mean (VM) cerebral blood flow velocities of the middle cerebral artery in 23 individuals (12 severe SAS patients and 11 control subjects) using transcranial Doppler sonography befure sleep, during sleep (NREM and REM) and upon awakening. All three velocities (Vs87.4 cm/s compared to 104.7 cm/s, VD41.6 em/s compared to 47.7 cm/s, and VM 57.0 cm/s compared to 67.0 cm/s) were decreased in patients with SAS and Vs and VM were significantly lower than in control subjects (p=0.005 and pO.033, respectively). The end-tidal CO@ (PEi'CO1) in the SAS patients (47.3 mm Hg) compared to the control subjects (41.8 mm Hg) was significantly higher (p=0.003). When the VM was adjusted to normalized CO using the Marlcwalder's equation, the reduction in velocity in patients with SAS(47.5 cm/s)compared to control subjects (63.0 cm/s) became more significant (p0,005). This study shows that cerebral blood flow velocities are lower in patients with SAS compared to control subjects and that transcranial Doppler sonography may be useful in such evaluations. (Chest 1992; 102:1402-06)