Relationship between overnight rostral fluid shift and obstructive sleep apnea in drug-resistant hypertension.
نویسندگان
چکیده
Obstructive sleep apnea occurs frequently in patients with drug-resistant hypertension. The factors accounting for this observation, however, are unclear. Both conditions demonstrate clinical features suggestive of extracellular fluid volume overload. The aims of this study were to examine whether the spontaneous overnight fluid shift from the legs to the upper body is associated with obstructive sleep apnea in hypertensive subjects and whether its magnitude is greater in drug-resistant hypertension. Leg fluid volume and the circumference of the calf and neck were measured before and after sleep in drug-resistant hypertensive (n = 25) and controlled hypertensive (n=15) subjects undergoing overnight polysomnography. The severity of obstructive sleep apnea was greater in the drug-resistant hypertensive group than in the controlled hypertensive group (apnea-hypopnea index: 43.0 ± 5.4 versus 18.1 ± 4.2 events per hour of sleep; P = 0.02, case-mix adjusted). In both groups, the apnea-hypopnea index strongly related to the amount of leg fluid volume displaced (R² = 0.56; P < 0.0001), although the magnitude of change was greater in the drug-resistant hypertensive group (346.7 ± 24.1 versus 175.8 ± 31.3 mL; P = 0.01, propensity-score adjusted). The overnight reduction in calf circumference and increase in neck circumference were also greater in drug-resistant hypertension (both P ≤ 0.02). In hypertensive subjects, rostral fluid displacement strongly relates to the severity of obstructive sleep apnea with its magnitude being greater in drug-resistant hypertension. Our findings support the concept that fluid redistribution centrally during sleep accounts for the high prevalence of obstructive sleep apnea in drug-resistant hypertension.
منابع مشابه
Sleep Apnea Relationship Between Overnight Rostral Fluid Shift and Obstructive Sleep Apnea in Drug-Resistant Hypertension
Obstructive sleep apnea occurs frequently in patients with drug-resistant hypertension. The factors accounting for this observation, however, are unclear. Both conditions demonstrate clinical features suggestive of extracellular fluid volume overload. The aims of this study were to examine whether the spontaneous overnight fluid shift from the legs to the upper body is associated with obstructi...
متن کاملInfluence of lower body positive pressure on upper airway cross-sectional area in drug-resistant hypertension.
We previously showed that in hypertensive patients the amount of fluid displaced from the legs overnight is directly related to the severity of obstructive sleep apnea and that the rostral fluid shift was greater in drug-resistant hypertensive patients. The findings suggested that this fluid redistribution increases upper airway collapsibility, yet more direct evidence is lacking. The present s...
متن کاملEditorial Commentary Overnight Rostral Fluid Shift and Obstructive Sleep Apnea in Treatment Resistant Hypertension Connecting the Dots Clarifies the Picture
The article by Friedman et al1 in the present issue of Hypertension represents a thoughtfully designed study. Their report connects previously established but loosely connected lines of research into a coherent and credible theme with important therapeutic and research implications. First, treatment-resistant hypertension is associated with obstructive sleep apnea. Many patients with treatment-...
متن کاملOvernight rostral fluid shift and obstructive sleep apnea in treatment resistant hypertension: connecting the dots clarifies the picture.
The article by Friedman et al1 in the present issue of Hypertension represents a thoughtfully designed study. Their report connects previously established but loosely connected lines of research into a coherent and credible theme with important therapeutic and research implications. First, treatment-resistant hypertension is associated with obstructive sleep apnea. Many patients with treatment-...
متن کاملDiffering relationship of nocturnal fluid shifts to sleep apnea in men and women with heart failure.
BACKGROUND In men with heart failure, nocturnal rostral fluid shift is associated with an overnight increase in the neck circumference (NC) and with severity of obstructive sleep apnea. Because the prevalence of obstructive sleep apnea is lower in women than in men with heart failure, we hypothesized that less fluid would shift into the neck in association with less severe obstructive sleep apn...
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ورودعنوان ژورنال:
- Hypertension
دوره 56 6 شماره
صفحات -
تاریخ انتشار 2010