Hemodynamics in Sleep-Induced Apnea

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Abstract
Twelve patients with predominantly obstructive type sleep apnea underwent cardiac catheterization, hemodynamic monitoring and arterial blood gas analysis during wakefulness and sleep. Abnormalities during wakefulness included systemic hypertension in 4 of 12, exercise-induced mild pulmonary hypertension in 5 of 12, and alveolar hypoventilation in 1. During sleep 9 patients had cyclic elevations of arterial pressure with each apneic episode exceeding 200 mm Hg systolic in 3 of 12. Pulmonary artery pressures increased in 19 of 12, exceeding 60 mm Hg systolic in 5. Marked degrees of hypoxemia (arterial PO2 [O2 tension], < 50 mm Hg in 8 of 12) and moderate hypercapnia with respiratory acidosis were associated with these hemodynamic changes. Cyclic upper airway obstruction during sleep may result in hypercapnia, acidosis and pronounced hypoxemia, which can lead to hemodynamic abnormalities during sleep. Sustained pulmonary hypertension and possibly systemic hypertension may follow. Tracheostomy is an effective therapy and is recommended to symptomatic patients who have predominantly obstructive apnea but no relievable anatomic cause of upper airway obstruction.

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