Blood Flow of the Middle Cerebral Artery With Sleep-Disordered Breathing

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Abstract
Background and Purpose —Epidemiological data link heavy snoring to an increased risk for stroke, an association often ascribed to hypertension and/or sleep apnea. The aim of this study was to determine whether obstructive hypopneas, central apneas, or obstructive apneas during sleep alter blood flow of the middle cerebral artery (MCA). Methods —Doppler sonography of the MCA was performed in conjunction with nightly polysomnography in 11 men and one woman. Results —A significant decline in blood flow occurred in 76% (169/223) of obstructive hypopneas and in 80% (98/123) of obstructive apneas, compared with only 14% (13/96) of central apneas ( P ≤.0001). While duration of events was not significantly different, MCA blood flow reductions were associated only with the duration of the obstructive hypopneas ( P ≤.01) and not with the duration of central ( P =.17) or obstructive ( P =.07) apneas. The magnitude of fall in arterial oxygen saturation from baseline correlated with a reduced blood flow with obstructive hypopneas but not with obstructive or central apneas. Conclusions —With obstructive hypopneas and obstructive apneas, MCA blood flow is more often decreased in comparison to central apneas. MCA blood flow reductions occur with longer obstructive hypopneas and with those hypopneas with greater falls in oxygen saturation. These observations indicate pathophysiology relevant to an increased risk for stroke in heavy snorers and patients with obstructive hypopneas and apneas.