Advertisement
Mayo Clinic Proceedings Home

Cardiopulmonary Consequences of Obstructive Sleep Apnea

      During sleep, oxygen consumption and systemic blood pressure decrease in normal subjects; during rapid eye movement sleep, irregular ventilation can be accompanied by brief periods of apnea. In patients with obstructive sleep apnea, alveolar ventilation during an apneic episode is immediately reduced to zero, and the metabolic demands for oxygen must be met from oxygen stores within the body. As the stores of oxygen within the lung are diminished, the rate of arterial oxyhemoglobin desaturation increases. The development of alveolar hypoventilation during wakefulness seems to be based on a balance between central ventilatory drives to breathe and mechanical loads placed on the respiratory system. Coexistent cardiopulmonary or neuromuscular disease in patients with obstructive sleep apnea contributes to the development of alveolar hypoventilation. During apneic episodes, the systemic blood pressure increases while the heart rate and cardiac output decrease. Both bradycardias and increased ventricular ectopic activity have been associated with these disordered breathing episodes. Because of the possibility of apnea-associated arrhythmias, patients with obstructive sleep apnea may be at increased risk for cardiovascular mortality. The influence of these recurrent nocturnal episodes of asphyxia on cardiovascular longevity needs further investigation.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Brebbia DR
        • Altschuler KZ
        Oxygen consumption rate and electroencephalographs stage of sleep.
        Science. 1965; 150: 1621-1623
        • Fraser G
        • Trinder J
        • Colrain IM
        • Montgomery I
        Effect of sleep and circadian cycle on sleep period energy expenditure.
        J Appl Physiol. 1989; 66: 830-836
        • Webb P
        • Hiestand M
        Sleep metabolism and age.
        J Appl Physiol. 1975; 38: 257-262
        • Reed DJ
        • Kellogg RH
        Changes in respiratory response to C02 during natural sleep at sea level and at altitude.
        J Appl Physiol. 1958; 13: 325-330
        • Robin ED
        • Whaley RD
        • Crump CH
        • Travis DM
        Alveolar gas tensions, pulmonary ventilation and blood pH during physiologic sleep inormal subjects.
        J Clin Invest. 1958; 37: 981-989
        • Douglas NJ
        • White DP
        • Weil JV
        • Pickett CK
        • Martin RJ
        • Hudgel DW
        • Zwillich CW
        Hypoxic ventilatory response decreases during sleep in normal men.
        Am Rev Respir Dis. 1982; 125: 286-289
        • Berthon-Jones M
        • Sullivan CE
        Ventilatory and arousal responses to hypoxia in sleeping humans.
        Am Rev Respir Dis. 1982; 125: 632-639
        • Berthon-Jones M
        • Sullivan CE
        Ventilation and arousal responses to hypercapnia in normal sleeping humans.
        J Appl Physiol. 1984; 57: 59-67
        • Bristow JD
        • Honour AJ
        • Pickering TG
        • Sleight P
        Cardiovascular and respiratory changes during sleep in normal and hypertensive subjects.
        Cardiovasc Res. 1969; 3: 476-485
        • Coccagna G
        • Mantovani M
        • Brignani F
        • Manzini A
        • Lugaresi E
        Arterial pressure changes during spontaneous sleep in man.
        Electroencephalogr Clin Neurophysiol. 1971; 31: 277-281
        • Khatri IM
        • Freis ED
        Hemodynamic changes during sleep.
        J Appl Physiol. 1967; 22: 867-873
        • Snyder F
        • Hobson JA
        • Morrison DF
        • Goldfrank F
        Changes in respiration, heart rate, and systolic blood pressure in human sleep.
        J Appl Physiol. 1964; 19: 417-422
        • Mancia G
        • Zanchetti A
        Cardiovascular regulation during sleep.
        in: Orem J Barnes CD Physiology in Sleep. Academic Press, New York1980: 1-55
        • Lugaresi E
        • Cirignotta F
        • Coccagna G
        • Piana C
        Some epidemiological data on snoring and cardiocirculatory disturbances.
        Sleep. 1980; 3: 221-224
        • Miller JC
        • Horvath SM
        Cardiac output during human sleep.
        Aviat Space Environ Med. 1976; 47: 1046-1051
        • Findley LJ
        • Ries AL
        • Tisi GM
        • Wagner PD
        Hypoxemia during apnea in normal subjects: mechanisms and impact of lung volume.
        J Appl Physiol. 1983; 55: 1777-1783
        • Strohl KP
        • Altose MD
        Oxygen saturation during breath-holding and during apneas in sleep.
        Chest. 1984; 85: 181-186
        • Shepard Jr, JW
        Gas exchange and hemodynamics during sleep.
        Med Clin North Am. November 1985; 69: 1243-1264
        • Shepard Jr, JW
        • Garrison M
        • Grither D
        • Corriveau M
        • Dolan GF
        Effects of acute reductions in tidal volume on gas exchange in dogs (abstract).
        Am Rev Respir Dis. 1986; 133: A340
        • Anch AM
        • Remmers JE
        • Bunce III, H
        Supraglottic airway resistance in normal subjects and patients with occlusive sleep apnea.
        J Appl Physiol. 1982; 53: 1158-1163
        • Garay SM
        • Rapoport D
        • Sorkin B
        • Epstein H
        • Feinberg I
        • Goldring RM
        Regulation of ventilation in the obstructive sleep apnea syndrome.
        Am Rev Respir Dis. 1981; 124: 451-457
        • Sampson MG
        • Grassino A
        Neuromechanical properties in obese patients during carbon dioxide re-breathing.
        Am J Med. 1983; 75: 81-90
        • Rapoport DM
        • Garay SM
        • Epstein H
        • Goldring RM
        Hypercapnia in the obstructive sleep apnea syndrome: a reevaluation of the “pickwickian syndrome”.
        Chest. 1986; 89: 627-635
        • Shepard Jr, JW
        Physiologic and clinical consequences of sleep apnea.
        Semin Resp Med. 1988; 9: 560-568
        • White DP
        • Douglas NJ
        • Pickett CK
        • Zwillich CW
        • Weil JV
        Sleep deprivation and the control of ventilation.
        Am Rev Respir Dis. 1983; 128: 984-986
        • Coccagna G
        • Mantovani M
        • Brignani F
        • Parchi C
        • Lugaresi E
        Continuous recording of the pulmonary and systemic arterial pressure during sleep in syndromes of hypersomnia with periodic breathing.
        Bull Physiopathol Respir. 1972; 8: 1159-1170
        • Scharf SM
        Influence of sleep state and breathing on cardiovascular function.
        Lung Biol Health Dis. 1984; 21: 221
        • Schroeder JS
        • Motta J
        • Guilleminault C
        Hemodynamic studies in sleep apnea.
        in: Guilleminault C Dement WC Sleep Apnea Syndromes. Alan R Liss, New York1978: 177-196
        • Marrone O
        • Bellia V
        • Ferrara G
        • Milone F
        • Romano L
        • Salvaggio A
        • Stallone A
        • Bonsignore G
        Transmural pressure measurements: importance in the assessment of pulmonary hypertension in obstructive sleep apneas.
        Chest. 1989; 95: 338-343
        • Guilleminault C
        • Motta J
        • Mihm F
        • Melvin K
        Obstructive sleep apnea and cardiac index.
        Chest. 1986; 89: 331-334
        • Zwillich C
        • Devlin T
        • White D
        • Douglas N
        • Weil J
        • Martin R
        Bradycardia during sleep apnea: characteristics and mechanism.
        J Clin Invest. 1982; 69: 1286-1292
        • Shepard Jr, JW
        Hemodynamics in obstructive sleep apnea.
        in: Fletcher EC Abnormalities of Respiration During Sleep. Grune & Stratton, Orlando, Florida1986: 39-61
        • Guilleminault C
        • Connolly S
        • Winkle R
        • Melvin K
        • Tilkian A
        Cyclical variation of the heart rate in sleep apnoea syndrome.
        Lancet. 1984; 1: 126-131
        • Guilleminault C
        • Connolly SJ
        • Winkle RA
        Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome.
        Am J Cardiol. 1983; 52: 490-494
        • Shepard Jr, JW
        • Garrison MW
        • Grither DA
        • Dolan GF
        Relationship of ventricular ectopy to oxyhemoglobin desaturation in patients with obstructive sleep apnea.
        Chest. 1985; 88: 335-340
        • Millman RP
        • Redline S
        • Randall C
        • Carlisle CC
        • Levinson P
        • Braman SS
        The relationship between nocturnal sleep events and daytime hypertension in a population of patients with obstructive sleep apnea (abstract).
        Sleep Res. 1988; 17: 219
        • Partinen M
        • Jamieson A
        • Guilleminault C
        Long-term outcome for obstructive sleep apnea syndrome patients: mortality.
        Chest. 1988; 94: 1200-1204
        • Guilleminault C
        • Simmons FB
        • Motta J
        • Cummiskey J
        • Rosekind M
        • Schroeder JS
        • Dement WC
        Obstructive sleep apnea syndrome and tracheostomy: long-term follow-up experience.
        Arch Intern Med. 1981; 141: 985-988
        • Clark RW
        • Boudoulas H
        • Schaal SF
        • Schmidt HS
        Adrenergic hyperactivity and cardiac abnormality in primary disorders of sleep.
        Neurology. 1980; 30: 113-119
        • Fletcher EC
        • Miller J
        • Schaaf JW
        • Fletcher JG
        Urinary catecholamines before and after tracheostomy in patients with obstructive sleep apnea and hypertension.
        Sleep. 1987; 10: 35-44
        • Kales A
        • Bixler EO
        • Cadieux RJ
        • Schneck DW
        • Shaw III, LC
        • Locke TW
        • Vela-Beuno A
        • Soldatos CR
        Sleep apnoea in a hypertensive population.
        Lancet. 1984; 2: 1005-1008
        • Lavie P
        • Ben-Yosef R
        • Rubin AE
        Prevalence of sleep apnea syndrome among patients with essential hypertension.
        Am Heart J. 1984; 108: 373-376
        • Fletcher EC
        • DeBehnke RD
        • Lovoi MS
        • Gorin AB
        Undiagnosed sleep apnea in patients with essential hypertension.
        Ann Intern Med. 1985; 103: 190-194
        • Tilkian AG
        • Guilleminault C
        • Schroeder JS
        • Lehrman KL
        • Simmons FL
        • Dement WC
        Hemodynamics in sleep-induced apnea: studies during wakefulness and sleep.
        Ann Intern Med. 1976; 85: 714-719
        • Bradley TD
        • Rutherford R
        • Grossman RF
        • Lue F
        • Zamel N
        • Moldofsky H
        • Phillipson EA
        Role of daytime hypoxemia in the pathogenesis of right heart failure in the obstructive sleep apnea syndrome.
        Am Rev Respir Dis. 1985; 131: 835-839
        • Weitzenblum E
        • Krieger J
        • Apprill M
        • Vallée E
        • Ehrhart M
        • Ratomaharo J
        • Oswald M
        • Kurtz D
        Daytime pulmonary hypertension in patients with obstructive sleep apnea syndrome.
        Am Rev Respir Dis. 1988; 138: 345-349
        • Smolensky M
        • Holberg F
        • Sargent F
        Chronobiology of the life sequence.
        in: Itoh S Ogata K Yoshimura H Advances in Climatic Physiology. Igaku Shoin, Tokyo1972: 281-318
        • Mitler MM
        • Hajdukovic RM
        • Shafor R
        • Hahn PM
        • Kripke DF
        When people die: cause of death versus time of death.
        Am J Med. 1987; 82: 266-274
        • He J
        • Kryger MH
        • Zorick FJ
        • Conway W
        • Roth T
        Mortality and apnea index in obstructive sleep apnea: experience in 385 male patients.
        Chest. 1988; 94: 9-14
        • Guilleminault C
        Natural history, cardiac impact, and long-term follow-up of sleep apnea syndrome.
        in: Guilleminault C Lugaresi E Sleep/Wake Disorders: Natural History, Epidemiology, and Long-Term Evolution. Raven Press, New York1983: 107-125
        • Gonzalez-Rothi RJ
        • Foresman GE
        • Block AJ
        Do patients with sleep apnea die in their sleep?.
        Chest. 1988; 94: 531-538