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From the Neurological Clinic (Drs. Diomedi, Placidi, Cupini, Bernardi, and Silvestrini), S. Eugenio Hospital, "Tor Vergata" University of Rome; and IRCCS S. Lucia (Drs. Placidi, Bernardi, and Silvestrini), Rome, Italy.
Address correspondence and reprint requests to Dr. Mauro Silvestrini, Clinica Neurologica - Ospedale S. Eugenio, Università di Roma "Tor Vergata," P.le dell'Umanesimo 10, 00144 Roma, Italy.
Background and Objective: A clear association among snoring, sleep apnea, and increased risk of stroke has been shown by previous studies. However, the possible role played by sleep apnea in the pathogenesis of cerebrovascular disease is subject to debate. To evaluate the influence of hemodynamic changes caused by obstructive sleep apnea syndrome (OSAS), we investigated cerebrovascular reactivity to hypercapnia in patients with OSAS.
Methods: The study was performed at baseline and after 1 night and 1 month of nasal continuous positive airway pressure (n-CPAP) therapy, with patients in the waking state (8:00 to 8:30 AM and 5:30 to 6:00 PM) with transcranial Doppler ultrasonography. Cerebrovascular reactivity was calculated with the breath-holding index (BHI).
Results: In the baseline condition, compared with normal subjects, patients with OSAS showed significantly lower BHI values in both the morning (0.57 versus 1.40, p < 0.0001) and the afternoon (1.0 versus 1.51, p < 0.0001). Cerebrovascular reactivity was significantly higher in the afternoon than it was in the morning in both patients (p < 0.0001) and controls (p < 0.05). In patients, the BHI returned to normal values, comparable with those of control subjects, after both 1 night and 1 month of n-CPAP therapy.
Conclusions: These findings suggest an association between OSAS and diminished cerebral vasodilator reserve. This condition may be related to the increased susceptibility to cerebral ischemia in patients with OSAS, particularly evident in the early morning.
Received April 16, 1998. Accepted in final form June 13, 1998.
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