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Vol. 83, Issue 5, 1671-1680, 1997
Department of Anesthesiology and Critical Care Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, and Department of Surgery, Johns Hopkins University, Baltimore, Maryland 21224
Received 17 December 1996; accepted in final form 14 July 1997.
Schneider, H., C. D. Schaub, K. A. Andreoni, A. R. Schwartz,
R. L. Smith, J. L. Robotham, and C. P. O'Donnell. Systemic and
pulmonary hemodynamic responses to normal and obstructed breathing during sleep. J. Appl. Physiol. 83(5):
1671-1680, 1997.
We examined the hemodynamic responses to normal
breathing and induced upper airway obstructions during sleep in a
canine model of obstructive sleep apnea. During normal breathing,
cardiac output decreased (12.9 ± 3.5%,
P < 0.025) from wakefulness to
non-rapid-eye-movement sleep (NREM) but did not change from NREM to
rapid-eye-movement (REM) sleep. There was a decrease
(P < 0.05) in systemic (7.2 ± 2.1 mmHg) and pulmonary (2.0 ± 0.6 mmHg) arterial pressures from
wakefulness to NREM sleep. In contrast, systemic (8.1 ± 1.0 mmHg,
P < 0.025), but not pulmonary,
arterial pressures decreased from NREM to REM sleep. During repetitive
airway obstructions (56.0 ± 4.7 events/h) in NREM sleep, cardiac
output (17.9 ± 3.1%) and heart rate (16.2 ± 2.5%) increased
(P < 0.05), without a change in
stroke volume, compared with normal breathing during NREM sleep. During
single obstructive events, left (7.8 ± 3.0%,
P < 0.05) and right (7.1 ± 0.7%, P < 0.01)
ventricular outputs decreased during the apneic period. However, left
(20.7 ± 1.6%, P < 0.01) and
right (24.0 ± 4.2%, P < 0.05)
ventricular outputs increased in the postapneic period because of an
increase in heart rate. Thus 1) the
systemic, but not the pulmonary, circulation vasodilates during REM
sleep with normal breathing; 2)
heart rate, rather than stroke volume, is the dominant factor
modulating ventricular output in response to apnea; and
3) left and right ventricular outputs oscillate markedly and in phase throughout the apnea cycle.
cardiac output; non-rapid-eye-movement sleep; obstructive sleep apnea; rapid-eye-movement sleep
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