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From the Sleep Research Center, Division of Pulmonary and Critical Care
Medicine, Case Western Reserve University, Cleveland, Ohio (N.N., K.P.S.);
Division of Sports Medicine, Department of Medicine, University Hospital, Ulm,
Germany (N.N., M.L.); and Division of Pulmonary Medicine, Department of
Medicine, University Hospital, Freiburg, Germany (P.W., I.J.).
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
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.
© 1998 American Heart Association, Inc.
Original Contributions
Blood Flow of the Middle Cerebral Artery With Sleep-Disordered Breathing
Correlation With Obstructive Hypopneas
.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.
Key Words: cerebral blood flow • oxygen • sleep apnea syndromes
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