Middle cerebral artery blood flow velocity, end-tidal pCO2 and blood pressure in patients with obstructive sleep apnea and in healthy subjects during continuous positive airway pressure breathing.

There is conflicting evidence in the literature as to the potential effect of continuous positive airway pressure (CPAP) on cerebral perfusion. Compromising cerebral perfusion could possibly outweigh the benefit of improved oxygenation. Patients with the obstructive sleep apnea syndrome (OSAS) have been claimed to have a higher cerebrovascular reactivity to changes in end-tidal pCO2. In this study, we investigated 23 patients with OSAS and 16 healthy young adults in the waking state. Both groups performed a series of 10 min of normal breathing, 20 min with 9 cmH2O nasal CPAP, and then 10 min of normal breathing while wearing a nasal CPAP mask. The following parameters were assessed: bilateral transcranial Doppler signal of the middle cerebral artery, systolic and diastolic blood pressure assessed manually, and cerebrovascular reactivity to changes in pCO2 during hyperventilation and rebreathing into an airbag. Continuous end-tidal pCO2 measurements were performed in 14 subjects. As compared with normal breathing middle cerebral artery blood flow velocity and pCO2 remained unchanged during CPAP. Systolic and diastolic blood pressure increased slightly by 1.2 mmHg (p = 0.015) and 1.1 mmHg (p = 0.007), respectively. Cerebrovascular reactivity did not differ in the two groups. Nasal CPAP of 9 cmH2O is a safe treatment with respect to the maintenance of cerebral blood flow. Our study gives further evidence for the autoregulation's capacity to maintain cerebral blood flow velocity constant during different levels of intrathoracic pressure and different cerebral perfusion pressures. We could not demonstrate any difference in cerebrovascular reactivity between patients with OSAS and healthy persons.