Assessment of continuous positive airway pressure treatment in obstructive sleep apnea syndrome using 24‐hour urinary catecholamines

Background : Obstructive sleep apnea syndrome (OSAS) is related to diurnal sympathetic hyperactivity and increased blood pressure, both factors that are likely to lead to the development of cardiovascular disease. Hypothesis : The study investigated whether 24‐h urinary catecholamines would reflect the effect of obstructive sleep apnea on autonomic activity. Methods : Standard poly somnography was performed in 17 patients with OSAS (age 53.7 ± 13.5 years, mean ± standard deviation). The number of apnea/hypopnea episodes per hour of sleep (apnea/hypopnea index [AHI]); number of oxygen desaturation episodes per hour (desaturation index [DSI]); arousals per hour (arousal index); lowest oxygen saturation (lowest SpO 2 ); and percentages of stages 1, 2, 3/4, and rapid eye movement sleep (% stage 1, −2, and ‐ 3/4, and % REM, respectively) were measured. Overnight continuous positive airway pressure (CPAP) titration was performed the night after the baseline sleep measurements had been taken. Twenty‐four‐hour urinary adrenaline and noradrenaline were also examined. Results : During the CPAP treatment, both 24‐h urinary adrenaline and noradrenaline were significantly lower compared with natural sleep. Continuous positive airway pressure significantly decreased the AHI, DSI, % stage 1, and arousal index and significantly increased the lowest SpO 2 . There were no significant differences in % stage 2, % stage 3/4, and % REM between before and during CPAP treatment. Multiple analysis of covariance tests revealed that lowest SpO 2 was the most important factor for increasing 24‐h urinary noradrenaline levels (F = 4.75, p = 0.048). Conclusions : One night CPAP treatment could improve autonomic dysfunction. The assessment of 24‐h urinary noradrenaline would provide important information for evaluating the effect of CPAP treatment.