nataliezzz
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Obstructive Sleep Apnea and Orthostatic Hypotension: An Unconventional Association
Ryan S Cobb , Mildred Barnett , Kevin Patel
https://academic.oup.com/sleep/article/48/Supplement_1/A618/8135020 (PDF available)
Introduction
Although Obstructive Sleep Apnea (OSA) has a commonly recognized association with hypertension, it is not often thought of as causing or exacerbating hypotension, specifically orthostatic hypotension. Here we present the unusual case of a patient with a long history of OSA and good compliance with Auto-PAP therapy, whom after temporarily going without PAP therapy due to parts malfunction, developed progressively worsening orthostatic symptoms ultimately necessitating inpatient admission and remedied after restoration of PAP therapy.
Report of case
61yo M with PMHx known OSA, mild traumatic brain injury, Pulmonary embolism, Paroxysmal Atrial Fibrillation s/p ablation and hypothyroidism who presented to the Emergency Department at his primary care physician’s recommendation due to progressively worsening BP at home with systolic blood pressures as low as 80s as well as dizziness upon standing. The symptoms started 3 weeks after he reported difficulty using his Auto-PAP due to improper fit of a new mask. He was given IV fluids in the Emergency Department which did not alleviate his symptoms. Adrenal insufficiency workup was also negative. Interestingly, once he was loaned an Auto-PAP, his symptoms improved, and he was discharged shortly thereafter. The appropriate adjustments were made to his home device, and his symptoms have not recurred since.
Conclusion
In this unique case, the patient developed symptoms consistent with orthostatic hypotension after discontinuing PAP therapy, and his symptoms resolved after restoration of appropriate PAP therapy. This uncommon observation raises an intriguing thought regarding our current understanding of blood pressure control and its relationship with untreated OSA. Although the mechanisms between OSA and hypertension are well established, we propose that the orthostatic hypotension observed in this case is due to baroreceptor dysregulation as well as increased Atrial Natriuretic Peptide (ANP) release causing a relative hypovolemia.
Ryan S Cobb , Mildred Barnett , Kevin Patel
https://academic.oup.com/sleep/article/48/Supplement_1/A618/8135020 (PDF available)
Introduction
Although Obstructive Sleep Apnea (OSA) has a commonly recognized association with hypertension, it is not often thought of as causing or exacerbating hypotension, specifically orthostatic hypotension. Here we present the unusual case of a patient with a long history of OSA and good compliance with Auto-PAP therapy, whom after temporarily going without PAP therapy due to parts malfunction, developed progressively worsening orthostatic symptoms ultimately necessitating inpatient admission and remedied after restoration of PAP therapy.
Report of case
61yo M with PMHx known OSA, mild traumatic brain injury, Pulmonary embolism, Paroxysmal Atrial Fibrillation s/p ablation and hypothyroidism who presented to the Emergency Department at his primary care physician’s recommendation due to progressively worsening BP at home with systolic blood pressures as low as 80s as well as dizziness upon standing. The symptoms started 3 weeks after he reported difficulty using his Auto-PAP due to improper fit of a new mask. He was given IV fluids in the Emergency Department which did not alleviate his symptoms. Adrenal insufficiency workup was also negative. Interestingly, once he was loaned an Auto-PAP, his symptoms improved, and he was discharged shortly thereafter. The appropriate adjustments were made to his home device, and his symptoms have not recurred since.
Conclusion
In this unique case, the patient developed symptoms consistent with orthostatic hypotension after discontinuing PAP therapy, and his symptoms resolved after restoration of appropriate PAP therapy. This uncommon observation raises an intriguing thought regarding our current understanding of blood pressure control and its relationship with untreated OSA. Although the mechanisms between OSA and hypertension are well established, we propose that the orthostatic hypotension observed in this case is due to baroreceptor dysregulation as well as increased Atrial Natriuretic Peptide (ANP) release causing a relative hypovolemia.
