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J Appl Physiol (1985). 2015 Apr 1;118(7):858-62. doi: 10.1152/japplphysiol.00562.2014. Epub 2015 Jan 22.

Effect of breath holding on cerebrovascular hemodynamics in normal pregnancy and preeclampsia.

Author information

1
University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, the Netherlands; Baylor College of Medicine, Department of Obstetrics and Gynecology, Houston, Texas; teelkien@gmail.com.
2
University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom; and.
3
Baylor College of Medicine, Department of Obstetrics and Gynecology, Houston, Texas; St. David's Women's Center of Texas, North Austin Maternal-Fetal Medicine, Austin, Texas.
4
University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, the Netherlands;
5
Baylor College of Medicine, Department of Obstetrics and Gynecology, Houston, Texas;

Abstract

Preeclampsia (PE) is associated with endothelial dysfunction and impaired autonomic function, which is hypothesized to cause cerebral hemodynamic abnormalities. Our aim was to test this hypothesis by estimating the difference in the cerebrovascular response to breath holding (BH; known to cause sympathetic stimulation) between women with preeclampsia and a group of normotensive controls. In a prospective cohort analysis, cerebral blood flow velocity (CBFV) in the middle cerebral artery (transcranial Doppler), blood pressure (BP, noninvasive arterial volume clamping), and end-tidal carbon dioxide (EtCO2) were simultaneously recorded during a 20-s breath hold maneuver. CBFV changes were broken down into standardized subcomponents describing the relative contributions of BP, cerebrovascular resistance index (CVRi), critical closing pressure (CrCP), and resistance area product (RAP). The area under the curve (AUC) was calculated for changes in relation to baseline values. A total of 25 preeclamptic (before treatment) and 25 normotensive women in the second half of pregnancy were enrolled, and, 21 patients in each group were included in the analysis. The increase in CBFV and EtCO2 was similar in both groups. However, the AUC for CVRi and RAP during BH was significantly different between the groups (3.05 ± 2.97 vs. -0.82 ± 4.98, P = 0.006 and 2.01 ± 4.49 vs. -2.02 ± 7.20, P = 0.037), indicating an early, transient increase in CVRi and RAP in the control group, which was absent in PE. BP had an equal contribution in both groups. Women with preeclampsia have an altered initial CVRi response to the BH maneuver. We propose that this is due to blunted sympathetic or myogenic cerebrovascular response in women with preeclampsia.

KEYWORDS:

autonomic nervous system; cerebral blood flow; preeclampsia; transcranial Doppler

PMID:
25614597
DOI:
10.1152/japplphysiol.00562.2014
[Indexed for MEDLINE]
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