Copyright © 1989 by the European Society of Cardiology.
© 1989 The European Society of Cardiology
Marked blood pressure fluctuations during narcoleptic attacks alternating with abnormal wakefulness: Effects of treatment with clonidine
Istituto di Clinica Medica Generate e Terapia Medica, Universita di Milano and Centro di Fisiologia Clinica e Ipertensione Ospedale Maggiore, Milano, Italy
Received 14 March 1988; revised 14 July 1988; .
Address for correspondence: Dr Paolo Reggiani, Centro di Fisiologi Clinica e Ipertensions, Ospedale Maggiore—Via F. Sforza 35, 201222 Milano, Italy.
Abstract
A middle-aged man was admitted to our department because of sleep-wake cycle disorders (alternating hypersomnia and sleeplessness), bipolar behavioural disturbances and marked fluctuations in blood pressure and heart rate. Neither evident precipitating stimuli nor an obvious cause for his illness were found. When tests that normally activate intrinsic autonomic responses were performed, two distinct circulatory patterns were recognized. During hypersomnia (phase A), cardiovascular reflex activity was blunted or abolished and orthostasis could not be maintained. The clinical, biochemical, behavioural pictures and the observed decrease in sympathetic outflow resembled the effects of clonidine administration. On the contrary, during sleeplessness (phase B) the autonomic pathways were functionally integral and orthostatic hypotension was not detected. The clinical, biochemical, behavioural features and cardiovascular overactivity closely mimicked the abrupt withdrawal syndrome encountered with clonidine. Three hypothetical mechanisms are advanced to explain this intriguing case as well as the acute and chronic relief of our patient's clinical problem following institution of clonidine therapy (phase C). The role played by central alpha adrenoceptors in integrating sleep-wake, cardiovascular and behavioural functions is also suggested.
Key Words: Sleep-wake • behavioural disturbances • blood pressure and heart rate fluctuations • auto-nomic pathways dysfunction • clonidine
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