1998 Volume 31 Issue 12 Pages 1465-1469
Recently, many clinical and experimental observations have linked obstructive sleep apnea, morning headaches, and daytime hypertension. We report a hemodialysis patient who exhibited morning headaches and hypertension due to metabolic alkalosis and sleep apnea. A 55-year-old male had been receiving hemodialysis since 1994. His blood pressure began to increase in June, 1996, and more intensive antihypertensive therapy was needed. Along with the progression of hypertension, morning headaches developed. Occasionally, significant metabolic alkalosis and hypoventilation was noticed when severe headaches occurred prior to hemodialysis sessions. Neurological examination and CT revealed no abnormalities. The headaches were refractory to all analgesics. Continuous respiratory monitoring recorded frequent sleep apnea. A detailed history evaluation disclosed that he had been consuming a large amount of antiacids containing 4.5g of sodium bicarbonate per day. He did not receive antiacids in the hospital ward. Several days later, metabolic alkalosis improved, the frequency of sleep apneic episodes normalized and morning headaches subsided. We concluded that bicarbonate abuse induced metabolic alkalosis, sleep apnea, and morning headaches. Although his blood pressure remained high during the hospitalization, it gradually decreased to hypotensive levels in spite of a relatively large amount of water intake after a few months. This case demonstrates that sleep apnea can cause morning headaches and chronic hypertension, probably due to persistent acceleration of the sympathetic nervous system in hemodialysis patients.
