Attenuation of obstructive sleep apnea by compression stockings in subjects with venous insufficiency

Rationale: Fluid accumulation in the legs and its overnight redistri- bution into the neck appears to play a causative role in obstructive sleep apnea (OSA) in sedentary men. Chronic venous insufficiency (CVI) promotes fluid accumulation in the legs that can be counter- acted by compression stockings. Objectives: To test the hypotheses that, in nonobese subjects with CVI and OSA, wearing compression stockings during the day will attenuate OSA by reducing the amount of fluid displaced into the neck overnight. Methods: Nonobese subjects with CVI and OSA were randomly assigned to 1 week of wearing compression stockings or to a 1-week control period without compression stockings, after which they crossed over to the other arm. Polysomnography and measurement of overnight changes in leg fluid volume and neck circumference were performed at baseline and at the end of compression stockings and control periods. Measurements and Main Results: Twelve subjects participated. Com- pared with the end of the control period, at the end of the compres- sion stockings period there was a 62% reduction in the overnight leg fluid volume change (P 1⁄4 0.001) and a 60% reduction in the over- night neck circumference increase (P 1⁄4 0.001) in association with a 36% reduction in the number of apneas and hypopneas per hour of sleep (from 48.4 6 26.9 to 31.3 6 20.2, P 1⁄4 0.002). Conclusions: Redistribution of fluid from the legs into the neck at night contributes to the pathogenesis of OSA in subjects with CVI. Prevention of fluid accumulation in the legs during the day, and its nocturnal displacement into the neck, attenuates OSA in such subjects.