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Yang X, Lippert J, Dekkers M, Baillieul S, Duss SB, Reichlin T, Brill AK, Bernasconi C, Schmidt MH, Bassetti CL. Impact of Comorbid Sleep-Disordered Breathing and Atrial Fibrillation on the Long-Term Outcome After Ischemic Stroke. Stroke 2024; 55:586-594. [PMID: 38275115 PMCID: PMC10896199 DOI: 10.1161/strokeaha.123.042856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 11/13/2023] [Accepted: 12/01/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) and atrial fibrillation (AF) are highly prevalent in patients with stroke and are recognized as independent risk factors for stroke. Little is known about the impact of comorbid SDB and AF on long-term outcomes after stroke. METHODS In this prospective cohort study, 353 patients with acute ischemic stroke or transient ischemic attacks were analyzed. Patients were screened for SDB by respiratory polygraphy during acute hospitalization. Screening for AF was performed using a 7-day ECG up to 3× in the first 6 months. Follow-up visits were scheduled at 1, 3, 12, 24, and 36 months poststroke. Cox regression models adjusted for various factors (age, sex, body mass index, hypertension, diabetes, dyslipidemia, and heart failure) were used to assess the impact of comorbid SDB and AF on subsequent death or cerebro-cardiovascular events. RESULTS Among 353 patients (299 ischemic stroke and 54 transient ischemic attacks), median age, 67 (interquartile range, 57-74) years with 63% males. Moderate-to-severe SDB (apnea-hypopnea index score, ≥15/h) was present in 118 (33.4%) patients. Among the 56 (15.9%) patients with AF, 28 had comorbid moderate-to-severe SDB and AF. Over 36 months, there were 12 deaths and 67 recurrent cerebro-cardiovascular events. Patients with comorbid moderate-to-severe SDB and AF had a higher risk of subsequent death or cerebro-cardiovascular events compared with those with only moderate-to-severe SDB without AF (hazard ratio, 2.49 [95% CI, 1.18-5.24]) and to those without moderate-to-severe SDB or AF (hazard ratio, 2.25 [95% CI, 1.12-4.50]). However, no significant difference was found between the comorbid moderate-to-severe SDB and AF group and the group with only AF without moderate-to-severe SDB (hazard ratio, 1.64 [95% CI, 0.62-4.36]). CONCLUSIONS Comorbid moderate-to-severe SDB and AF significantly increase the risk of long-term mortality or recurrent cerebro-cardiovascular events after acute ischemic stroke. Considering both conditions as cumulative and modifiable cerebro-cardiovascular risk factors is of interest for the management of acute stroke. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02559739.
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Affiliation(s)
- Xiaoli Yang
- Department of Neurology (X.Y., J.L., M.D., S.B.D., C.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
- Interdisciplinary Sleep-Wake-Epilepsy-Center (X.Y., J.L., M.D., S.B.D., A.-K.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Julian Lippert
- Department of Neurology (X.Y., J.L., M.D., S.B.D., C.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
- Interdisciplinary Sleep-Wake-Epilepsy-Center (X.Y., J.L., M.D., S.B.D., A.-K.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Martijn Dekkers
- Department of Neurology (X.Y., J.L., M.D., S.B.D., C.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
- Interdisciplinary Sleep-Wake-Epilepsy-Center (X.Y., J.L., M.D., S.B.D., A.-K.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Sebastien Baillieul
- Grenoble Alpes University, HP2 Laboratory, INSERM U1300 and Grenoble Alpes University Hospital, France (S.B.)
| | - Simone B. Duss
- Department of Neurology (X.Y., J.L., M.D., S.B.D., C.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology (T.R.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Anne-Kathrin Brill
- Interdisciplinary Sleep-Wake-Epilepsy-Center (X.Y., J.L., M.D., S.B.D., A.-K.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
- Department of Pulmonary Medicine and Allergology (A.-K.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Corrado Bernasconi
- Department of Neurology (X.Y., J.L., M.D., S.B.D., C.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Markus H. Schmidt
- Department of Neurology (X.Y., J.L., M.D., S.B.D., C.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
- Interdisciplinary Sleep-Wake-Epilepsy-Center (X.Y., J.L., M.D., S.B.D., A.-K.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Claudio L.A. Bassetti
- Department of Neurology (X.Y., J.L., M.D., S.B.D., C.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
- Interdisciplinary Sleep-Wake-Epilepsy-Center (X.Y., J.L., M.D., S.B.D., A.-K.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
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Huhtakangas JK, Huhtakangas J, Bloigu R, Saaresranta T. Unattended sleep study in screening for sleep apnea in the acute phase of ischemic stroke. Sleep Med 2020; 65:121-126. [DOI: 10.1016/j.sleep.2019.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/29/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022]
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Improvement of Cognitive Function after Continuous Positive Airway Pressure Treatment for Subacute Stroke Patients with Obstructive Sleep Apnea: A Randomized Controlled Trial. Brain Sci 2019; 9:brainsci9100252. [PMID: 31557935 PMCID: PMC6826775 DOI: 10.3390/brainsci9100252] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 09/23/2019] [Accepted: 09/23/2019] [Indexed: 01/10/2023] Open
Abstract
Background: Obstructive sleep apnea (OSA) is common after stroke. Various studies on continuous positive airway pressure (CPAP) therapy for OSA after stroke have been published. However, there have been no studies from Korea and Asia. The present Korean study aimed to determine whether CPAP treatment during inpatient rehabilitation of stroke patients with sleep disorders, especially OSA, improves function, cognition, sleep quality, and daytime sleepiness. Methods: This single-blind randomized controlled study included 40 stroke patients with OSA between November 2017 and November 2018. The patients were divided into the CPAP treatment group (CPAP and rehabilitation; n = 20) and control group (only rehabilitation; n = 20). The intervention period was 3 weeks. The primary outcomes were function and cognition improvements, and the secondary outcomes were sleep-related improvements. Results: CPAP treatment started at an average of 4.6 ± 2.8 days after admission. Both groups showed improvements in stroke severity, function, and cognition after the 3-week intervention. However, after the intervention, the degree of change in attention and calculation was significantly higher in the CPAP treatment group than in the control group. Additionally, the improvements in sleep quality and daytime sleepiness were greater in the CPAP treatment group than in the control group. Conclusion: CPAP treatment can improve cognitive function, sleep quality, and daytime sleepiness, and it should be considered as part of the rehabilitation program for patients with stroke. Our findings might help in the treatment of stroke patients with OSA in Korea.
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Zhang L, Zeng T, Gui Y, Sun Y, Xie F, Zhang D, Hu X. Application of Neck Circumference in Four-Variable Screening Tool for Early Prediction of Obstructive Sleep Apnea in Acute Ischemic Stroke Patients. J Stroke Cerebrovasc Dis 2019; 28:2517-2524. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/31/2019] [Accepted: 06/09/2019] [Indexed: 12/15/2022] Open
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Wu Z, Chen F, Yu F, Wang Y, Guo Z. A meta-analysis of obstructive sleep apnea in patients with cerebrovascular disease. Sleep Breath 2017; 22:729-742. [DOI: 10.1007/s11325-017-1604-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 11/05/2017] [Accepted: 12/06/2017] [Indexed: 12/21/2022]
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Poli M, Philip P, Taillard J, Debruxelles S, Renou P, Orgogozo J, Rouanet F, Sibon I. Atrial fibrillation is a major cause of stroke in apneic patients: a prospective study. Sleep Med 2017; 30:251-254. [DOI: 10.1016/j.sleep.2015.07.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 06/30/2015] [Accepted: 07/01/2015] [Indexed: 11/30/2022]
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Ryan CM, Wilton K, Bradley TD, Alshaer H. In-hospital diagnosis of sleep apnea in stroke patients using a portable acoustic device. Sleep Breath 2016; 21:453-460. [DOI: 10.1007/s11325-016-1438-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 08/03/2016] [Accepted: 11/16/2016] [Indexed: 11/28/2022]
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Sleep apnea syndrome and patent foramen ovale: a dangerous association in ischemic stroke? Sleep Med 2016; 25:29-33. [PMID: 27823712 DOI: 10.1016/j.sleep.2016.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/12/2016] [Accepted: 07/20/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND The coexistence of patent foramen ovale (PFO) and sleep apnea syndrome (SAS) might be related to the pathogenesis of cryptogenic stroke (CS). We aimed to determine the prevalence of SAS in patients with cryptogenic stroke and PFO. METHODS This is a prospective case-control study in which we included ischemic stroke patients consecutively admitted to our hospital's Acute Stroke Unit. Contrast transcranial Doppler (c-TCD) and sleep polygraphy within the first 72 h after stroke onset were performed to detect PFO and SAS. Demographic and clinical characteristics, time of stroke onset, score in the National Institute of Health Stroke Scale (NIHSS), and stroke subtype were registered. RESULTS A total of 97 patients were studied. Overall, 76% were men, with a mean ± SD age of 61 ± 13 years, and an NIHSS of 5 ± 5. Subtype of stroke was cryptogenic (CS) in 28 (29%) and non-CS in 69 (71%) of patients. PFO was more frequent among patients with CS (64% vs 29%, p = 0.002) and without SAS (60% vs 32%, p = 0.013). SAS was diagnosed in 74% of the whole group, with a higher prevalence in patients with known stroke etiology (83% vs 53%, p = 0.003). Finally, the prevalence of SAS and PFO coexistence was similar in patients with or without cryptogenic stroke (25% vs 22%, p = 1), and when comparing the group of patients with cryptogenic wake-up stroke to the other stroke patients (43% vs 21%, p = 0.35). CONCLUSIONS According to our results, there is no evidence of an association of PFO and SAS in the pathogenesis of cryptogenic stroke.
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Boulos MI, Elias S, Wan A, Im J, Frankul F, Atalla M, Black SE, Basile VS, Sundaram A, Hopyan JJ, Boyle K, Gladstone DJ, Swartz RH, Murray BJ. Unattended Hospital and Home Sleep Apnea Testing Following Cerebrovascular Events. J Stroke Cerebrovasc Dis 2016; 26:143-149. [PMID: 27717683 DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 09/03/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Home sleep apnea testing (HSAT) is an alternative to polysomnography for the detection of obstructive sleep apnea (OSA). We assessed the feasibility of HSAT as an unattended screening tool for patients with a stroke or transient ischemic attack (TIA). AIMS The primary outcome was the feasibility of unattended HSAT, as defined by analyzability of the data. Secondary outcomes included determining (1) predictors of obtaining nonanalyzable sleep data and (2) time to OSA detection and continuous positive airway pressure (CPAP) initiation. METHODS In this single-center prospective observational study, inpatients or outpatients who had sustained a stroke or TIA were screened for OSA using the ApneaLink Plus ambulatory sleep monitor in their home or hospital room. RESULTS There were 102 patients who completed unattended sleep monitoring. Mean age was 68.7 ± 13.7 years, 55.9% were male, 57.8% were outpatients, and 77.5% had a stroke (22.5% with TIA). Eighty-two (80.4%) patients obtained four or more hours of analyzable sleep data. Functional dependence (defined as a modified Rankin Scale of >2) and elevated body mass index were independently associated with obtaining nonanalyzable data. OSA was detected in 63.4% (52 of 82) of patients and, of those, 34 of 52 (65.4%) initiated CPAP therapy. The mean time from study recruitment to HSAT was 1.7 days (median: 1, interquartile range [IQR]: 2) and CPAP was initiated on average within 62.7 days of recruitment (median: 53, IQR: 30). CONCLUSIONS Unattended HSAT can be feasibly implemented after stroke or TIA. This method facilitates rapid diagnosis and management of OSA in both the outpatient and inpatient settings.
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Affiliation(s)
- Mark I Boulos
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, Ontario, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, Ontario, Canada.
| | - Sara Elias
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, Ontario, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, Ontario, Canada
| | - Anthony Wan
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, Ontario, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, Ontario, Canada
| | - James Im
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, Ontario, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, Ontario, Canada
| | - Fadi Frankul
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, Ontario, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, Ontario, Canada
| | - Mina Atalla
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, Ontario, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, Ontario, Canada
| | - Sandra E Black
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, Ontario, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, Ontario, Canada
| | - Vincenzo S Basile
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, Ontario, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, Ontario, Canada
| | - Arun Sundaram
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, Ontario, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, Ontario, Canada
| | - Julia J Hopyan
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, Ontario, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, Ontario, Canada
| | - Karl Boyle
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, Ontario, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, Ontario, Canada
| | - David J Gladstone
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, Ontario, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, Ontario, Canada
| | - Richard H Swartz
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, Ontario, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, Ontario, Canada
| | - Brian J Murray
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, Ontario, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, Ontario, Canada
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Semantic clustering and sleep in patients with amnestic mild cognitive impairment or with vascular cognitive impairment-no dementia. Int Psychogeriatr 2016; 28:1493-502. [PMID: 27169617 DOI: 10.1017/s1041610216000739] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cognition and sleep deficits occur in amnestic mild cognitive impairment (aMCI) and vascular cognitive impairment-no dementia (VCIND). However, how memory and sleep deficits differ between aMCI and VCIND remains unclear. METHODS Fifty aMCI and 50 VCIND patients and 38 sex- and age-matched healthy controls (HCs) were administered the Hopkins Verbal Learning Test-Revised (HVLT-R), Trail Making Test-A/B (TMT-A/B), Wisconsin Card Sorting Test (WCST), Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities Test (SDMT), Benton Judgment of Line Orientation (JLO) test, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Insomnia Severity Index (ISI) to quantify cognitive deficits and subjective sleep disturbance. RESULTS Compared with VCIND patients, aMCI patients had lower HVLT-R scores for total recall (p < 0.001), delayed recall (p < 0.001) and recognition (p = 0.001), and for total-recall (p = 0.002) and delayed-recall (p < 0.001) semantic clustering ratios (SCRs). However, VCIND patients exhibited more obvious executive dysfunction (TMT-A, p < 0.001; TMT-B, p < 0.001; WCST, p < 0.001), lower information processing speed (PASAT, p = 0.003; SDMT, p < 0.001), and more severe sleep disturbance (PSQI, p < 0.001; ESS, p < 0.001; ISI, p < 0.001). Additionally, sleep quality and efficiency were related to total and delayed recall (all r values from -0.31 to -0.60, p < 0.05) in aMCI and VCIND. CONCLUSIONS aMCI and VCIND differ in cognitive function, memory strategy and sleep impairment; these characteristics are helpful to identify and distinguish patients with very early cognitive impairment. Our results also suggest that memory deficits are associated with sleep disturbance in aMCI and VCIND.
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Kim TJ, Ko SB, Jeong HG, Lee JS, Kim CK, Kim Y, Nam K, Mo H, Joon An S, Choi HA, Yoon BW. Nocturnal Desaturation in the Stroke Unit Is Associated With Wake-Up Ischemic Stroke. Stroke 2016; 47:1748-53. [DOI: 10.1161/strokeaha.116.013266] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/26/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Tae Jung Kim
- From the Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea (T.J.K., S.-B.K., H.-G.J., K.N., H.M., S.J.A., B.-W.Y.); Clinical Research Center, Asan Medical Center, Seoul, Republic of Korea (J.S.L.); Department of Neruology, Korea University Guro Hospital, Seoul, Republic of Korea (C.K.K.); Department of Neurology, Bucheon St. Mary’s Hospital, Gyeonggi-do, Republic of Korea (Y.K.); and Department of Neurology and Neurosurgery, The Mischer Neuroscience Institute,
| | - Sang-Bae Ko
- From the Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea (T.J.K., S.-B.K., H.-G.J., K.N., H.M., S.J.A., B.-W.Y.); Clinical Research Center, Asan Medical Center, Seoul, Republic of Korea (J.S.L.); Department of Neruology, Korea University Guro Hospital, Seoul, Republic of Korea (C.K.K.); Department of Neurology, Bucheon St. Mary’s Hospital, Gyeonggi-do, Republic of Korea (Y.K.); and Department of Neurology and Neurosurgery, The Mischer Neuroscience Institute,
| | - Han-Gil Jeong
- From the Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea (T.J.K., S.-B.K., H.-G.J., K.N., H.M., S.J.A., B.-W.Y.); Clinical Research Center, Asan Medical Center, Seoul, Republic of Korea (J.S.L.); Department of Neruology, Korea University Guro Hospital, Seoul, Republic of Korea (C.K.K.); Department of Neurology, Bucheon St. Mary’s Hospital, Gyeonggi-do, Republic of Korea (Y.K.); and Department of Neurology and Neurosurgery, The Mischer Neuroscience Institute,
| | - Ji Sung Lee
- From the Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea (T.J.K., S.-B.K., H.-G.J., K.N., H.M., S.J.A., B.-W.Y.); Clinical Research Center, Asan Medical Center, Seoul, Republic of Korea (J.S.L.); Department of Neruology, Korea University Guro Hospital, Seoul, Republic of Korea (C.K.K.); Department of Neurology, Bucheon St. Mary’s Hospital, Gyeonggi-do, Republic of Korea (Y.K.); and Department of Neurology and Neurosurgery, The Mischer Neuroscience Institute,
| | - Chi Kyung Kim
- From the Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea (T.J.K., S.-B.K., H.-G.J., K.N., H.M., S.J.A., B.-W.Y.); Clinical Research Center, Asan Medical Center, Seoul, Republic of Korea (J.S.L.); Department of Neruology, Korea University Guro Hospital, Seoul, Republic of Korea (C.K.K.); Department of Neurology, Bucheon St. Mary’s Hospital, Gyeonggi-do, Republic of Korea (Y.K.); and Department of Neurology and Neurosurgery, The Mischer Neuroscience Institute,
| | - Yerim Kim
- From the Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea (T.J.K., S.-B.K., H.-G.J., K.N., H.M., S.J.A., B.-W.Y.); Clinical Research Center, Asan Medical Center, Seoul, Republic of Korea (J.S.L.); Department of Neruology, Korea University Guro Hospital, Seoul, Republic of Korea (C.K.K.); Department of Neurology, Bucheon St. Mary’s Hospital, Gyeonggi-do, Republic of Korea (Y.K.); and Department of Neurology and Neurosurgery, The Mischer Neuroscience Institute,
| | - Kiwoong Nam
- From the Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea (T.J.K., S.-B.K., H.-G.J., K.N., H.M., S.J.A., B.-W.Y.); Clinical Research Center, Asan Medical Center, Seoul, Republic of Korea (J.S.L.); Department of Neruology, Korea University Guro Hospital, Seoul, Republic of Korea (C.K.K.); Department of Neurology, Bucheon St. Mary’s Hospital, Gyeonggi-do, Republic of Korea (Y.K.); and Department of Neurology and Neurosurgery, The Mischer Neuroscience Institute,
| | - Heejung Mo
- From the Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea (T.J.K., S.-B.K., H.-G.J., K.N., H.M., S.J.A., B.-W.Y.); Clinical Research Center, Asan Medical Center, Seoul, Republic of Korea (J.S.L.); Department of Neruology, Korea University Guro Hospital, Seoul, Republic of Korea (C.K.K.); Department of Neurology, Bucheon St. Mary’s Hospital, Gyeonggi-do, Republic of Korea (Y.K.); and Department of Neurology and Neurosurgery, The Mischer Neuroscience Institute,
| | - Sang Joon An
- From the Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea (T.J.K., S.-B.K., H.-G.J., K.N., H.M., S.J.A., B.-W.Y.); Clinical Research Center, Asan Medical Center, Seoul, Republic of Korea (J.S.L.); Department of Neruology, Korea University Guro Hospital, Seoul, Republic of Korea (C.K.K.); Department of Neurology, Bucheon St. Mary’s Hospital, Gyeonggi-do, Republic of Korea (Y.K.); and Department of Neurology and Neurosurgery, The Mischer Neuroscience Institute,
| | - Huimahn Alex Choi
- From the Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea (T.J.K., S.-B.K., H.-G.J., K.N., H.M., S.J.A., B.-W.Y.); Clinical Research Center, Asan Medical Center, Seoul, Republic of Korea (J.S.L.); Department of Neruology, Korea University Guro Hospital, Seoul, Republic of Korea (C.K.K.); Department of Neurology, Bucheon St. Mary’s Hospital, Gyeonggi-do, Republic of Korea (Y.K.); and Department of Neurology and Neurosurgery, The Mischer Neuroscience Institute,
| | - Byung-Woo Yoon
- From the Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea (T.J.K., S.-B.K., H.-G.J., K.N., H.M., S.J.A., B.-W.Y.); Clinical Research Center, Asan Medical Center, Seoul, Republic of Korea (J.S.L.); Department of Neruology, Korea University Guro Hospital, Seoul, Republic of Korea (C.K.K.); Department of Neurology, Bucheon St. Mary’s Hospital, Gyeonggi-do, Republic of Korea (Y.K.); and Department of Neurology and Neurosurgery, The Mischer Neuroscience Institute,
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Swartz RH, Bayley M, Lanctôt KL, Murray BJ, Cayley ML, Lien K, Sicard MN, Thorpe KE, Dowlatshahi D, Mandzia JL, Casaubon LK, Saposnik G, Perez Y, Sahlas DJ, Herrmann N. Post-stroke depression, obstructive sleep apnea, and cognitive impairment: Rationale for, and barriers to, routine screening. Int J Stroke 2016; 11:509-18. [DOI: 10.1177/1747493016641968] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 01/24/2016] [Indexed: 11/16/2022]
Abstract
Stroke can cause neurological impairment ranging from mild to severe, but the impact of stroke extends beyond the initial brain injury to include a complex interplay of devastating comorbidities including: post-stroke depression, obstructive sleep apnea, and cognitive impairment (“DOC”). We reviewed the frequency, impact, and treatment options for each DOC condition. We then used the Ottawa Model of Research Use to examine gaps in care, understand the barriers to knowledge translation, identification, and addressing these important post-stroke comorbidities. Each of the DOC conditions is common and result in poorer recovery, greater functional impairment, increased stroke recurrence and mortality, even after accounting for traditional vascular risk factors. Despite the strong relationships between DOC comorbidities and these negative outcomes as well as recommendations for screening based on best practice recommendations from several countries, they are frequently not assessed. Barriers related to the nature of the screening tools (e.g., time consuming in high-volume clinics), practice environment (e.g., lack of human resources or space), as well as potential adopters (e.g., equipoise surrounding the benefits of treatment for these conditions) pose challenges to routine screening implementation. Simple, feasible approaches to routine screening coupled with appropriate, evidence-based treatment protocols are required to better identify and manage depression, obstructive sleep apnea, and cognitive impairment symptoms in stroke prevention clinic patients to reduce the impact of these important post-stroke comorbidities. These tools may in turn facilitate large-scale randomized controlled treatment trials of interventions for DOC conditions that may help to improve cardiovascular outcomes after stroke or TIA.
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Affiliation(s)
- Richard H Swartz
- University of Toronto, Toronto, Canada
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Canada
- Hurvitz Brain Sciences Research Program, Toronto, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, Canada
- University of Toronto Stroke Program, Toronto, Canada
| | - Mark Bayley
- University of Toronto, Toronto, Canada
- Department of Medicine (Physiatry), University Health Network, Toronto Rehabilitation Institute, Toronto, Canada
| | - Krista L Lanctôt
- University of Toronto, Toronto, Canada
- Hurvitz Brain Sciences Research Program, Toronto, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Brian J Murray
- University of Toronto, Toronto, Canada
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Canada
- Hurvitz Brain Sciences Research Program, Toronto, Canada
| | - Megan L Cayley
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Karen Lien
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Michelle N Sicard
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Kevin E Thorpe
- University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- St. Michael’s Hospital, Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Toronto, Canada
| | - Dar Dowlatshahi
- University of Ottawa, Ottawa, Canada
- Department of Medicine (Neurology), Ottawa Hospital, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jennifer L Mandzia
- Western University, London, Canada
- Department of Clinical Neurological Sciences, London Health Sciences Centre, London, Canada
| | - Leanne K Casaubon
- University of Toronto, Toronto, Canada
- University of Toronto Stroke Program, Toronto, Canada
- Department of Medicine (Neurology), University Health Network, Toronto Western Hospital, Toronto, Canada
| | - Gustavo Saposnik
- University of Toronto, Toronto, Canada
- University of Toronto Stroke Program, Toronto, Canada
- Department of Medicine (Neurology), St. Michael’s Hospital, Toronto, Canada
| | - Yael Perez
- Department of Medicine (Neurology), Trillium Health Partners, Mississauga, Canada
| | - Demetrios J Sahlas
- McMaster University, Hamilton, Canada
- Department of Medicine (Neurology), Hamilton Health Sciences, Hamilton, Canada
- Department of Medicine (Neurology), Hamilton General Hospital, Hamilton, Canada
| | - Nathan Herrmann
- University of Toronto, Toronto, Canada
- Hurvitz Brain Sciences Research Program, Toronto, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
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15
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Boulos MI, Wan A, Im J, Elias S, Frankul F, Atalla M, Black SE, Basile VS, Sundaram A, Hopyan JJ, Boyle K, Gladstone DJ, Murray BJ, Swartz RH. Identifying obstructive sleep apnea after stroke/TIA: evaluating four simple screening tools. Sleep Med 2016; 21:133-9. [PMID: 27448484 DOI: 10.1016/j.sleep.2015.12.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 11/15/2015] [Accepted: 12/23/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Despite its high prevalence and unfavorable clinical consequences, obstructive sleep apnea (OSA) often remains underappreciated after cerebrovascular events. The purpose of our study was to evaluate the clinical utility of four simple paper-based screening tools for excluding OSA after stroke or transient ischemic attack (TIA). PATIENTS/METHODS Sixty-nine inpatients and outpatients with stroke or TIA during the past 180 days completed the 4-Variable screening tool (4V), STOP-BAG questionnaire (ie, STOP-BANG questionnaire without the neck circumference measurement), Berlin questionnaire, and the Sleep Obstructive apnea score optimized for Stroke (SOS). They subsequently underwent objective testing using a portable sleep monitoring device. Cutoffs were selected to maximize sensitivity and exclude OSA (AHI ≥ 10) in ≥10% of the cohort. RESULTS The mean age was 68.3 ± 14.2 years and 47.8% were male. Thirty-two patients (46.4%) were found to have OSA. Male sex, body mass index (BMI), and atrial fibrillation were independent predictors of OSA. Among the screening tools, the 4V had the greatest area under the curve (AUC) of 0.688 (p = 0.007); the sensitivity was 96.9% for a cutoff of <6. The STOP-BAG also significantly detected OSA with an AUC of 0.677 (p = 0.012); the sensitivity was 93.8% for a cutoff of <2. Scores on the 4V and STOP-BAG were significantly correlated with the AHI. CONCLUSIONS The 4V and STOP-BAG questionnaire may aid clinicians with ruling out OSA within 180 days of stroke/TIA. Due to the atypical presentation of poststroke/TIA OSA, these tools are only moderately predictive; objective testing should still be used for OSA diagnosis in this population.
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Affiliation(s)
- Mark I Boulos
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, ON, Canada; LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, ON, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, ON, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, ON, Canada; University of Toronto Stroke Program, Toronto, ON, Canada.
| | - Anthony Wan
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, ON, Canada; LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, ON, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, ON, Canada
| | - James Im
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, ON, Canada; LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, ON, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, ON, Canada
| | - Sara Elias
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, ON, Canada; LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, ON, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, ON, Canada
| | - Fadi Frankul
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, ON, Canada; LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, ON, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, ON, Canada
| | - Mina Atalla
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, ON, Canada; LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, ON, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, ON, Canada
| | - Sandra E Black
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, ON, Canada; LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, ON, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, ON, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, ON, Canada; University of Toronto Stroke Program, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, School of Graduate Studies, University of Toronto, Toronto, ON, Canada
| | - Vincenzo S Basile
- Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, ON, Canada; University of Toronto Stroke Program, Toronto, ON, Canada
| | - Arun Sundaram
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, ON, Canada; LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, ON, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, ON, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, ON, Canada; University of Toronto Stroke Program, Toronto, ON, Canada
| | - Julia J Hopyan
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, ON, Canada; LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, ON, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, ON, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, ON, Canada; University of Toronto Stroke Program, Toronto, ON, Canada
| | - Karl Boyle
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, ON, Canada; LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, ON, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, ON, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, ON, Canada; University of Toronto Stroke Program, Toronto, ON, Canada
| | - David J Gladstone
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, ON, Canada; LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, ON, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, ON, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, ON, Canada; University of Toronto Stroke Program, Toronto, ON, Canada
| | - Brian J Murray
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, ON, Canada; LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, ON, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, ON, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, ON, Canada
| | - Richard H Swartz
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre (HSC), Toronto, ON, Canada; LC Campbell Cognitive Neurology Research Unit, Sunnybrook Research Institute, University of Toronto, ON, Canada; Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, ON, Canada; Department of Medicine (Neurology), University of Toronto and Sunnybrook HSC, Toronto, ON, Canada; University of Toronto Stroke Program, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, School of Graduate Studies, University of Toronto, Toronto, ON, Canada
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16
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Molnar MZ, Mucsi I, Novak M, Szabo Z, Freire AX, Huch KM, Arah OA, Ma JZ, Lu JL, Sim JJ, Streja E, Kalantar-Zadeh K, Kovesdy CP. Association of incident obstructive sleep apnoea with outcomes in a large cohort of US veterans. Thorax 2015; 70:888-95. [PMID: 26038534 PMCID: PMC4575815 DOI: 10.1136/thoraxjnl-2015-206970] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 05/09/2015] [Indexed: 11/04/2022]
Abstract
RATIONALE There is a paucity of large cohort studies examining the association of obstructive sleep apnoea (OSA) with clinical outcomes including all-cause mortality, coronary heart disease (CHD), strokes and chronic kidney disease (CKD). OBJECTIVES We hypothesised that a diagnosis of incident OSA is associated with higher risks of these adverse clinical outcomes. METHODS, MEASUREMENTS In a nationally representative cohort of over 3 million (n=3 079 514) US veterans (93% male) with baseline estimated glomerular filtration rate (eGFR)≥60 mL/min/1.73 m(2), we examined the association between the diagnosis of incident OSA, treated and untreated with CPAP, and: (1) all-cause mortality, (2) incident CHD, (3) incident strokes, (4)incident CKD defined as eGFR<60 mL/min/1.73 m(2), and (5) slopes of eGFR. MAIN RESULTS Compared with OSA-negative patients, untreated and treated OSA was associated with 86% higher mortality risk, (adjusted HR and 95% CI 1.86 (1.81 to 1.91) and 35% (1.35 (1.21 to 1.51)), respectively. Similarly, untreated and treated OSA was associated with 3.5 times (3.54 (3.40 to 3.69)) and 3 times (3.06 (2.62 to 3.56)) higher risk of incident CHD; 3.5 times higher risk of incident strokes (3.48 (3.28 to 3.64) and 3.50 (2.92 to 4.19)) for untreated and treated OSA, respectively. The risk of incident CKD was also significantly higher in untreated (2.27 (2.19 to 2.36)) and treated (2.79 (2.48 to 3.13)) patients with OSA. The median (IQR) of the eGFR slope was -0.41 (-2.01 to 0.99), -0.61 (-2.69 to 0.93) and -0.87 (-3.00 to 0.70) mL/min/1.73 m(2) in OSA-negative patients, untreated OSA-positive patients and treated OSA-positive patients, respectively. CONCLUSIONS In this large and contemporary cohort of more than 3 million US veterans, a diagnosis of incident OSA was associated with higher mortality, incident CHD, stroke and CKD and with faster kidney function decline.
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Affiliation(s)
- Miklos Z Molnar
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Istvan Mucsi
- Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Canada
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
| | - Marta Novak
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
- Department of Psychiatry, University Health Network, University of Toronto, Toronto, Canada
| | - Zoltan Szabo
- Department of Cardiothoracic Surgery and Cardiothoracic Anesthesia, Linköping University Hospital, Linköping, Sweden
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Amado X Freire
- Pulmonary Section, Memphis Veterans Affairs Medical Center, Memphis, TN, USA
| | - Kim M Huch
- Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, TN, USA
| | - Onyebuchi A Arah
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Jennie Z Ma
- Division of Nephrology, University of Virginia, Charlottesville, VA, USA
| | - Jun L Lu
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Elani Streja
- Division of Nephrology, University of California, Irvine, CA, USA
| | | | - Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, TN, USA
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17
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Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, Fang MC, Fisher M, Furie KL, Heck DV, Johnston SCC, Kasner SE, Kittner SJ, Mitchell PH, Rich MW, Richardson D, Schwamm LH, Wilson JA. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45:2160-236. [PMID: 24788967 DOI: 10.1161/str.0000000000000024] [Citation(s) in RCA: 2851] [Impact Index Per Article: 285.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy. Special sections address use of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and implementation of guidelines.
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18
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Manconi M, Zavalko I, Cereda C, Pisarenco I, Ott S, Fulda S, Bassetti CL. Longitudinal Polysomnographic Assessment from Acute to Subacute Phase in Infratentorial versus Supratentorial Stroke. Cerebrovasc Dis 2014; 37:85-93. [DOI: 10.1159/000356323] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 10/08/2013] [Indexed: 11/19/2022] Open
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19
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Ferre A, Ribó M, Rodríguez-Luna D, Romero O, Sampol G, Molina C, Álvarez-Sabin J. Strokes and their relationship with sleep and sleep disorders. NEUROLOGÍA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.nrleng.2010.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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20
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Ahn SH, Kim JH, Kim DU, Choo IS, Lee HJ, Kim HW. Interaction between Sleep-Disordered Breathing and Acute Ischemic Stroke. J Clin Neurol 2013; 9:9-13. [PMID: 23346154 PMCID: PMC3543913 DOI: 10.3988/jcn.2013.9.1.9] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 07/18/2012] [Accepted: 07/18/2012] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND PURPOSE Sleep-disordered breathing (SDB) is suggested to be strongly associated with ischemic strokes. Risk factors, stroke subtypes, stroke lesion distribution, and the outcome of SDB in stroke patients remain unclear in Korea. METHODS We prospectively studied 293 patients (159 men, 134 women; age 68.4±10.5) with acute ischemic stroke. Cardiovascular risk factors, stroke severity, sleep-related stroke onset, distribution of stroke lesions, and 3-month score on the modified Rankin Scale (mRS) were assessed. Stroke severity was assessed by the US National Institutes of Health Stroke Scale (NIHSS) and the mRS. The apnea-hypopnea index (AHI) was determined 6.3±2.2 days after stroke onset with the Apnea Link portable sleep apnea monitoring device. RESULTS The prevalence of SDB (defined as an AHI of ≥10) was 63.1% (111 men, 74 women). Those in the SDB group were older, had higher NIHSS and mRS scores, greater bulbar weakness, and a higher incidence of sleep-associated stroke onset. Among risk-factor profiles, alcohol consumption and atrial fibrillation were significantly related to SDB. The stroke outcome was worse in patients with SDB than in those without SDB. The lesion location and specific stroke syndrome were not correlated with SDB. CONCLUSIONS SDB is very common in acute cerebral infarction. Different risk-factor profiles and sleep-related stroke onsets suggest SDB as a cause of ischemic stroke. The higher NIHSS score and greater bulbar involvement in the SDB group seem to show the influence of ischemic stroke on the increased SDB prevalence.
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Affiliation(s)
- Seong Hwan Ahn
- Department of Neurology, College of Medicine, Chosun University, Gwangju, Korea
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21
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Validity of sheet-type portable monitoring device for screening obstructive sleep apnea syndrome. Sleep Breath 2012; 17:589-95. [PMID: 22707086 DOI: 10.1007/s11325-012-0725-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 05/21/2012] [Accepted: 05/23/2012] [Indexed: 10/28/2022]
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22
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Ferre A, Ribó M, Rodríguez-Luna D, Romero O, Sampol G, Molina CA, Álvarez-Sabin J. Strokes and their relationship with sleep and sleep disorders. Neurologia 2010; 28:103-18. [PMID: 21163212 DOI: 10.1016/j.nrl.2010.09.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 08/26/2010] [Accepted: 09/18/2010] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION In the current population, strokes are one of the most important causes of morbidity and mortality, to which new risk factors are increasingly being attributed. Of late, there is increased interest in the relationship between sleep disorders and strokes as regards risk and prognosis. DEVELOPMENT This article presents the changes in sleep architecture and brain activity in stroke patients, as well as the interaction between stroke and sleep disorders, including those which may also influence the outcome and recovery from strokes. The different treatments discussed in the literature are also reviewed, as correct treatment of such sleep disorders may not only improve quality of life and reduce after-effects, but can also increase life expectancy. CONCLUSIONS Sleep disorders are becoming increasingly associated with stroke. In addition to being a risk factor, they can also interfere in the outcome and recovery of stroke patients. This article aims to present an exhaustive and current review on strokes and their relationship with sleep alterations and sleep disorders.
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Affiliation(s)
- A Ferre
- Servicio de Neurofisiología Clínica, Unidad de Sueño, Hospital Universitario de la Vall d'Hebron, Barcelona, España.
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