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Du L, He X, Xiong X, Zhang X, Jian Z, Yang Z. Vagus nerve stimulation in cerebral stroke: biological mechanisms, therapeutic modalities, clinical applications, and future directions. Neural Regen Res 2024; 19:1707-1717. [PMID: 38103236 PMCID: PMC10960277 DOI: 10.4103/1673-5374.389365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/31/2023] [Accepted: 09/26/2023] [Indexed: 12/18/2023] Open
Abstract
Stroke is a major disorder of the central nervous system that poses a serious threat to human life and quality of life. Many stroke victims are left with long-term neurological dysfunction, which adversely affects the well-being of the individual and the broader socioeconomic impact. Currently, post-stroke brain dysfunction is a major and difficult area of treatment. Vagus nerve stimulation is a Food and Drug Administration-approved exploratory treatment option for autism, refractory depression, epilepsy, and Alzheimer's disease. It is expected to be a novel therapeutic technique for the treatment of stroke owing to its association with multiple mechanisms such as altering neurotransmitters and the plasticity of central neurons. In animal models of acute ischemic stroke, vagus nerve stimulation has been shown to reduce infarct size, reduce post-stroke neurological damage, and improve learning and memory capacity in rats with stroke by reducing the inflammatory response, regulating blood-brain barrier permeability, and promoting angiogenesis and neurogenesis. At present, vagus nerve stimulation includes both invasive and non-invasive vagus nerve stimulation. Clinical studies have found that invasive vagus nerve stimulation combined with rehabilitation therapy is effective in improving upper limb motor and cognitive abilities in stroke patients. Further clinical studies have shown that non-invasive vagus nerve stimulation, including ear/cervical vagus nerve stimulation, can stimulate vagal projections to the central nervous system similarly to invasive vagus nerve stimulation and can have the same effect. In this paper, we first describe the multiple effects of vagus nerve stimulation in stroke, and then discuss in depth its neuroprotective mechanisms in ischemic stroke. We go on to outline the results of the current major clinical applications of invasive and non-invasive vagus nerve stimulation. Finally, we provide a more comprehensive evaluation of the advantages and disadvantages of different types of vagus nerve stimulation in the treatment of cerebral ischemia and provide an outlook on the developmental trends. We believe that vagus nerve stimulation, as an effective treatment for stroke, will be widely used in clinical practice to promote the recovery of stroke patients and reduce the incidence of disability.
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Affiliation(s)
- Li Du
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Xuan He
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Xiaoxing Xiong
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Xu Zhang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Zhihong Jian
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Zhenxing Yang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
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Mayer-Suess L, Ibrahim A, Moelgg K, Cesari M, Knoflach M, Högl B, Stefani A, Kiechl S, Heidbreder A. Sleep disorders as both risk factors for, and a consequence of, stroke: A narrative review. Int J Stroke 2024; 19:490-498. [PMID: 37885093 PMCID: PMC11134986 DOI: 10.1177/17474930231212349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND AND PURPOSE Sleep disorders are increasingly implicated as risk factors for stroke, as well as a determinant of stroke outcome. They can also occur secondary to the stroke itself. In this review, we describe the variety of different sleep disorders associated with stroke and analyze their effect on stroke risk and outcome. METHODS A search term-based literature review ("sleep," "insomnia," "narcolepsy," "restless legs syndrome," "periodic limb movements during sleep," "excessive daytime sleepiness" AND "stroke" OR "cerebrovascular" in PubMed; "stroke" and "sleep" in ClinicalTrials.gov) was performed. English articles from 1990 to March 2023 were considered. RESULTS Increasing evidence suggests that sleep disorders are risk factors for stroke. In addition, sleep disturbance has been reported in half of all stroke sufferers; specifically, an increase is not only sleep-related breathing disorders but also periodic limb movements during sleep, narcolepsy, rapid eye movement (REM) sleep behavior disorder, insomnia, sleep duration, and circadian rhythm sleep-wake disorders. Poststroke sleep disturbance has been associated with worse outcome. CONCLUSION Sleep disorders are risk factors for stroke and associated with worse stroke outcome. They are also a common consequence of stroke. Recent guidelines suggest screening for sleep disorders after stroke. It is possible that treatment of sleep disorders could both reduce stroke risk and improve stroke outcome, although further data from clinical trials are required.
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Affiliation(s)
- Lukas Mayer-Suess
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Abubaker Ibrahim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Kurt Moelgg
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage—Research Centre on Clinical Stroke Research, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Neurological Clinical Research Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage—Research Centre on Clinical Stroke Research, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neurology, Johannes Kepler University Linz, Linz, Austria
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Yang J, Lin A, Tan Q, Dou W, Wu J, Zhang Y, Lin H, Wei B, Huang J, Xie J. Development of insomnia in patients with stroke: A systematic review and meta-analysis. PLoS One 2024; 19:e0297941. [PMID: 38598535 PMCID: PMC11006172 DOI: 10.1371/journal.pone.0297941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/14/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND AND AIM Stroke is a serious threat to human life and health, and post-stroke insomnia is one of the common complications severely impairing patients' quality of life and delaying recovery. Early understanding of the relationship between stroke and post-stroke insomnia can provide clinical evidence for preventing and treating post-stroke insomnia. This study was to investigate the prevalence of insomnia in patients with stroke. METHODS The Web of Science, PubMed, Embase, and Cochrane Library databases were used to obtain the eligible studies until June 2023. The quality assessment was performed to extract valid data for meta-analysis. The prevalence rates were used a random-efect. I2 statistics were used to assess the heterogeneity of the studies. RESULTS Twenty-six studies met the inclusion criteria for meta-analysis, with 1,193,659 participants, of which 497,124 were patients with stroke.The meta-analysis indicated that 150,181 patients with stroke developed insomnia during follow-up [46.98%, 95% confidence interval (CI): 36.91-57.18] and 1806 patients with ischemic stroke (IS) or transient ischemic attack (TIA) developed insomnia (47.21%, 95% CI: 34.26-60.36). Notably, 41.51% of patients with the prevalence of nonclassified stroke developed insomnia (95% CI: 28.86-54.75). The incidence of insomnia was significantly higher in patients with acute strokes than in patients with nonacute strokes (59.16% vs 44.07%, P < 0.0001).Similarly, the incidence of insomnia was significantly higher in the patients with stroke at a mean age of ≥65 than patients with stroke at a mean age of <65 years (47.18% vs 40.50%, P < 0.05). Fifteen studies reported the follow-up time. The incidence of insomnia was significantly higher in the follow-up for ≥3 years than follow-up for <3 years (58.06% vs 43.83%, P < 0.05). Twenty-one studies used the Insomnia Assessment Diagnostic Tool, and the rate of insomnia in patients with stroke was 49.31% (95% CI: 38.59-60.06). Five studies used self-reporting, that the rate of insomnia in patients with stroke was 37.58% (95% CI: 13.44-65.63). CONCLUSIONS Stroke may be a predisposing factor for insomnia. Insomnia is more likely to occur in acute-phase stroke, and the prevalence of insomnia increases with patient age and follow-up time. Further, the rate of insomnia is higher in patients with stroke who use the Insomnia Assessment Diagnostic Tool.
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Affiliation(s)
- Junwei Yang
- The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, 530023, China
| | - Aitao Lin
- Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, 530001, China
| | - Qingjing Tan
- The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, 530023, China
| | - Weihua Dou
- The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, 530023, China
| | - Jinyu Wu
- The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, 530023, China
| | - Yang Zhang
- The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, 530023, China
| | - Haohai Lin
- The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, 530023, China
| | - Baoping Wei
- The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, 530023, China
| | - Jiemin Huang
- The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, 530023, China
| | - Juanjuan Xie
- The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, 530023, China
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Mohamed B, Yarlagadda K, Self Z, Simon A, Rigueiro F, Sohooli M, Eisenschenk S, Doré S. Obstructive Sleep Apnea and Stroke: Determining the Mechanisms Behind their Association and Treatment Options. Transl Stroke Res 2024; 15:239-332. [PMID: 36922470 DOI: 10.1007/s12975-023-01123-x] [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: 10/14/2022] [Revised: 01/02/2023] [Accepted: 01/02/2023] [Indexed: 03/18/2023]
Abstract
Sleep-disordered breathing (SDB) can be a sequela of stroke caused by vascular injury to vital respiratory centers, cerebral edema, and increased intracranial pressure of space-occupying lesions. Likewise, obstructive sleep apnea (OSA) contributes to increased stroke risk through local mechanisms such as impaired ischemic cerebrovascular response and systemic effects such as promoting atherosclerosis, hypercoagulability, cardiac arrhythmias, vascular-endothelial dysfunction, and metabolic syndrome. The impact of OSA on stroke outcomes has been established, yet it receives less attention in national guidelines on stroke management than hyperglycemia and blood pressure dysregulation. Furthermore, whether untreated OSA worsens stroke outcomes is not well-described in the literature. This scoping review provides an updated investigation of the correlation between OSA and stroke, including inter-relational pathophysiology. This review also highlights the importance of OSA treatment and its role in stroke outcomes. Knowledge of pathophysiology, the inter-relationship between these common disorders, and the impact of OSA therapy on outcomes affect the clinical management of patients with acute ischemic stroke. In addition, understanding the relationship between stroke outcomes and pre-existing OSA will allow clinicians to predict outcomes while treating acute stroke.
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Affiliation(s)
- Basma Mohamed
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Keerthi Yarlagadda
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Zachary Self
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Alexandra Simon
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Frank Rigueiro
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Maryam Sohooli
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Stephan Eisenschenk
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Sylvain Doré
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA.
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, 32610, USA.
- Departments of Neurology, Psychiatry, Pharmaceutics, and Neuroscience, Center for Translational Research in Neurodegenerative Disease, McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, 32610, USA.
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Chen P, Wang W, Ban W, Zhang K, Dai Y, Yang Z, You Y. Deciphering Post-Stroke Sleep Disorders: Unveiling Neurological Mechanisms in the Realm of Brain Science. Brain Sci 2024; 14:307. [PMID: 38671959 PMCID: PMC11047862 DOI: 10.3390/brainsci14040307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/15/2024] [Accepted: 03/17/2024] [Indexed: 04/28/2024] Open
Abstract
Sleep disorders are the most widespread mental disorders after stroke and hurt survivors' functional prognosis, response to restoration, and quality of life. This review will address an overview of the progress of research on the biological mechanisms associated with stroke-complicating sleep disorders. Extensive research has investigated the negative impact of stroke on sleep. However, a bidirectional association between sleep disorders and stroke exists; while stroke elevates the risk of sleep disorders, these disorders also independently contribute as a risk factor for stroke. This review aims to elucidate the mechanisms of stroke-induced sleep disorders. Possible influences were examined, including functional changes in brain regions, cerebrovascular hemodynamics, neurological deficits, sleep ion regulation, neurotransmitters, and inflammation. The results provide valuable insights into the mechanisms of stroke complicating sleep disorders.
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Affiliation(s)
- Pinqiu Chen
- Key Laboratory of Molecular Pharmacology and Drug Evaluation, Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, School of Pharmacy, Yantai University, Yantai 264005, China; (P.C.)
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100193, China
| | - Wenyan Wang
- Key Laboratory of Molecular Pharmacology and Drug Evaluation, Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, School of Pharmacy, Yantai University, Yantai 264005, China; (P.C.)
| | - Weikang Ban
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100193, China
| | - Kecan Zhang
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100193, China
| | - Yanan Dai
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100193, China
| | - Zhihong Yang
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100193, China
| | - Yuyang You
- School of Automation, Beijing Institute of Technology, Beijing 100081, China
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Mohandas P, Alomari Z, Arti F, Alhneif M, Alejandra Ruiz P, Ahmed AK, Wei CR, Amin A. A Systematic Review and Meta-Analysis on the Identification of Predictors Associated With Insomnia or Sleep Disturbance in Post-stroke Patients. Cureus 2024; 16:e56578. [PMID: 38646398 PMCID: PMC11027028 DOI: 10.7759/cureus.56578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
The aim of this study was to identify the factors associated with sleep disturbances in individuals after a stroke. To systematically identify relevant studies, an extensive search strategy was devised. We conducted comprehensive searches in major electronic databases including PubMed, Embase, PsycINFO, and Cochrane Library. The search was limited to articles published in English between January 1, 2011, and February 10, 2024. Pooled effect estimates, such as odds ratio (OR) or mean difference (MD) along with their confidence interval (CIs), were calculated using random-effects models for categorical variables and continuous variables, respectively. A total of nine studies were included in this meta-analysis. The pooled prevalence of insomnia across the included studies was determined to be 40% (95% CI = 30%-49%), with individual study prevalence ranging from 22% to 72%. A pooled analysis showed that gender demonstrated a statistically significant association with sleep disturbance, with females exhibiting a higher likelihood (OR = 1.49, 95% CI = 1.16-1.91, p = 0.002) compared to males. The National Institutes of Health Stroke Scale (NIHSS) score, a measure of stroke severity, was associated with sleep disturbance (MD = 0.86, 95% CI = 0.56-1.17, p = 0.001), indicating that patients with severe strokes may be more prone to sleep disturbances. These findings underscore the importance of comprehensive evaluation and targeted interventions to address sleep-related issues in stroke patients, particularly those with severe neurological impairment.
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Affiliation(s)
| | - Zaid Alomari
- Internal Medicine, Tbilisi State Medical University, Tbilisi, GEO
| | - Fnu Arti
- Medicine, Ghulam Muhammad Mahar Medical College, Sukkur, PAK
| | - Mohammad Alhneif
- Neuropathology, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | | | | | - Calvin R Wei
- Research and Development, Shing Huei Group, Taipei, TWN
| | - Adil Amin
- Cardiology, Pakistan Navy Ship Shifa, Karachi, PAK
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Denis C, Jaussent I, Guiraud L, Mestejanot C, Arquizan C, Mourand I, Chenini S, Abril B, Wacongne A, Tamisier R, Baillieul S, Pepin JL, Barateau L, Dauvilliers Y. Functional recovery after ischemic stroke: Impact of different sleep health parameters. J Sleep Res 2024; 33:e13964. [PMID: 37338010 DOI: 10.1111/jsr.13964] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/24/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Abstract
Sleep disturbances after ischaemic stroke include alterations of sleep architecture, obstructive sleep apnea, restless legs syndrome, daytime sleepiness and insomnia. Our aim was to explore their impacts on functional outcomes at month 3 after stroke, and to assess the benefit of continuous positive airway pressure in patients with severe obstructive sleep apnea. Ninety patients with supra-tentorial ischaemic stroke underwent clinical screening for sleep disorders and polysomnography at day 15 ± 4 after stroke in a multisite study. Patients with severe obstructive apnea (apnea-hypopnea index ≥ 30 per hr) were randomized into two groups: continuous positive airway pressure-treated and sham (1:1 ratio). Functional independence was assessed with the Barthel Index at month 3 after stroke in function of apnea-hypopnea index severity and treatment group. Secondary objectives were disability (modified Rankin score) and National Institute of Health Stroke Scale according to apnea-hypopnea index. Sixty-one patients (71.8 years, 42.6% men) completed the study: 51 (83.6%) had obstructive apnea (21.3% severe apnea), 10 (16.7%) daytime sleepiness, 13 (24.1%) insomnia, 3 (5.7%) depression, and 20 (34.5%) restless legs syndrome. Barthel Index, modified Rankin score and Stroke Scale were similar at baseline and 3 months post-stroke in the different obstructive sleep apnea groups. Changes at 3 months in those three scores were similar in continuous positive airway pressure versus sham-continuous positive airway pressure patients. In patients with worse clinical outcomes at month 3, mean nocturnal oxygen saturation was lower whereas there was no association with apnea-hypopnea index. Poorer outcomes at 3 months were also associated with insomnia, restless legs syndrome, depressive symptoms, and decreased total sleep time and rapid eye movement sleep.
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Affiliation(s)
- Claire Denis
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France
| | | | - Lily Guiraud
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France
| | - Caroline Mestejanot
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France
| | - Caroline Arquizan
- Stroke University, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France
| | - Isabelle Mourand
- Stroke University, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France
| | - Sofiène Chenini
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France
- INM, University Montpellier, INSERM, Montpellier, France
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France
| | - Beatriz Abril
- Sleep University, Carémeau Hospital, CHU, Nîmes, France
| | - Anne Wacongne
- Neurology Department, Carémeau Hospital, CHU, Nîmes, France
| | - Renaud Tamisier
- University Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, Grenoble, France
| | - Sébastien Baillieul
- University Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, Grenoble, France
| | - Jean-Louis Pepin
- University Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, Grenoble, France
| | - Lucie Barateau
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France
- INM, University Montpellier, INSERM, Montpellier, France
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France
| | - Yves Dauvilliers
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France
- INM, University Montpellier, INSERM, Montpellier, France
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France
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Zhang XH, Zhang X, Liu XW, Lai PH, Cao CC, Wang YL, Ren LJ. Examining the Role of GLU/GABA to GLN Metabolic Cycle in the Pathogenesis of Post-Stroke Depressive Disorder and Insomnia. Neuropsychiatr Dis Treat 2023; 19:2833-2840. [PMID: 38149001 PMCID: PMC10750479 DOI: 10.2147/ndt.s443844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/04/2023] [Indexed: 12/28/2023] Open
Abstract
Objective This study aims to elucidate the potential links between the GLU/GABA to GLN metabolic cycle disruptions and the onset of depressive and insomnia disorders following a stroke. We particularly focus on understanding if these disorders share a common underlying pathogenic mechanism. Methods We examined 63 patients with post-stroke insomnia, 62 patients with post-stroke depression, and 18 healthy individuals. The study involved assessing insomnia using the Acute Insomnia Scale (AIS) and depression using the Hamilton Depression Rating Scale. We measured serum concentrations of GLN, GLU, and GABA and analyzed their correlations with AIS and HAMD scores. Results Our results indicate no significant difference in the serum levels of GLN, GLU, and GABA between the post-stroke insomnia and depression groups. However, these levels were notably lower in both patient groups compared to the healthy control group. A negative correlation between AIS scores and GABA levels was observed in the post-stroke insomnia group, suggesting a potential link between GABAergic disturbances and insomnia. Conversely, no significant correlation was found between Hamilton Depression Rating Scale scores and the levels of GABA, GLU, or GLN in the post-stroke depression group. Conclusion The study highlights that abnormalities in the GLU/GABA to GLN metabolic cycle, particularly the levels of GLN, GABA, and GAD, might be intricately linked to the pathogenesis of post-stroke insomnia and depression. Our findings suggest that GABAergic imbalances could be indicative of post-stroke insomnia, serving as potential biological markers for differential diagnosis in clinical settings. Further research is warranted to explore these relationships in greater depth, potentially leading to new diagnostic and therapeutic approaches for post-stroke neuropsychiatric disorders.
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Affiliation(s)
- Xiao-Hua Zhang
- Department of Rehabilitation, Shenzhen Dapeng New District Nanao People’s Hospital, Shenzhen, 518121, People’s Republic of China
| | - Xin Zhang
- Department of Rehabilitation, Shenzhen Dapeng New District Nanao People’s Hospital, Shenzhen, 518121, People’s Republic of China
| | - Xuan-Wei Liu
- Department of Rehabilitation, Shenzhen Dapeng New District Nanao People’s Hospital, Shenzhen, 518121, People’s Republic of China
| | - Peng-Hui Lai
- Department of Rehabilitation, Shenzhen Dapeng New District Nanao People’s Hospital, Shenzhen, 518121, People’s Republic of China
| | - Chang-Chun Cao
- Department of Rehabilitation, Shenzhen Dapeng New District Nanao People’s Hospital, Shenzhen, 518121, People’s Republic of China
| | - Yu-Long Wang
- Department of Rehabilitation, The First Affiliated Hospital, Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, 518000, People’s Republic of China
| | - Li-Jie Ren
- Department of Rehabilitation, The First Affiliated Hospital, Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, 518000, People’s Republic of China
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9
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Song Z, Ying chen, Li J, Chen Z, Lu X, Wang Z. Comparative effectiveness of different treatments for post-stroke insomnia: A network meta-analysis. Heliyon 2023; 9:e21801. [PMID: 38027586 PMCID: PMC10658229 DOI: 10.1016/j.heliyon.2023.e21801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 08/25/2023] [Accepted: 10/28/2023] [Indexed: 12/01/2023] Open
Abstract
Background :Post-stroke insomnia(PSI)is one of the common complications after stroke and it is a chronic problem and hampers the patient's recovery. Some treatments have been shown to be effective in treating post-stroke insomnia. However, it is not clear which treatment is more effective. Methods In this study, we searched CNKI, PubMed, and Cochrane Library for appropriate keywords with a deadline of October 2022 to select 23 randomized controlled trials(RCTs). The mean difference between different treatments was assessed and summarized as mean and 95 % confidence interval (CI), resulting in a Bayesian network meta-analysis. Results By meta-analysis of Bayesian networks, we found acupuncture(MD, -2.49; 95 % CI, [-3.63, -1.31]) and herbal (MD, -2.79; 95 % CI, [-4.9, -0.69]) were significantly better than estazolam in terms of PSQI score change, and the difference was statistically significant. Dexzopiclone, electrics stimulation, rTMS and zopiclone were not statistically significant with other treatments. Conclusion Herbal, zopiclone, and acupuncture were more effective in improving PSQI scores in patients with post-stroke insomnia, followed by rTMS and dexzopiclone. However, the effectiveness between herbal, zopiclone and acupuncture was not statistically significant. Acupuncture and herbal are promising for the treatment of PSI, and more research remains to be invested.
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Affiliation(s)
- Zhaoming Song
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, 215006, China
| | - Ying chen
- Department of Neurosurgery, The First People's Hospital of Taicang, Taicang Affiliated Hospital of Soochow University, Soochow Medical College of Soochow University, Suzhou, Jiangsu Province, 215400, China
| | - Jian Li
- Department of Neurosurgery, The First People's Hospital of Zhangjiagang, Jiangsu Province, 215600, China
| | - Zhouqin Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, 215006, China
| | - Xiaojun Lu
- Department of Neurosurgery, The First People's Hospital of Taicang, Taicang Affiliated Hospital of Soochow University, Soochow Medical College of Soochow University, Suzhou, Jiangsu Province, 215400, China
| | - Zhong Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, 215006, China
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Zhang XH, Zhang X, Feng HY, Cao CC, Lv HL, Wang YL, Ren LJ. An investigation on the changes of serum CCK-8, substance P, and 5-HT in patients with post-stroke insomnia. Technol Health Care 2023; 31:2355-2361. [PMID: 37483040 DOI: 10.3233/thc-230506] [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] [Indexed: 07/25/2023]
Abstract
BACKGROUND At present, the pathogenesis of post-stroke insomnia (PSI) is still inconclusive. OBJECTIVE To explore the changes and significance of serum cholecystokinin-8 (CCK-8), substance P (SP), and 5-hydroxytryptamine (5-HT) in patients with PSI. METHODS Ninety-one patients with stroke were selected as the research subjects, and according to the score of the Athens Insomnia Scale (AIS), they were divided into the insomnia group and the non-insomnia group. The serum levels of CCK-8, SP, and 5-HT in the two groups were compared to explore their relationships with PSI. RESULTS Among the 91 patients, 56 were in the insomnia group and 35 were in the non-insomnia group, and the incidence of insomnia was 61.5%. There was no significant difference in the serum levels of CCK-8, SP, and 5-HT between the two groups (P= 0.696, 0.980, and 0.809, respectively). One-way analysis of variance showed that there was no significant correlation between the serum levels of CCK-8, SP, 5-HT, and the AIS score (P= 0.7393, 0.9581, and 0.5952, respectively). CONCLUSION The incidence of PSI was relatively high, but it could not be proved that CCK-8, SP, and 5-HT were involved in the pathogenesis of PSI. There might exist other neurotransmitters involved in the pathophysiological process of PSI, which should be further explored.
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Affiliation(s)
- Xiao-Hua Zhang
- Department of Rehabilitation, Shenzhen Dapeng New District Nanao People's Hospital, Shenzhen, Guangdong, China
| | - Xin Zhang
- Department of Rehabilitation, Shenzhen Dapeng New District Nanao People's Hospital, Shenzhen, Guangdong, China
| | - Hong-Ye Feng
- Department of Rehabilitation, The First Affiliated Hospital, Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Chang-Chun Cao
- Department of Rehabilitation, Shenzhen Dapeng New District Nanao People's Hospital, Shenzhen, Guangdong, China
| | - Hui-Lan Lv
- Department of Rehabilitation, Shenzhen Dapeng New District Nanao People's Hospital, Shenzhen, Guangdong, China
| | - Yu-Long Wang
- Department of Rehabilitation, The First Affiliated Hospital, Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Li-Jie Ren
- Department of Rehabilitation, The First Affiliated Hospital, Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
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Association of circadian rhythms with brain disorder incidents: a prospective cohort study of 72242 participants. Transl Psychiatry 2022; 12:514. [PMID: 36517471 PMCID: PMC9751105 DOI: 10.1038/s41398-022-02278-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/26/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Circadian rhythm disruption (CRD) is a shared characteristic of various brain disorders, such as Alzheimer's disease (AD), Parkinson's disease (PD), and major depression disorder (MDD). Disruption of circadian rhythm might be a risk factor for brain disorder incidents. From 7-day accelerometry data of 72,242 participants in UK Biobank, we derived a circadian relative amplitude variable, which to some extent reflected the degree of circadian rhythm disruption. Records of brain disorder incidents were obtained from a wide range of health outcomes across self-report, primary care, hospital inpatient data, and death data. Using multivariate Cox proportional hazard ratio regression, we created two models adjusting for different covariates. Then, linear correlations between relative amplitude and several brain morphometric measures were examined in participants with brain MRI data. After a median follow-up of around 6.1 years, 72,242 participants were included in the current study (female 54.9%; mean age 62.1 years). Individuals with reduced relative amplitude had increasing risk of all-cause dementia (Hazard ratio 1.23 [95% CI 1.15 to 1.31]), PD (1.33 [1.25 to 1.41]), stroke (1.13 [1.06 to 1.22]), MDD (1.18 [1.13 to 1.23]), and anxiety disorder (1.14 [1.09 to 1.20]) in fully adjusted models. Additionally, significant correlations were found between several cortical regions and white matter tracts and relative amplitude that have been linked to dementia and psychiatric disorders. We confirm CRD to be a risk factor for various brain disorders. Interventions for regulating circadian rhythm may have clinical relevance to reducing the risk of various brain disorders.
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Wang H, Huang Y, Li M, Yang H, An J, Leng X, Xu D, Qiu S. Regional brain dysfunction in insomnia after ischemic stroke: A resting-state fMRI study. Front Neurol 2022; 13:1025174. [PMID: 36504641 PMCID: PMC9733724 DOI: 10.3389/fneur.2022.1025174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022] Open
Abstract
Objective This study aimed to explore the abnormality of local brain function in patients with post-stroke insomnia (PSI) based on fMRI and explore the possible neuropathological mechanisms of insomnia in patients with PSI in combination with the Pittsburgh sleep quality index (PSQI) score and provide an objective evaluation index for the follow-up study of acupuncture treatment of PSI. Methods A total of 27 patients with insomnia after stroke were enrolled, and the PSQI was used to evaluate their sleep status. Twenty-seven healthy participants who underwent physical examinations during the same period were selected as controls. Resting-state brain function images and structural images of the two groups of participants were collected, and the abnormal changes in the regional brain function in patients with PSI were analyzed using three methods: regional homogeneity (ReHo), the amplitude of low-frequency fluctuations (ALFF) and fractional ALFF (fALFF), and a correlation analysis with the PSQI scale score. Results Compared with the HCs, the ReHo values of the PSI group in the bilateral lingual gyrus, right cuneus, right precentral and postcentral gyri were significantly lower, and the ReHo values of the left supramarginal gyrus were significantly higher. In the PSI group, the ALFF values in the bilateral lingual gyrus were significantly decreased, whereas those in the bilateral middle temporal gyrus, right inferior temporal gyrus, right inferior frontal gyrus, right limbic lobe, right precuneus, left posterior cingulate gyrus, and left middle occipital gyrus were significantly increased. Compared with HCs, the fALFF values of the bilateral lingual gyrus, bilateral inferior occipital gyrus, and bilateral cuneus in the PSI group were significantly higher. The ReHo value of the left supramarginal gyrus in the PSI group was significantly negatively correlated with the total PSQI score. Conclusion Patients with PSI have abnormal local activities in multiple brain regions, including the visual processing-related cortex, sensorimotor cortex, and some default-mode network (DMN) regions. Over-arousal of the DMN and over-sensitivity of the audiovisual stimuli in patients with PSI may be the main mechanisms of insomnia and can lead to a decline in cognitive function and abnormalities in emotion regulation simultaneously.
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Affiliation(s)
- Hongzhuo Wang
- Medical Imaging Center, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Yunxuan Huang
- Rehabilitation and Nursing Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mingrui Li
- Department of Magnetic Resonance Imaging, Zhanjiang First Hospital of Traditional Chinese Medicine, Zhanjiang, China
| | - Han Yang
- Rehabilitation and Nursing Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jie An
- Medical Imaging Center, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Xi Leng
- Medical Imaging Center, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Danghan Xu
- Rehabilitation and Nursing Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shijun Qiu
- Medical Imaging Center, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China,*Correspondence: Shijun Qiu
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Pajediene E, Paulekas E, Salteniene V, Skieceviciene J, Arstikyte J, Petrikonis K, Kupcinskas J, Bassetti CL, Daiva R. Diurnal variation of clock genes expression and other sleep-wake rhythm biomarkers among acute ischemic stroke patients. Sleep Med 2022; 99:1-10. [DOI: 10.1016/j.sleep.2022.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 10/31/2022]
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Li L, Wang D, Pan H, Huang L, Sun X, He C, Wei Q. Non-invasive Vagus Nerve Stimulation in Cerebral Stroke: Current Status and Future Perspectives. Front Neurosci 2022; 16:820665. [PMID: 35250458 PMCID: PMC8888683 DOI: 10.3389/fnins.2022.820665] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/25/2022] [Indexed: 12/26/2022] Open
Abstract
Stroke poses a serious threat to human health and burdens both society and the healthcare system. Standard rehabilitative therapies may not be effective in improving functions after stroke, so alternative strategies are needed. The FDA has approved vagus nerve stimulation (VNS) for the treatment of epilepsy, migraines, and depression. Recent studies have demonstrated that VNS can facilitate the benefits of rehabilitation interventions. VNS coupled with upper limb rehabilitation enhances the recovery of upper limb function in patients with chronic stroke. However, its invasive nature limits its clinical application. Researchers have developed a non-invasive method to stimulate the vagus nerve (non-invasive vagus nerve stimulation, nVNS). It has been suggested that nVNS coupled with rehabilitation could be a promising alternative for improving muscle function in chronic stroke patients. In this article, we review the current researches in preclinical and clinical studies as well as the potential applications of nVNS in stroke. We summarize the parameters, advantages, potential mechanisms, and adverse effects of current nVNS applications, as well as the future challenges and directions for nVNS in cerebral stroke treatment. These studies indicate that nVNS has promising efficacy in reducing stroke volume and attenuating neurological deficits in ischemic stroke models. While more basic and clinical research is required to fully understand its mechanisms of efficacy, especially Phase III trials with a large number of patients, these data suggest that nVNS can be applied easily not only as a possible secondary prophylactic treatment in chronic cerebral stroke, but also as a promising adjunctive treatment in acute cerebral stroke in the near future.
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Affiliation(s)
- Lijuan Li
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu, China
| | - Dong Wang
- Department of Rehabilitation Medicine, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Hongxia Pan
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu, China
| | - Liyi Huang
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu, China
| | - Xin Sun
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu, China
| | - Chengqi He
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu, China
| | - Quan Wei
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu, China
- *Correspondence: Quan Wei,
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Lei H, Wang W, Cao Y, Ma Y, Xue X. Efficacy and safety evaluation of bright light therapy in patients with post-stroke insomnia: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e27937. [PMID: 34918641 PMCID: PMC8677890 DOI: 10.1097/md.0000000000027937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Post-stroke insomnia (PSI) is a common and severe illness among the complications of stroke. Although there are plenty of drugs currently used for PSI treatment, they generate several side effects and other problems. Bright light therapy (BLT) is thought to be relatively safe and effective in treating PSI patients. Despite this, there is still a lack of systematic review on BLT in the treatment of PSI. Allowing for this, the aim of this study is to assess the efficacy and safety of BLT for PSI. METHODS The meta-analysis and systematic review will perform a comprehensive electronic search for items fulfilling the required criteria in Web of Science, Google Scholar, Wan Fang database, MEDLINE, Baidu Scholar, PubMed, SinoMed, Embase, Chinese Biomedical Literature Database (CBM), China national knowledge infrastructure database (CNKI), Cochrane Library Central Register of Controlled Trials (CENTRAL), and Wei Pu database from establishment to January 1, 2022. We will select articles, collect data, and assess the methodology quality. And we will set the primary outcome and secondary outcomes in this research. RevMan 5.3 software will be used to analyze the data for this investigation. RESULTS The work of this research will be published in peer-reviewed scientific journals. CONCLUSION The aim of this study is to assess the efficacy and safety of BLT for PSI and present robust scientific evidence concerning BLT for PSI. REGISTRATION INPLASY2021100065.
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Effect of the Interaction between Depression and Sleep Disorders on the Stroke Occurrence: An Analysis Based on National Health and Nutritional Examination Survey. Behav Neurol 2021; 2021:6333618. [PMID: 34712368 PMCID: PMC8548119 DOI: 10.1155/2021/6333618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/24/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To investigate the effect of the interaction between depression and sleep disorders on the stroke occurrence based on the data from the National Health and Nutritional Examination Survey (NHANES). METHODS Seven cycles of 2-year NHANES data (2005-2018) were analyzed in this study. Univariate analysis was first performed between the stroke and nonstroke patients, and then, multivariate logistic regression models were conducted to analyze the association of depression, sleep disorders, and their interactions with stroke occurrence. RESULTS A total of 30473 eligible participants were included in this study, including 1138 (3.73%) with stroke and 29335 (96.27%) with nonstroke. Except sex, the differences were all significant between the stroke and nonstroke patients in baseline information (all P < 0.001). Depression (odds ratio (OR): 2.494, 95% confidence interval (CI): 2.098-2.964), depression severity (moderate, OR: 2.013, 95% CI: 1.612-2.514; moderately severe, OR: 2.598, 95% CI: 1.930-3.496; severe, OR: 5.588, 95% CI: 3.883-8.043), and sleep disorders (OR: 1.677, 95% CI: 1.472-1.910) were presented to be associated with an increased risk of stroke after correcting all the confounders. The logistic regression analysis showed that there was a synergic, additive interaction between depression and sleep disorders on the stroke occurrence, and the proportion of stroke patients caused by this interaction accounted for 27.1% of all the stroke patients. CONCLUSION Depression, depression severity, and sleep disorders are all independently associated with a high risk of stroke. The interaction between depression and sleep disorders can synergistically increase the stroke occurrence.
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Qiu X, Han NS, Yao JX, Yu FR, Lin YY, Zhuang X. Acupuncture Reduced the Risk for Insomnia in Stroke Patients: A Propensity-Score Matched Cohort Study. Front Aging Neurosci 2021; 13:698988. [PMID: 34483881 PMCID: PMC8414891 DOI: 10.3389/fnagi.2021.698988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/20/2021] [Indexed: 01/02/2023] Open
Abstract
Background: Post-stroke insomnia (PSI) affects the quality of life for stroke patients, reduces the likelihood of successful rehabilitation, and produces additional complications following stroke. Previous reports have provided some information regarding PSI risk factors, but little is known concerning protective factors for PSI. This study analyzed the relationship between acupuncture and insomnia in stroke patients and explored the use of acupuncture as a preventive treatment. Methods: Patients diagnosed with stroke from 2010 to 2019 were identified in the case database of the First Affiliated Hospital of Guangzhou University of Chinese These patients followed until 2020, and numerous factors were examined, including gender, age, stroke type, stroke location, and baseline comorbidities. A 1:1 propensity score was used to match an equal number of patients receiving acupuncture with stroke patients who did not receive acupuncture (N = 1,680 for each group). The purpose of the study was to compare the incidence of insomnia in these two stroke cohorts. We used the Cox regression model and Kaplan-Meier method to estimate the risk of insomnia as the outcome event. Results: Compared with the non-acupuncture cohort in general, stroke patients who received acupuncture treatment exhibited a lower risk of insomnia after adjusting for age, gender, stroke type, stroke location, and comorbidities (adjusted hazard ratio HR = 0.27, 95% confidential interval = 0.23 to 0.32). Acupuncture also reduced the risk of PSI for both genders. The respective risks were HR = 0.28 (adjusted) for males and HR = 0.26 (adjusted) for females. Acupuncture also lowered the risk for PSI for different age groups. The risks were HR = 0.22 (adjusted) for individuals 18 to 39 years of age, HR = 0.31 (adjusted) for individuals 40 to 59 years of age, HR = 0.28 (adjusted) for those 60 to 79 years of age, and HR = 0.18 (adjusted) for individuals 80 years of age and older. Concerning the stroke type, regardless of whether the stroke was ischemic, hemorrhagic, or a combination of the two stroke types, patients who received acupuncture exhibited lower risk (adjusted HR = 0.28, 0.17, and 0.49, respectively). Concerning stroke location, except for the cerebral hemispheres (adjusted HR = 1.10, 95% confidential interval = 0.12 to 1.01), the risk of PSI after receiving acupuncture was lower for the frontal lobe (adjusted HR = 0.42), the basal ganglia (adjusted HR = 0.22), the radiation crown (adjusted HR = 0.42), the diencephalon (adjusted HR = 0.20), or multiple partial strokes (adjusted HR = 0.26), the risk of PSI after receiving acupuncture was lower. For all baseline complications, acupuncture reduced the risk of insomnia. The cumulative incidence of insomnia in the acupuncture cohort was significantly lower than the non-acupuncture cohort (log-rank test, P = 0.000). Limitations: First, our research only included patients from a single center. Second, we did not classify the post-stroke insomnia severity. Second, the information was extracted manually. Overall, the sample size was small, and we needed to increase the sample size to strengthen the conclusions. Conclusion: Acupuncture treatment reduced the risk of insomnia in stroke patients. Future research be conducted with increased sample sizes and further elaboration on the specific acupuncture protocols that were used.
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Affiliation(s)
- Xuan Qiu
- Acupuncture and Rehabilitation Clinical School, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Nan Sheng Han
- Acupuncture and Rehabilitation Clinical School, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Jie Xiao Yao
- Acupuncture and Rehabilitation Clinical School, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Fang Rui Yu
- Acupuncture and Rehabilitation Clinical School, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Yan Yan Lin
- Department of Traditional Chinese Medicine, The Second Clinical Medical College, Guangdong Medical University, Dongguan, China
| | - Xun Zhuang
- The First Affiliated Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
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Katzan IL, Thompson NR, Walia HK, Moul DE, Foldvary-Schaefer N. Sleep disturbance predicts future health status after stroke. J Clin Sleep Med 2021; 16:1863-1870. [PMID: 32691725 DOI: 10.5664/jcsm.8700] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
STUDY OBJECTIVES We evaluated factors associated with the presence of sleep disturbance in patients with stroke and whether sleep disturbance predicted change in other patient-reported domains of health over time. METHODS Observational cohort study of 2,190 patients with stroke seen in a cerebrovascular clinic February 17, 2015 to July 5, 2017 who completed patient-reported outcome measures (PROMs) at ≥ 1 visit, including the Patient Health Questionnaire-9 depression screen, Quality of Life in Neurological Disorders (NeuroQoL) cognitive function and Patient-Reported Outcomes Information Measurement System (PROMIS) sleep disturbance, fatigue, anxiety, social role satisfaction, physical function, and pain interference. Separate multivariable models were constructed with PROMIS sleep disturbance as the dependent variable. Covariates included clinical and demographic variables, the Patient Health Questionnaire-9 depression screen scored on the PROMIS metric, and 1 of the 6 other PROMs. Among the 476 patients with ≥ 2 visits, linear regression models were constructed to determine the association of baseline sleep disturbance with follow-up PROMs after adjustment for the corresponding baseline PROMIS/NeuroQol scores, depression score, and clinical variables. RESULTS Younger age and all PROM scores were associated with sleep disturbance; depression had the greatest association among PROMs (beta estimate 0.53, 95% confidence interval, 0.49, 0.57), physical function had the least (-0.06, 95% confidence interval, -0.11, -0.01). Baseline PROMIS sleep disturbance score was associated with worse adjusted follow-up scores for depression, fatigue, social role satisfaction, and physical function. CONCLUSIONS Younger age and all 8 PROMs were associated with sleep disturbance in patients with stroke. The degree of sleep disturbance predicted future patient-reported outcomes for multiple domains of health. Further study is warranted to determine if interventions shown to improve sleep symptoms will also improve other outcomes.
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Affiliation(s)
- Irene L Katzan
- Neurological Institute Center for Outcomes Research & Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.,Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Nicolas R Thompson
- Neurological Institute Center for Outcomes Research & Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Harneet K Walia
- Sleep Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Douglas E Moul
- Sleep Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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Kim SH, Lim JH. Herbal medicine for post-stroke insomnia: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26223. [PMID: 34087901 PMCID: PMC8183778 DOI: 10.1097/md.0000000000026223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Post-stroke insomnia (PSI) is a highly prevalent complication in patients with stroke. However, there has been no comprehensive systematic review assessing the efficacy and safety of herbal medicine (HM) on PSI. This protocol was developed to conduct a systematic review and meta-analysis to evaluate the evidence related to the efficacy and safety of HM on PSI. METHODS We will perform a comprehensive electronic search, including Medline, EMBASE, CENTRAL, AMED, CINAHL, PsycARTICLES, and Chinese, Korean, and Japanese databases from their inception to November 2020. This systemic review will include only randomized controlled clinical trials of HM on PSI. The main outcome is the Pittsburgh Sleep Quality Index score. Two researchers will independently screen citations and abstracts, identify full-text articles for inclusion, extract data, and appraise the quality and risk of bias of included studies. A meta-analysis will be conducted using Review Manager 5.4. The evidence quality of each outcome will be appraised according to Grades of Recommendation, Assessment, Development, and Evaluation. RESULTS This protocol adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-P (PRISMA-P) guidelines to ensure clarity and completeness of reporting in all phases of the systematic review. CONCLUSION This study will provide evidence regarding the efficacy and safety of HM for the treatment of PSI. ETHICS AND DISSEMINATION No ethical approval will be needed because data from previously published studies in which informed consent was obtained by primary investigators will be retrieved and analyzed. We will publish this systematic review in a peer-reviewed journal. OSF REGISTRATION DOI 10.17605/OSF.IO/PEHQZ.
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Affiliation(s)
- Sang-Ho Kim
- Department of Neuropsychiatry of Korean Medicine, Pohang Korean Medicine Hospital, Daegu Haany University, 411 Saecheonnyeon-daero, Nam-gu, Pohang-si, Gyeongsangbuk-do
| | - Jung-Hwa Lim
- Department of Neuropsychiatry, School of Korean Medicine, Pusan National University, 49 Busandaehak-ro, Mulgeum-eup, Yangsan, Republic of Korea
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Cai H, Wang XP, Yang GY. Sleep Disorders in Stroke: An Update on Management. Aging Dis 2021; 12:570-585. [PMID: 33815883 PMCID: PMC7990374 DOI: 10.14336/ad.2020.0707] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 07/07/2020] [Indexed: 12/18/2022] Open
Abstract
Stroke is a leading cause of disability and mortality all over the world. Due to an aging population, the incidence of stroke is rising significantly, which has led to devastating consequences for patients. In addition to traditional risk factors such as age, hypertension, hyperlipidemia, diabetes and atrial fibrillation, sleep disorders, as independent modifiable risk factors for stroke, have been highlighted increasingly. In this review, we provide an overview of common types of current sleep disturbances in cerebrovascular diseases, including insomnia, hypersomnia, breathing-related sleep disorders, and parasomnias. Moreover, evidence-based clinical therapeutic strategies and pitfalls of specific sleep disorders after stroke are discussed. We also review the neurobiological mechanisms of these treatments as well as their effects on stroke. Since depression after stroke is so prevalent and closely related to sleep disorders, treatments of post-stroke depression are also briefly mentioned in this review article.
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Affiliation(s)
- Hongxia Cai
- 1Department of Neurology, Tong-Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Ping Wang
- 1Department of Neurology, Tong-Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guo-Yuan Yang
- 2Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
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Green TL, McNair ND, Hinkle JL, Middleton S, Miller ET, Perrin S, Power M, Southerland AM, Summers DV. Care of the Patient With Acute Ischemic Stroke (Posthyperacute and Prehospital Discharge): Update to 2009 Comprehensive Nursing Care Scientific Statement: A Scientific Statement From the American Heart Association. Stroke 2021; 52:e179-e197. [PMID: 33691469 DOI: 10.1161/str.0000000000000357] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In 2009, the American Heart Association/American Stroke Association published a comprehensive scientific statement detailing the nursing care of the patient with an acute ischemic stroke through all phases of hospitalization. The purpose of this statement is to provide an update to the 2009 document by summarizing and incorporating current best practice evidence relevant to the provision of nursing and interprofessional care to patients with ischemic stroke and their families during the acute (posthyperacute phase) inpatient admission phase of recovery. Many of the nursing care elements are informed by nurse-led research to embed best practices in the provision and standard of care for patients with stroke. The writing group comprised members of the Stroke Nursing Committee of the Council on Cardiovascular and Stroke Nursing and the Stroke Council. A literature review was undertaken to examine the best practices in the care of the patient with acute ischemic stroke. The drafts were circulated and reviewed by all committee members. This statement provides a summary of best practices based on available evidence to guide nurses caring for adult patients with acute ischemic stroke in the hospital posthyperacute/intensive care unit. In many instances, however, knowledge gaps exist, demonstrating the need for continued nurse-led research on care of the patient with acute ischemic stroke.
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Duss SB, Brill AK, Baillieul S, Horvath T, Zubler F, Flügel D, Kägi G, Benz G, Bernasconi C, Ott SR, Korostovtseva L, Sviryaev Y, Salih F, Endres M, Tamisier R, Gouveris H, Winter Y, Denier N, Wiest R, Arnold M, Schmidt MH, Pépin JL, Bassetti CLA. Effect of early sleep apnoea treatment with adaptive servo-ventilation in acute stroke patients on cerebral lesion evolution and neurological outcomes: study protocol for a multicentre, randomized controlled, rater-blinded, clinical trial (eSATIS: early Sleep Apnoea Treatment in Stroke). Trials 2021; 22:83. [PMID: 33482893 PMCID: PMC7820538 DOI: 10.1186/s13063-020-04977-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/15/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Sleep-disordered breathing (SDB) is highly prevalent in acute ischaemic stroke and is associated with worse functional outcome and increased risk of recurrence. Recent meta-analyses suggest the possibility of beneficial effects of nocturnal ventilatory treatments (continuous positive airway pressure (CPAP) or adaptive servo-ventilation (ASV)) in stroke patients with SDB. The evidence for a favourable effect of early SDB treatment in acute stroke patients remains, however, uncertain. METHODS eSATIS is an open-label, multicentre (6 centres in 4 countries), interventional, randomized controlled trial in patients with acute ischaemic stroke and significant SDB. Primary outcome of the study is the impact of immediate SDB treatment with non-invasive ASV on infarct progression measured with magnetic resonance imaging in the first 3 months after stroke. Secondary outcomes are the effects of immediate SDB treatment vs non-treatment on clinical outcome (independence in daily functioning, new cardio-/cerebrovascular events including death, cognition) and physiological parameters (blood pressure, endothelial functioning/arterial stiffness). After respiratory polygraphy in the first night after stroke, patients are classified as having significant SDB (apnoea-hypopnoea index (AHI) > 20/h) or no SDB (AHI < 5/h). Patients with significant SDB are randomized to treatment (ASV+ group) or no treatment (ASV- group) from the second night after stroke. In all patients, clinical, physiological and magnetic resonance imaging studies are performed between day 1 (visit 1) and days 4-7 (visit 4) and repeated at day 90 ± 7 (visit 6) after stroke. DISCUSSION The trial will give information on the feasibility and efficacy of ASV treatment in patients with acute stroke and SDB and allows assessing the impact of SDB on stroke outcome. Diagnosing and treating SDB during the acute phase of stroke is not yet current medical practice. Evidence in favour of ASV treatment from a randomized multicentre trial may lead to a change in stroke care and to improved outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT02554487 , retrospectively registered on 16 September 2015 (actual study start date, 13 August 2015), and www.kofam.ch (SNCTP000001521).
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Affiliation(s)
- Simone B. Duss
- Department of Neurology, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
- Interdisciplinary Sleep-Wake-Epilepsy-Center, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Anne-Kathrin Brill
- Interdisciplinary Sleep-Wake-Epilepsy-Center, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
- Department of Pulmonary Medicine, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Sébastien Baillieul
- Grenoble Alpes University, HP2 Laboratory, INSERM U1042, Grenoble, France
- Pôle Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Thomas Horvath
- Department of Neurology, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Frédéric Zubler
- Department of Neurology, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Dominique Flügel
- Department of Neurology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Georg Kägi
- Department of Neurology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Gabriel Benz
- Department of Pneumology, Cantonal Hospital St Gallen, St. Gallen, Switzerland
| | - Corrado Bernasconi
- Department of Neurology, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Sebastian R. Ott
- Department of Pulmonary Medicine, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Lyudmila Korostovtseva
- Hypertension Department, Somnology Group, Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Yurii Sviryaev
- Hypertension Department, Somnology Group, Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Farid Salih
- Department of Neurology, Center for Stroke Research Berlin (CSB), Charité – University Medicine Berlin, Berlin, Germany
| | - Matthias Endres
- Department of Neurology, Center for Stroke Research Berlin (CSB), Charité – University Medicine Berlin, Berlin, Germany
| | - Renaud Tamisier
- Grenoble Alpes University, HP2 Laboratory, INSERM U1042, Grenoble, France
- Pôle Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Haralampos Gouveris
- Department of Otorhinolaryngology, Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Yaroslav Winter
- Department of Neurology, Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Niklaus Denier
- University Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Roland Wiest
- University Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Markus H. Schmidt
- Department of Neurology, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
- Interdisciplinary Sleep-Wake-Epilepsy-Center, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Jean-Louis Pépin
- Grenoble Alpes University, HP2 Laboratory, INSERM U1042, Grenoble, France
- Pôle Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France
| | - Claudio L. A. Bassetti
- Department of Neurology, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
- Interdisciplinary Sleep-Wake-Epilepsy-Center, Bern University Hospital (Inselspital) and University of Bern, Bern, Switzerland
- Department of Neurology, Sechenov University, Moscow, Russia
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Lowe A, Bailey M, O’Shaughnessy T, Macavei V. Treatment of sleep disturbance following stroke and traumatic brain injury: a systematic review of conservative interventions. Disabil Rehabil 2020; 44:2975-2987. [DOI: 10.1080/09638288.2020.1856948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Alex Lowe
- The Hillingdon Hospitals NHS Foundation Trust, Hillingdon Hospital, London, UK
| | - Mark Bailey
- NHS Grampian, Woodend Hospital, Aberdeen, UK
| | | | - Vladimir Macavei
- Barts Health NHS Trust, Newham University Hospital, London, UK
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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24
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“Hyperacute” Stroke Rehabilitation Care: Common Issues and Considerations. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00872-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Carlozzi NE, Boileau NR, Hanks RA, Sander AM, Nakase-Richardson R, Massengale JP. Sleep impairment is related to health-related quality of life among caregivers of lower-functioning traumatic brain injury survivors. Rehabil Psychol 2020; 65:2020-58894-001. [PMID: 32772535 PMCID: PMC7873168 DOI: 10.1037/rep0000334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective: The purpose of this study was to examine perceived sleep-related impairment in caregivers of individuals with traumatic brain injury (TBI). Specifically, we examined the relationship between caregiver-perceived sleep-related impairment and different aspects of health-related quality of life (HRQOL) and explored whether these relationships were moderated by the perceived level of everyday function in the person with TBI. Method: Three hundred forty-one caregivers of individuals with TBI completed surveys to determine whether the association between sleep-related impairment and HRQOL was moderated by caregiver-perceived functional impairment of the person with injury. Participants completed measures from the Patient-Reported Outcomes Measurement Information System and the TBI-CareQOL. These measures were used to examine different aspects of HRQOL: caregiver-specific HRQOL, mental HRQOL, social HRQOL, and fatigue. The Mayo-Portland Adaptability Inventory-4 was used to measure caregiver perceptions of the level of everyday function in the person with injury. Results: Results indicated that caregiver-perceived sleep-related impairment was associated with each of the four HRQOL scores. This relationship was moderated by the caregiver-reported level of everyday function in the person with TBI for both caregiver-specific HRQOL and fatigue but not mental or social HRQOL. For caregiver-specific HRQOL and fatigue, caregiver-perceived sleep-related impairment was associated with worse HRQOL for those caring for individuals with lower perceived levels of everyday function, but not for those caring for individuals with higher levels of everyday function. Conclusions: Interventions to improve caregiver sleep and HRQOL should consider both psychosocial and environmental factors (i.e., factors related to the person with the TBI). (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Kratz AL, Boileau NR, Sander AM, Nakase-Richardson R, Hanks RA, Massengale JP, Miner JA, Carlozzi NE. Do emotional distress and functional problems in persons with traumatic brain injury contribute to perceived sleep-related impairment in caregivers? Rehabil Psychol 2020; 65:2020-31793-001. [PMID: 32406737 PMCID: PMC7665992 DOI: 10.1037/rep0000327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The goal of this study was to examine the association between characteristics of persons with traumatic brain injury (PwTBI) and perceived sleep-related impairment of the caregivers. METHOD Fifty-two dyads (n = 23 civilians, n = 29 service members/veterans [SMVs]) were enrolled. Caregivers completed the Patient-Reported Outcomes Measurement Information System Sleep-Related Impairment computer adaptive test, and PwTBI completed Quality of Life in Neurological Disorders measures of depression, anxiety, anger, cognitive functioning, and upper and lower extremity functioning. Hierarchical linear regression models, stratified by civilian/SMV group, were employed to assess prediction of caregiver-perceived sleep-related impairment from emotional distress of the PwTBI (anxiety, depressed mood, and anger) and perceived functional status of the PwTBI (cognitive, upper extremity, lower extremity functioning). RESULTS Compared with caregivers of civilians, caregivers of SMVs reported higher perceived sleep-related impairment. Regression results showed that characteristics of the PwTBI accounted for moderate amounts of variance in the sleep-related impairment of caregivers of both civilians and SMVs. Within-group analyses showed that the strongest predictor of sleep-related impairment of caregivers of civilians was self-reported cognitive function of the PwTBI (β = -0.82, p = .08); the strongest predictor of sleep-related impairment of caregivers of SMVs was self-reported anger of the PwTBI (β = 0.54, p = .07). CONCLUSIONS In both caregivers of civilians and SMVs with TBI, characteristics of the PwTBI were related to perceived caregiver sleep-related impairment. These preliminary data can inform future research with larger samples that examine the impact of multiple characteristics of the caregiver and care recipient on caregiver sleep. Findings highlight the potential importance of considering the dynamics of the dyad in rehabilitation programming not only for the PwTBI but for caregivers as well. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Anna L Kratz
- Department of Physical Medicine and Rehabilitation
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27
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Intracerebral hemorrhage in the mouse altered sleep-wake patterns and activated microglia. Exp Neurol 2020; 327:113242. [DOI: 10.1016/j.expneurol.2020.113242] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/22/2020] [Accepted: 02/09/2020] [Indexed: 01/06/2023]
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Crespo A, Baillieul S, Marhuenda E, Bradicich M, Andrianopoulos V, Louvaris Z, Marillier M, Almendros I. ERS International Congress, Madrid, 2019: highlights from the Sleep and Clinical Physiology Assembly. ERJ Open Res 2020; 6:00373-2019. [PMID: 32714963 PMCID: PMC7369446 DOI: 10.1183/23120541.00373-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 05/13/2020] [Indexed: 12/12/2022] Open
Abstract
The 2019 European Respiratory Society (ERS) International Congress took place in Madrid, Spain, and served as a platform to find out the latest advances in respiratory diseases research. The research aims are to understand the physiology and consequences of those diseases, as well as the improvement in their diagnoses, treatments and patient care. In particular, the scientific sessions arranged by ERS Assembly 4 provided novel insights into sleep-disordered breathing and new knowledge in respiratory physiology. This article, divided by session, will summarise the most relevant studies presented at the ERS International Congress. Each section has been written by Early Career Members specialising in the different fields of this interdisciplinary assembly.
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Affiliation(s)
- Andrea Crespo
- Multidisciplinary Sleep Unit, Dept of Pulmonology, Rio Hortega University Hospital, Valladolid, Spain
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
- All authors contributed equally to this work
| | - Sébastien Baillieul
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University, Grenoble, France
- FCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France
- All authors contributed equally to this work
| | - Esther Marhuenda
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias CIBERES, Madrid, Spain
- All authors contributed equally to this work
| | - Matteo Bradicich
- Dept of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
- All authors contributed equally to this work
| | - Vasileios Andrianopoulos
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
- All authors contributed equally to this work
| | - Zafeiris Louvaris
- Faculty of Kinesiology and Rehabilitation Sciences, Division of Respiratory Rehabilitation, Department Rehabilitation Sciences KU Leuven, University Hospitals Leuven, Leuven, Belgium
- All authors contributed equally to this work
| | - Mathieu Marillier
- Laboratory of Clinical Exercise Physiology, Queen's University, Kingston, ON, Canada
- All authors contributed equally to this work
| | - Isaac Almendros
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias CIBERES, Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- All authors contributed equally to this work
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29
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Zhao B, Bi Y, Li L, Zhang J, Hong Y, Zhang L, He J, Fang J, Rong P. The Instant Spontaneous Neuronal Activity Modulation of Transcutaneous Auricular Vagus Nerve Stimulation on Patients With Primary Insomnia. Front Neurosci 2020; 14:205. [PMID: 32231517 PMCID: PMC7082749 DOI: 10.3389/fnins.2020.00205] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/24/2020] [Indexed: 01/19/2023] Open
Abstract
Primary insomnia (PI) is associated with increased spontaneous neuronal activity. Transcutaneous auricular vagus nerve stimulation (taVNS) modulates brain function, and it is an effective treatment for primary insomnia. However, whether taVNS alleviates insomnia through modulating spontaneous neuronal activity is not fully clarified. This study aims to investigate the instant effect of taVNS in modulating spontaneous neuronal activity in PI patients using resting-state functional magnetic resonance imaging (rs-fMRI). Twenty-two PI subjects underwent rs-fMRI scanning prior and immediately after 30 min treatment of taVNS controlled by twenty healthy adults. Amplitude of low frequency fluctuations (ALFF) analysis was employed to assess the difference in spontaneous neuronal activity between PI patients and healthy adults, as well as between pre-treatment and post-treatment of taVNS. The taVNS-induced altered ALFF brain areas were then selected as regions of interest to perform the resting state functional connectivity (RSFC) analysis in PI patients. The right precuneus showed significantly increased ALFF in PI patients. After immediate taVNS treatment, the ALFF was significantly decreased in the right precuneus and increased in the left middle occipital gyrus. The RSFC in right precuneus with right angular, right superior frontal gyrus, and right middle frontal gyrus was significantly decreased. This study provides insights into the instant brain effects of taVNS on PI patients.
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Affiliation(s)
- Bin Zhao
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yanzhi Bi
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Liang Li
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jinling Zhang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yang Hong
- Department of Radiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Lei Zhang
- Department of Radiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiakai He
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiliang Fang
- Department of Radiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Peijing Rong
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
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30
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Baylan S, Griffiths S, Grant N, Broomfield NM, Evans JJ, Gardani M. Incidence and prevalence of post-stroke insomnia: A systematic review and meta-analysis. Sleep Med Rev 2020; 49:101222. [DOI: 10.1016/j.smrv.2019.101222] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 10/20/2019] [Accepted: 10/21/2019] [Indexed: 11/17/2022]
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31
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Katzan IL, Thompson NR, Walia HK, Moul DE, Foldvary-Schaefer N. Sleep-related symptoms in patients with mild stroke. J Clin Sleep Med 2020; 16:55-64. [PMID: 31957653 DOI: 10.5664/jcsm.8122] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
STUDY OBJECTIVES Treatable sleep-related conditions are frequent in stroke patients, although their prevalence across stroke types and ideal method for screening is not clear. The objectives of this study were to evaluate the prevalence of sleep disturbance across different stroke types and identify approaches to the collection of sleep-related measures in clinical practice. METHODS We performed an observational cohort study of 2,213 patients with ischemic stroke, intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), or transient ischemic attack seen in a cerebrovascular clinic February 17, 2015 through July 5, 2017 who completed at least one of the following sleep-related questionnaires: Patient-Reported Outcomes Measurement Information System (PROMIS) sleep disturbance, Insomnia Severity Index (ISI), Sleep Apnea Probability Scale (SAPS), and sleep duration. Prevalence of abnormal scores were calculated using the following thresholds: PROMIS sleep disturbance ≥ 55, ISI ≥ 15, SAPS score ≥ 0.50, and sleep duration fewer than 6 or more than 9 hours. Sensitivity, specificity, and positive and negative predictive values of PROMIS sleep disturbance T-score ≥ 55 to identify patients with moderate-severe insomnia (ISI ≥ 15) were computed. RESULTS In the cohort, 28.6% patients (624/2183) had PROMIS sleep disturbance score ≥ 55, 17.6% (142/808) had ISI ≥ 15, and 61.3% (761/1241) had a positive SAPS screen. The frequency of abnormal sleep scale scores was similar across time periods and stroke types. The sensitivity and specificity of PROMIS sleep disturbance T-score ≥ 55 to identify patients with ISI ≥ 15 were 0.89 (95% confidence interval 0.83-0.94) and 0.81 (95% confidence interval 0.78-0.84), respectively. CONCLUSIONS The prevalence of sleep-related symptoms in patients with mild stroke are similar across stroke types and time periods after stroke. Potential approaches to screening for sleep disturbance in stroke patients are provided.
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Affiliation(s)
- Irene L Katzan
- Neurological Institute Center for Outcomes Research & Evaluation, Cleveland Clinic, Cleveland, Ohio.,Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio
| | - Nicolas R Thompson
- Neurological Institute Center for Outcomes Research & Evaluation, Cleveland Clinic, Cleveland, Ohio
| | - Harneet K Walia
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Douglas E Moul
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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He W, Qiu H, Zhu J, Feng W, Lin Y, Shu M, He J. The effect of uric acid on sleep quality after acute ischemic stroke. J Clin Neurosci 2019; 69:155-159. [PMID: 31420274 DOI: 10.1016/j.jocn.2019.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 08/05/2019] [Indexed: 12/15/2022]
Abstract
Sleep disturbance is a common psychiatric complication after stroke. Oxidative stress has been an important pathophysiological mechanism of sleep disturbance. However, no study has explored the relationship between uric acid (UA) and post-stroke sleep quality. This prospective study included 191 patients who were followed up for two months after acute ischemic stroke. Serum UA levels were measured at admission and divided into 3 tertiles (≤251 μmol/L, 252-326 μmol/L, ≥327 μmol/L). Patients in the 3rd tertile of UA levels had a lower incidence of poor sleep quality than those belonging to 2nd or 1st tertile, respectively (9.7% vs. 27.7% vs. 35.9%; P = 0.002). Furthermore, high UA levels (≥327 μmol/L) were independently associated with low risk of poor sleep quality (OR = 0.129, 95%CI = 0.031-0.528, P = 0.004) after adjusting for demographics, cardiovascular risk factors, stroke severity, functional outcome and depressive symptoms. High modified Rankin Scale score and depressive symptoms were associated with increased risk of poor sleep quality after stroke (OR = 1.836, 95%CI = 1.035-3.354, P = 0.038) and (OR = 5.082, 95%CI = 1.709-15.115, P = 0.003). In conclusion, high UA levels may reduce the risk of poor sleep quality after acute ischemic stroke. Further randomized controlled trials are necessary in examining whether appropriate UA supplement could provide a potential prevention or therapeutic target for sleep disturbance after stroke.
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Affiliation(s)
- Weilei He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Huihua Qiu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Jie Zhu
- Department of Mental Health, Mental Health School, Wenzhou Medical University, Wenzhou 325000, China
| | - Wenqian Feng
- Department of Mental Health, Mental Health School, Wenzhou Medical University, Wenzhou 325000, China
| | - Yichang Lin
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Meichun Shu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Jincai He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
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33
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Zhao B, Li L, Jiao Y, Luo M, Xu K, Hong Y, Cao JD, Zhang Y, Fang JL, Rong PJ. Transcutaneous auricular vagus nerve stimulation in treating post-stroke insomnia monitored by resting-state fMRI: The first case report. Brain Stimul 2019; 12:824-826. [DOI: 10.1016/j.brs.2019.02.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/13/2019] [Accepted: 02/19/2019] [Indexed: 10/27/2022] Open
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34
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Baillieul S, Revol B, Jullian-Desayes I, Joyeux-Faure M, Tamisier R, Pépin JL. Diagnosis and management of central sleep apnea syndrome. Expert Rev Respir Med 2019; 13:545-557. [PMID: 31014146 DOI: 10.1080/17476348.2019.1604226] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction: Central sleep apnea (CSA) syndrome has gained a considerable interest in the sleep field within the last 10 years. It is overrepresented in particular subpopulations such as patients with stroke or heart failure. Early detection and diagnosis, as well as appropriate treatment of central breathing disturbances during sleep remain challenging. Areas covered: Based on a systematic review of CSA in adults the clinical evidence and polysomnographic patterns useful for discerning central from obstructive events are discussed. Current therapeutic indications of CSA and perspectives are presented, according to the type of respiratory disturbances during sleep, alterations in blood gases and ventilatory control. Expert opinion: The precise identification of central events during polysomnographic recording is mandatory. Therapeutic choices for CSA depend on the typology of respiratory disturbances observed by polysomnography, changes in blood gases and ventilatory control. In CSA with normocapnia and ventilatory instability, adaptive servo-ventilation is recommended. In CSA with hypercapnia and/or rapid-eye movement sleep hypoventilation, non-invasive ventilation is required. Further studies are required as strong evidence is lacking regarding the long-term consequences of CSA and the long-term impact of current treatment strategies.
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Affiliation(s)
- Sébastien Baillieul
- a Grenoble Alpes University , HP2 Laboratory , INSERM U1042, Grenoble , France.,b Pôle Thorax et Vaisseaux , Grenoble Alpes University Hospital , Grenoble , France
| | - Bruno Revol
- a Grenoble Alpes University , HP2 Laboratory , INSERM U1042, Grenoble , France.,b Pôle Thorax et Vaisseaux , Grenoble Alpes University Hospital , Grenoble , France
| | - Ingrid Jullian-Desayes
- a Grenoble Alpes University , HP2 Laboratory , INSERM U1042, Grenoble , France.,b Pôle Thorax et Vaisseaux , Grenoble Alpes University Hospital , Grenoble , France
| | - Marie Joyeux-Faure
- a Grenoble Alpes University , HP2 Laboratory , INSERM U1042, Grenoble , France.,b Pôle Thorax et Vaisseaux , Grenoble Alpes University Hospital , Grenoble , France
| | - Renaud Tamisier
- a Grenoble Alpes University , HP2 Laboratory , INSERM U1042, Grenoble , France.,b Pôle Thorax et Vaisseaux , Grenoble Alpes University Hospital , Grenoble , France
| | - Jean-Louis Pépin
- a Grenoble Alpes University , HP2 Laboratory , INSERM U1042, Grenoble , France.,b Pôle Thorax et Vaisseaux , Grenoble Alpes University Hospital , Grenoble , France
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35
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Polivka J, Polivka J, Pesta M, Rohan V, Celedova L, Mahajani S, Topolcan O, Golubnitschaja O. Risks associated with the stroke predisposition at young age: facts and hypotheses in light of individualized predictive and preventive approach. EPMA J 2019; 10:81-99. [PMID: 30984317 DOI: 10.1007/s13167-019-00162-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/06/2019] [Indexed: 12/25/2022]
Abstract
Stroke is one of the most devastating pathologies of the early twenty-first century demonstrating 1-month case-fatality rates ranging from 13 to 35% worldwide. Though the majority of cases do occur in individuals at an advanced age, a persistently increasing portion of the patient cohorts is affected early in life. Current studies provide alarming statistics for the incidence of "young" strokes including adolescents. Young stroke is a multifactorial disease involving genetic predisposition but also a number of modifiable factors, the synergic combination of which potentiates the risks. The article analyzes the prevalence and impacts of "traditional" risk factors such as sedentary lifestyle, smoking, abnormal alcohol consumption, drug abuse, overweight, hypertension, abnormal sleep patterns, and usage of hormonal contraceptives, among others. Further, less explored risks such as primary vascular dysregulation and associated symptoms characteristic for Flammer syndrome (FS) are considered, and the relevance of the FS phenotype for the stroke predisposition at young age is hypothesized. Considering the high prevalence of known genetic and modifiable risk factors in the overall predisposition to the young stroke, the risk mitigating measures are recommended including innovative screening programs by application of specialized questionnaires and biomarker panels as well as educational programs adapted to the target audiences such as children, adolescents, and young adults.
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Affiliation(s)
- Jiri Polivka
- 1Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University, Staré Město, Czech Republic
- 2Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Staré Město, Czech Republic
- 3Department of Neurology, University Hospital Pilsen, and Faculty of Medicine in Pilsen, Charles University, Staré Město, Czech Republic
| | - Jiri Polivka
- 3Department of Neurology, University Hospital Pilsen, and Faculty of Medicine in Pilsen, Charles University, Staré Město, Czech Republic
| | - Martin Pesta
- 2Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Staré Město, Czech Republic
- 4Department of Biology, Faculty of Medicine in Pilsen, Charles University, Staré Město, Czech Republic
| | - Vladimir Rohan
- 3Department of Neurology, University Hospital Pilsen, and Faculty of Medicine in Pilsen, Charles University, Staré Město, Czech Republic
| | - Libuse Celedova
- 5Department of Social and Assessment Medicine, Faculty of Medicine in Pilsen, Charles University, Staré Město, Czech Republic
| | | | - Ondrej Topolcan
- 7Department of Immunochemistry, University Hospital Pilsen, Pilsen, Czech Republic
| | - Olga Golubnitschaja
- 8Radiological Clinic, UKB, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
- 9Breast Cancer Research Centre, UKB, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
- 10Centre for Integrated Oncology, Cologne-Bonn, UKB, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
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