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Das P, Wang Y, Angom RS, Dredla B, Wang E, Jansen-West K, Badi M, Ross O, Meschia JF, Mukhopadhyay D. Changes in plasma concentrations of novel vascular and inflammatory biomarkers in obstructive sleep apnea patients pre- and post-stroke. Sleep Med 2024; 119:518-525. [PMID: 38805859 DOI: 10.1016/j.sleep.2024.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/19/2024] [Accepted: 05/14/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is increasingly recognized as a common condition in the general population and causes significant OSA-associated morbidities including cardiovascular and cerebrovascular events such as cerebral small vessel disease (CSVD) and stroke. METHODS In this study, using sensitive ELISA immunoassays, we measured subset of endothelial/vascular and inflammatory biomarkers as well as neurofilament light chain (NfL), a sensitive marker for neuroaxonal injury, using plasma from OSA patients post-stroke (Acute Cerebral Infarction (ACI), N = 26) to determine their usefulness as potential prognostic markers in disease progression. RESULTS Our results showed significantly increased plasma TNFα and NfL concentrations and decreased concentrations of platelet derived growth factor (PDGF-AA) in post-stroke OSA patients with more severe white matter hyperintensities (WMHs). And after separating the patients based on sex, compared to females, male post-stroke OSA patients with severe WMHs have increased circulating levels of inflammatory chemokine CXCL10 and cytokine Interleukin-10 (IL-10) and significantly decreased levels of Angiopoietin-1 (Ang-1) an important protein responsible for endothelial/vascular integrity functions. Importantly, in a subset of newly diagnosed OSA patients (without prior history of stroke), significantly increased plasma CXCL10 levels and decreased plasma Ang-1 levels were also readily observed when compared to healthy controls, indicating possible altered endothelial integrity and ongoing vascular inflammation in these newly diagnosed OSA patients. CONCLUSIONS In summary, our study has identified a novel set of plasma biomarkers including PDGF-AA, CXCL10 and Ang-1 for their potential prognostic value for disease outcomes pre- and post-stroke in OSA patients and use as surrogate markers to measure efficacy of treatment modalities.
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Affiliation(s)
- Pritam Das
- Department of Biochemistry and Molecular Biology, Mayo Clinic Florida, Jacksonville, FL, USA.
| | - Ying Wang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA; Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA
| | - Ramcharan Singh Angom
- Department of Biochemistry and Molecular Biology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Brynn Dredla
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Enfeng Wang
- Department of Biochemistry and Molecular Biology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Karen Jansen-West
- Department of Neuroscience, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Mohammed Badi
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Owen Ross
- Department of Neuroscience, Mayo Clinic Florida, Jacksonville, FL, USA
| | - James F Meschia
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Debabrata Mukhopadhyay
- Department of Biochemistry and Molecular Biology, Mayo Clinic Florida, Jacksonville, FL, USA.
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2
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Culebras A. Sleep apnea and stroke: A dynamic duo. Sleep Med Rev 2024; 75:101943. [PMID: 38754280 DOI: 10.1016/j.smrv.2024.101943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Affiliation(s)
- Antonio Culebras
- SUNY Upstate Medical University, 5199 Fairlawn Drive, Fayetteville, NY, 13066, USA; Upstate University Sleep Center, Syracuse, NY, USA.
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3
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Thomas RJ. A matter of fragmentation. Sleep 2024; 47:zsae030. [PMID: 38285604 DOI: 10.1093/sleep/zsae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Indexed: 01/31/2024] Open
Affiliation(s)
- Robert Joseph Thomas
- Professor of Medicine, Harvard Medical School, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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4
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Ercolano E, Bencivenga L, Palaia ME, Carbone G, Scognamiglio F, Rengo G, Femminella GD. Intricate relationship between obstructive sleep apnea and dementia in older adults. GeroScience 2024; 46:99-111. [PMID: 37814196 PMCID: PMC10828345 DOI: 10.1007/s11357-023-00958-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/21/2023] [Indexed: 10/11/2023] Open
Abstract
Numerous evidence reports direct correlation between cognitive impairment, Alzheimer's disease and sleep disorders, in particular obstructive sleep apnea. Both obstructive sleep apnea and Alzheimer's disease are highly prevalent conditions whose incidence increases with age. Several studies demonstrate how sleep-disordered breathing may lead to poor cognition, even though the underlying mechanisms of this association remain partially unclear. According to the most recent studies, obstructive sleep apnea may be considered a modifiable risk factor for cognitive dysfunction. In the present review, the authors aim to integrate recent research examining obstructive sleep apnea and Alzheimer's disease biomarkers, also focusing on the mechanisms that support this correlation, including but not limited to the role of hypoxia and cardiovascular risk. Moreover, the potential favourable effect of obstructive sleep apnea therapy on cognitive function is discussed, to evaluate the benefits deriving from appropriate treatment of sleep-disordered breathing on cognition.
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Affiliation(s)
- Erica Ercolano
- Department of Translational Medical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples, Italy
| | - Leonardo Bencivenga
- Department of Translational Medical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples, Italy
| | - Maria Emiliana Palaia
- Department of Translational Medical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples, Italy
| | - Giovanni Carbone
- Department of Translational Medical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples, Italy
| | - Francesco Scognamiglio
- Department of Translational Medical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples, Italy
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples, Italy
- Istituti Clinici Scientifici ICS Maugeri - S.P.A. - Istituti Di Ricovero E Cura a Carattere Scientifico (IRCCS) Istituto Scientifico Di Telese Terme, Telese, Italy
| | - Grazia Daniela Femminella
- Department of Translational Medical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples, Italy.
- Department of Brain Sciences, Imperial College London, London, UK.
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5
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Parillo M, Vaccarino F, Di Gennaro G, Kumar S, Van Goethem J, Beomonte Zobel B, Quattrocchi CC, Parizel PM, Mallio CA. Overview of the Current Knowledge and Conventional MRI Characteristics of Peri- and Para-Vascular Spaces. Brain Sci 2024; 14:138. [PMID: 38391713 PMCID: PMC10886993 DOI: 10.3390/brainsci14020138] [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: 12/09/2023] [Revised: 01/10/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
Brain spaces around (perivascular spaces) and alongside (paravascular or Virchow-Robin spaces) vessels have gained significant attention in recent years due to the advancements of in vivo imaging tools and to their crucial role in maintaining brain health, contributing to the anatomic foundation of the glymphatic system. In fact, it is widely accepted that peri- and para-vascular spaces function as waste clearance pathways for the brain for materials such as ß-amyloid by allowing exchange between cerebrospinal fluid and interstitial fluid. Visible brain spaces on magnetic resonance imaging are often a normal finding, but they have also been associated with a wide range of neurological and systemic conditions, suggesting their potential as early indicators of intracranial pressure and neurofluid imbalance. Nonetheless, several aspects of these spaces are still controversial. This article offers an overview of the current knowledge and magnetic resonance imaging characteristics of peri- and para-vascular spaces, which can help in daily clinical practice image description and interpretation. This paper is organized into different sections, including the microscopic anatomy of peri- and para-vascular spaces, their associations with pathological and physiological events, and their differential diagnosis.
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Affiliation(s)
- Marco Parillo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Federica Vaccarino
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Gianfranco Di Gennaro
- Department of Health Sciences, Chair of Medical Statistics, University of Catanzaro "Magna Græcia", 88100 Catanzaro, Italy
| | - Sumeet Kumar
- Department of Neuroradiology, National Neuroscience Institute, Singapore 308433, Singapore
- Duke-National University of Singapore Medical School, Singapore 169857, Singapore
| | - Johan Van Goethem
- Department of Radiology, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Bruno Beomonte Zobel
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Carlo Cosimo Quattrocchi
- Centre for Medical Sciences-CISMed, University of Trento, Via S. Maria Maddalena 1, 38122 Trento, Italy
| | - Paul M Parizel
- Royal Perth Hospital & University of Western Australia, Perth, WA 6000, Australia
- Medical School, University of Western Australia, Perth, WA 6009, Australia
| | - Carlo Augusto Mallio
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
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6
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Garic D, McKinstry RC, Rutsohn J, Slomowitz R, Wolff J, MacIntyre LC, Weisenfeld LAH, Kim SH, Pandey J, St. John T, Estes AM, Schultz RT, Hazlett HC, Dager SR, Botteron KN, Styner M, Piven J, Shen MD. Enlarged Perivascular Spaces in Infancy and Autism Diagnosis, Cerebrospinal Fluid Volume, and Later Sleep Problems. JAMA Netw Open 2023; 6:e2348341. [PMID: 38113043 PMCID: PMC10731509 DOI: 10.1001/jamanetworkopen.2023.48341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/03/2023] [Indexed: 12/21/2023] Open
Abstract
Importance Perivascular spaces (PVS) and cerebrospinal fluid (CSF) are essential components of the glymphatic system, regulating brain homeostasis and clearing neural waste throughout the lifespan. Enlarged PVS have been implicated in neurological disorders and sleep problems in adults, and excessive CSF volume has been reported in infants who develop autism. Enlarged PVS have not been sufficiently studied longitudinally in infancy or in relation to autism outcomes or CSF volume. Objective To examine whether enlarged PVS are more prevalent in infants who develop autism compared with controls and whether they are associated with trajectories of extra-axial CSF volume (EA-CSF) and sleep problems in later childhood. Design, Setting, and Participants This prospective, longitudinal cohort study used data from the Infant Brain Imaging Study. Magnetic resonance images were acquired at ages 6, 12, and 24 months (2007-2017), with sleep questionnaires performed between ages 7 and 12 years (starting in 2018). Data were collected at 4 sites in North Carolina, Missouri, Pennsylvania, and Washington. Data were analyzed from March 2021 through August 2022. Exposure PVS (ie, fluid-filled channels that surround blood vessels in the brain) that are enlarged (ie, visible on magnetic resonance imaging). Main Outcomes and Measures Outcomes of interest were enlarged PVS and EA-CSF volume from 6 to 24 months, autism diagnosis at 24 months, sleep problems between ages 7 and 12 years. Results A total of 311 infants (197 [63.3%] male) were included: 47 infants at high familial likelihood for autism (ie, having an older sibling with autism) who were diagnosed with autism at age 24 months, 180 high likelihood infants not diagnosed with autism, and 84 low likelihood control infants not diagnosed with autism. Sleep measures at school-age were available for 109 participants. Of infants who developed autism, 21 (44.7%) had enlarged PVS at 24 months compared with 48 infants (26.7%) in the high likelihood but no autism diagnosis group (P = .02) and 22 infants in the control group (26.2%) (P = .03). Across all groups, enlarged PVS at 24 months was associated with greater EA-CSF volume from ages 6 to 24 months (β = 4.64; 95% CI, 0.58-8.72; P = .002) and more frequent night wakings at school-age (F = 7.76; η2 = 0.08; P = .006). Conclusions and Relevance These findings suggest that enlarged PVS emerged between ages 12 and 24 months in infants who developed autism. These results add to a growing body of evidence that, along with excessive CSF volume and sleep dysfunction, the glymphatic system could be dysregulated in infants who develop autism.
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Affiliation(s)
- Dea Garic
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill
| | - Robert C. McKinstry
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Joshua Rutsohn
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
| | | | - Jason Wolff
- Department of Educational Psychology, University of Minnesota Twin Cities College of Education and Human Development, Minneapolis
| | - Leigh C. MacIntyre
- McGill Centre for Integrative Neuroscience, Montreal Neurological Institute-Hospital, McGill University, Montreal, Canada
| | - Leigh Anne H. Weisenfeld
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill
| | - Sun Hyung Kim
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill
| | - Juhi Pandey
- Center for Autism Research, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Tanya St. John
- Department of Speech and Hearing Science, University of Washington, Seattle
- University of Washington Autism Center, University of Washington, Seattle
| | - Annette M. Estes
- Department of Speech and Hearing Science, University of Washington, Seattle
- University of Washington Autism Center, University of Washington, Seattle
| | - Robert T. Schultz
- University of Washington Autism Center, University of Washington, Seattle
| | - Heather C. Hazlett
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill
| | - Stephen R. Dager
- Department of Radiology, University of Washington Medical Center, Seattle
| | - Kelly N. Botteron
- Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Martin Styner
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill
| | - Joseph Piven
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill
| | - Mark D. Shen
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill
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7
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Shih NC, Barisano G, Lincoln KD, Mack WJ, Sepehrband F, Choupan J. Effects of sleep on brain perivascular space in a cognitively healthy population. Sleep Med 2023; 111:170-179. [PMID: 37782994 PMCID: PMC10591884 DOI: 10.1016/j.sleep.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/20/2023] [Accepted: 09/23/2023] [Indexed: 10/04/2023]
Abstract
The magnetic resonance imaging (MRI) visible perivascular space (PVS) reportedly clears amyloid-β and metabolic waste during sleep. Previous studies reported an association between sleep and the PVS in small vessel disease, traumatic brain injury, and Alzheimer's disease. However, this relationship in a healthy cohort is still unclear. Here, we used the Human Connectome Project Aging dataset to analyze the relationship between sleep and the PVS in cognitively healthy adults across the aging continuum. We measured sleep parameters using the self-reported Pittsburgh Sleep Quality Index questionnaire. We found that older adults who had better sleep quality and sleep efficiency presented with a larger PVS volume fraction in the basal ganglia (BG). However, sleep measures were not associated with PVS volume fraction in the centrum semiovale (CSO). In addition, we found that body mass index (BMI) influenced the BG-PVS across middle-aged and older participants. In the entire cognitively healthy cohort, the effect of sleep quality on PVS volume fraction was mediated by BMI. However, BMI did not influence this effect in the older cohort. Furthermore, there are significant differences in PVS volume fraction across racial/ethnic cohorts. In summary, the effect of sleep on the PVS volume alteration was different in the middle-aged adults and older adults.
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Affiliation(s)
- Nien-Chu Shih
- Laboratory of Neuro Imaging, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Giuseppe Barisano
- Laboratory of Neuro Imaging, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Neurosurgery, Stanford University, Palo Alto, CA, USA
| | - Karen D Lincoln
- Program in Public Health, Department of Environmental and Occupational Health, University of California, Irvine, CA, USA
| | - Wendy J Mack
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Farshid Sepehrband
- Laboratory of Neuro Imaging, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jeiran Choupan
- Laboratory of Neuro Imaging, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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8
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Wu B, Liu F, Sun G, Wang S. Correlation between obstructive sleep apnea and cerebral small vessel disease: a mendelian randomization study. Genes Genomics 2023; 45:1179-1186. [PMID: 37300787 DOI: 10.1007/s13258-023-01402-9] [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: 01/21/2023] [Accepted: 05/12/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Whether obstructive sleep apnea (OSA) is causally associated with an increased risk of cerebral small vessel disease (CSVD) remains controversial. We conducted a two-sample Mendelian randomization (MR) study to clarify the causal relationship between OSA and CSVD risk. METHODS Single-nucleotide polymorphisms associated with OSA at the genome-wide significance level (P < 5 × 10- 8) in the FinnGen consortium were selected as instrumental variables. Summary-level data for white matter hyperintensities (WMHs), lacunar infarctions (LIs), cerebral microbleeds (CMBs), fractional anisotropy (FA), and mean diffusivity (MD) were obtained from three meta-analyses of genome-wide association studies (GWASs). The random-effects inverse-variance weighted (IVW) method was selected for the major analysis. Weighted-median, MR-Egger, MR pleiotropy residual sum and outlier (MR-PRESSO), and leave-one-out analysis methods were implemented for the sensitivity analyses. RESULTS Genetically predicted OSA was not associated with LIs (odds ratio [OR] = 1.10, 95% confidence interval [CI] = 0.86-1.40), WMHs (OR = 0.94, 95% CI = 0.83-1.07), FA (OR = 1.33, 95% CI = 0.75-2.33), MD (OR = 0.93, 95% CI = 0.58-1.47), CMBs (OR = 1.29, 95% CI = 0.86-1.94), mixed CMBs (OR = 1.17, 95% CI = 0.63-2.17), and lobar CMBs (OR = 1.15, 95% CI = 0.75-1.76) in IVW method. The results of the sensitivity analyses were generally consistent with the major analyses. CONCLUSIONS This MR study does not support causal associations between OSA and the risk of CSVD in individuals of European ancestry. These findings need to be further validated in randomized controlled trials, larger cohort studies, and MR studies based on larger GWASs.
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Affiliation(s)
- Bing Wu
- Department of Neurology, Army 78th Military Group Hospital, 1 Tian Qing Street, Ai Min District, Mudanjiang, 157000, China
| | - Fang Liu
- Department of Neurology, Army 78th Military Group Hospital, 1 Tian Qing Street, Ai Min District, Mudanjiang, 157000, China
| | - Guiyan Sun
- Department of Neurology, Army 78th Military Group Hospital, 1 Tian Qing Street, Ai Min District, Mudanjiang, 157000, China
| | - Shuang Wang
- Department of Neurology, Army 78th Military Group Hospital, 1 Tian Qing Street, Ai Min District, Mudanjiang, 157000, China.
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9
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Carvalho DZ, McCarter SJ, St Louis EK, Przybelski SA, Johnson Sparrman KL, Somers VK, Boeve BF, Petersen RC, Jack CR, Graff-Radford J, Vemuri P. Association of Polysomnographic Sleep Parameters With Neuroimaging Biomarkers of Cerebrovascular Disease in Older Adults With Sleep Apnea. Neurology 2023; 101:e125-e136. [PMID: 37164654 PMCID: PMC10351545 DOI: 10.1212/wnl.0000000000207392] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/23/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Our objective was to determine whether polysomnographic (PSG) sleep parameters are associated with neuroimaging biomarkers of cerebrovascular disease (CVD) related to white matter (WM) integrity in older adults with obstructive sleep apnea (OSA). METHODS From the population-based Mayo Clinic Study of Aging, we identified participants without dementia who underwent at least 1 brain MRI and PSG. We quantified 2 CVD biomarkers: WM hyperintensities (WMHs) from fluid-attenuated inversion recovery (FLAIR)-MRI, and fractional anisotropy of the genu of the corpus callosum (genu FA) from diffusion MRI. For this cross-sectional analysis, we fit linear models to assess associations between PSG parameters (NREM stage 1 percentage, NREM stage 3 percentage [slow-wave sleep], mean oxyhemoglobin saturation, and log of apnea-hypopnea index [AHI]) and CVD biomarkers (log of WMH and log of genu FA), respectively, while adjusting for age (at MRI), sex, APOE ε4 status, composite cardiovascular and metabolic conditions (CMC) score, REM stage percentage, sleep duration, and interval between MRI and PSG. RESULTS We included 140 participants with FLAIR-MRI (of which 103 had additional diffusion MRI). The mean ± SD age was 72.7 ± 9.6 years at MRI with nearly 60% being men. The absolute median (interquartile range [IQR]) interval between MRI and PSG was 1.74 (0.9-3.2) years. 90.7% were cognitively unimpaired (CU) during both assessments. For every 10-point decrease in N3%, there was a 0.058 (95% CI 0.006-0.111, p = 0.030) increase in the log of WMH and 0.006 decrease (95% CI -0.012 to -0.0002, p = 0.042) in the log of genu FA. After matching for age, sex, and N3%, participants with severe OSA had higher WMH (median [IQR] 0.007 [0.005-0.015] vs 0.006 [0.003-0.009], p = 0.042) and lower genu FA (median [IQR] 0.57 [0.55-0.63] vs 0.63 [0.58-0.65], p = 0.007), when compared with those with mild/moderate OSA. DISCUSSION We found that reduced slow-wave sleep and severe OSA were associated with higher burden of WM abnormalities in predominantly CU older adults, which may contribute to greater risk of cognitive impairment, dementia, and stroke. Our study supports the association between sleep depth/fragmentation and intermittent hypoxia and CVD biomarkers. Longitudinal studies are required to assess causation.
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Affiliation(s)
- Diego Z Carvalho
- From the Department of Neurology (D.Z.C., S.J.M., E.K.S.L., B.F.B., R.C.P., J.G.-R.), Center for Sleep Medicine (D.Z.C., S.J.M., E.K.S.L., B.F.B.), Division of Pulmonary and Critical Care, Department of Internal Medicine, Department of Quantitative Health Sciences (S.A.P., R.C.P.), Department of Radiology (K.L.J.S., C.R.J., P.V.), and Department of Cardiovascular Medicine (V.K.S.), Mayo Clinic, Rochester, MN.
| | - Stuart J McCarter
- From the Department of Neurology (D.Z.C., S.J.M., E.K.S.L., B.F.B., R.C.P., J.G.-R.), Center for Sleep Medicine (D.Z.C., S.J.M., E.K.S.L., B.F.B.), Division of Pulmonary and Critical Care, Department of Internal Medicine, Department of Quantitative Health Sciences (S.A.P., R.C.P.), Department of Radiology (K.L.J.S., C.R.J., P.V.), and Department of Cardiovascular Medicine (V.K.S.), Mayo Clinic, Rochester, MN
| | - Erik K St Louis
- From the Department of Neurology (D.Z.C., S.J.M., E.K.S.L., B.F.B., R.C.P., J.G.-R.), Center for Sleep Medicine (D.Z.C., S.J.M., E.K.S.L., B.F.B.), Division of Pulmonary and Critical Care, Department of Internal Medicine, Department of Quantitative Health Sciences (S.A.P., R.C.P.), Department of Radiology (K.L.J.S., C.R.J., P.V.), and Department of Cardiovascular Medicine (V.K.S.), Mayo Clinic, Rochester, MN
| | - Scott A Przybelski
- From the Department of Neurology (D.Z.C., S.J.M., E.K.S.L., B.F.B., R.C.P., J.G.-R.), Center for Sleep Medicine (D.Z.C., S.J.M., E.K.S.L., B.F.B.), Division of Pulmonary and Critical Care, Department of Internal Medicine, Department of Quantitative Health Sciences (S.A.P., R.C.P.), Department of Radiology (K.L.J.S., C.R.J., P.V.), and Department of Cardiovascular Medicine (V.K.S.), Mayo Clinic, Rochester, MN
| | - Kohl L Johnson Sparrman
- From the Department of Neurology (D.Z.C., S.J.M., E.K.S.L., B.F.B., R.C.P., J.G.-R.), Center for Sleep Medicine (D.Z.C., S.J.M., E.K.S.L., B.F.B.), Division of Pulmonary and Critical Care, Department of Internal Medicine, Department of Quantitative Health Sciences (S.A.P., R.C.P.), Department of Radiology (K.L.J.S., C.R.J., P.V.), and Department of Cardiovascular Medicine (V.K.S.), Mayo Clinic, Rochester, MN
| | - Virend K Somers
- From the Department of Neurology (D.Z.C., S.J.M., E.K.S.L., B.F.B., R.C.P., J.G.-R.), Center for Sleep Medicine (D.Z.C., S.J.M., E.K.S.L., B.F.B.), Division of Pulmonary and Critical Care, Department of Internal Medicine, Department of Quantitative Health Sciences (S.A.P., R.C.P.), Department of Radiology (K.L.J.S., C.R.J., P.V.), and Department of Cardiovascular Medicine (V.K.S.), Mayo Clinic, Rochester, MN
| | - Bradley F Boeve
- From the Department of Neurology (D.Z.C., S.J.M., E.K.S.L., B.F.B., R.C.P., J.G.-R.), Center for Sleep Medicine (D.Z.C., S.J.M., E.K.S.L., B.F.B.), Division of Pulmonary and Critical Care, Department of Internal Medicine, Department of Quantitative Health Sciences (S.A.P., R.C.P.), Department of Radiology (K.L.J.S., C.R.J., P.V.), and Department of Cardiovascular Medicine (V.K.S.), Mayo Clinic, Rochester, MN
| | - Ronald C Petersen
- From the Department of Neurology (D.Z.C., S.J.M., E.K.S.L., B.F.B., R.C.P., J.G.-R.), Center for Sleep Medicine (D.Z.C., S.J.M., E.K.S.L., B.F.B.), Division of Pulmonary and Critical Care, Department of Internal Medicine, Department of Quantitative Health Sciences (S.A.P., R.C.P.), Department of Radiology (K.L.J.S., C.R.J., P.V.), and Department of Cardiovascular Medicine (V.K.S.), Mayo Clinic, Rochester, MN
| | - Clifford R Jack
- From the Department of Neurology (D.Z.C., S.J.M., E.K.S.L., B.F.B., R.C.P., J.G.-R.), Center for Sleep Medicine (D.Z.C., S.J.M., E.K.S.L., B.F.B.), Division of Pulmonary and Critical Care, Department of Internal Medicine, Department of Quantitative Health Sciences (S.A.P., R.C.P.), Department of Radiology (K.L.J.S., C.R.J., P.V.), and Department of Cardiovascular Medicine (V.K.S.), Mayo Clinic, Rochester, MN
| | - Jonathan Graff-Radford
- From the Department of Neurology (D.Z.C., S.J.M., E.K.S.L., B.F.B., R.C.P., J.G.-R.), Center for Sleep Medicine (D.Z.C., S.J.M., E.K.S.L., B.F.B.), Division of Pulmonary and Critical Care, Department of Internal Medicine, Department of Quantitative Health Sciences (S.A.P., R.C.P.), Department of Radiology (K.L.J.S., C.R.J., P.V.), and Department of Cardiovascular Medicine (V.K.S.), Mayo Clinic, Rochester, MN
| | - Prashanthi Vemuri
- From the Department of Neurology (D.Z.C., S.J.M., E.K.S.L., B.F.B., R.C.P., J.G.-R.), Center for Sleep Medicine (D.Z.C., S.J.M., E.K.S.L., B.F.B.), Division of Pulmonary and Critical Care, Department of Internal Medicine, Department of Quantitative Health Sciences (S.A.P., R.C.P.), Department of Radiology (K.L.J.S., C.R.J., P.V.), and Department of Cardiovascular Medicine (V.K.S.), Mayo Clinic, Rochester, MN
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Sotgiu MA, Lo Jacono A, Barisano G, Saderi L, Cavassa V, Montella A, Crivelli P, Carta A, Sotgiu S. Brain perivascular spaces and autism: clinical and pathogenic implications from an innovative volumetric MRI study. Front Neurosci 2023; 17:1205489. [PMID: 37425010 PMCID: PMC10328421 DOI: 10.3389/fnins.2023.1205489] [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: 04/13/2023] [Accepted: 06/07/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Our single-center case-control study aimed to evaluate the unclear glymphatic system alteration in autism spectrum disorder (ASD) through an innovative neuroimaging tool which allows to segment and quantify perivascular spaces in the white matter (WM-PVS) with filtering of non-structured noise and increase of the contrast-ratio between perivascular spaces and the surrounding parenchyma. Methods Briefly, files of 65 ASD and 71 control patients were studied. We considered: ASD type, diagnosis and severity level and comorbidities (i.e., intellectual disability, attention-deficit hyperactivity disorder, epilepsy, sleep disturbances). We also examined diagnoses other than ASD and their associated comorbidities in the control group. Results When males and females with ASD are included together, WM-PVS grade and WM-PVS volume do not significantly differ between the ASD group and the control group overall. We found, instead, that WM-PVS volume is significantly associated with male sex: males had higher WM-PVS volume compared to females (p = 0.01). WM-PVS dilation is also non-significantly associated with ASD severity and younger age (< 4 years). In ASD patients, higher WM-PVS volume was related with insomnia whereas no relation was found with epilepsy or IQ. Discussion We concluded that WM-PVS dilation can be a neuroimaging feature of male ASD patients, particularly the youngest and most severe ones, which may rely on male-specific risk factors acting early during neurodevelopment, such as a transient excess of extra-axial CSF volume. Our findings can corroborate the well-known strong male epidemiological preponderance of autism worldwide.
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Affiliation(s)
| | - Alessandro Lo Jacono
- Unit of Child Neuropsychiatry, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Giuseppe Barisano
- Department of Neurosurgery, Stanford University, Stanford, CA, United States
| | - Laura Saderi
- Clinical Epidemiology and Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Vanna Cavassa
- Unit of Child Neuropsychiatry, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Andrea Montella
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Paola Crivelli
- Radiology Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Alessandra Carta
- Unit of Child Neuropsychiatry, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Stefano Sotgiu
- Unit of Child Neuropsychiatry, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
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11
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Association of Obstructive Sleep Apnea and Atrial Fibrillation in Acute Ischemic Stroke: A Cross-Sectional Study. J Pers Med 2023; 13:jpm13030527. [PMID: 36983709 PMCID: PMC10051494 DOI: 10.3390/jpm13030527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/17/2023] Open
Abstract
Background: There is a growing body of evidence suggesting a link between obstructive sleep apnea (OSA) and atrial fibrillation (AF). The primary objective of this study is to evaluate the association between OSA and AF in acute ischemic stroke. The secondary objective is to describe the clinical features of patients with acute ischemic stroke and concomitant OSA. Methods: We enrolled consecutive patients with acute ischemic stroke. All patients underwent full-night cardiorespiratory polygraphy. To determine if there is an association between AF and OSA, we compared the observed frequency of this association with the expected frequency from a random co-occurrence of the two conditions. Subsequently, patients with and without OSA were compared. Results: A total of 174 patients were enrolled (mean age 67.3 ± 11.6 years; 95 males). OSA and AF were present in 89 and 55 patients, respectively. The association OSA + AF was observed in 33/174 cases, which was not statistically different compared to the expected co-occurrence of the two conditions. Patients with OSA showed a higher neck circumference and body mass index, a higher prevalence of hypertension and dysphagia, and a higher number of central apneas/hypoapneas. In the multivariate analysis, dysphagia and hypertension were independent predictors of OSA. A positive correlation was observed between OSA severity, BMI, and neck circumference. The number of central apneas/hypoapneas was positively correlated with stroke severity. Conclusions: Our data suggest that OSA and AF are highly prevalent but not associated in acute stroke. Our findings support the hypothesis that OSA acts as an independent risk factor for stroke.
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12
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Lee G, Dharmakulaseelan L, Muir RT, Iskander C, Kendzerska T, Boulos MI. Obstructive sleep apnea is associated with markers of cerebral small vessel disease in a dose-response manner: A systematic review and meta-analysis. Sleep Med Rev 2023; 68:101763. [PMID: 36805589 DOI: 10.1016/j.smrv.2023.101763] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/10/2023]
Abstract
Cerebral small vessel disease manifests on neuroimaging as white matter hyperintensities, lacunes, cerebral microbleeds, perivascular spaces or subcortical infarcts and is a major contributor to dementia, stroke and incident death. We aimed to determine whether obstructive sleep apnea severity is associated cerebral small vessel disease. A systematic search was conducted for studies examining the association between obstructive sleep apnea and cerebral small vessel disease markers. A random-effects model was used to meta-analyze unadjusted odds ratios derived from event rates. The neuroimaging-derived measures of white matter hyperintensities, lacunes, and cerebral microbleeds were compared against increasing obstructive sleep apnea severity, as measured by apnea-hypopnea indices of <5, 5-15, ≥15 and ≥ 30. Thirty-two observational studies were included: ten reported effect sizes for white matter hyperintensities, nine for lacunes and three for cerebral microbleeds. Compared to patients without obstructive sleep apnea, the odds of possessing white matter hyperintensities were 1.7 [95% confidence interval 0.9-3.6] in mild, 3.9 [2.7-5.5] in moderate-severe and 4.3 [1.9-9.6] in severe obstructive sleep apnea. Moderate-severe obstructive sleep apnea was associated with a higher risk of lacunar infarcts. Obstructive sleep apnea had no association with cerebral microbleeds and an indeterminate association with perivascular spaces and subcortical infarcts due to insufficient data.
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Affiliation(s)
- Grace Lee
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Laavanya Dharmakulaseelan
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Ryan T Muir
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Carol Iskander
- Faculty of Medicine, The National University of Ireland, Galway, Ireland
| | - Tetyana Kendzerska
- Department of Medicine, Division of Respirology, The Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada
| | - Mark I Boulos
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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13
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Khoreva MA, Kuznetsova MP, Karkavina MV, Safonova SS. [Obstructive sleep apnea - underestimated cognitive impairments risk factor]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:36-41. [PMID: 37655408 DOI: 10.17116/jnevro202312308136] [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: 09/02/2023]
Abstract
About 40% of cases of cognitive impairment (CI) are associated with modifiable risk factors, such as inactivity, hypertension, diabetes and obesity. Recently, sleep disorders, including obstructive sleep apnea syndrome (OSA), have been considered among these factors. OSA is one of the most widespread conditions among patients with CI. The pathogenesis of cerebral lesions in OSA is complex. Timely diagnosis and complex therapy of patients with OSA can reduce the risk, reduce the severity of CI and slow their progression. Along with non-drug methods of treatment, the use of the drug Cortexin with a multimodal mechanism of action can minimize the negative impact of OSA on the cognitive health of patients. Early detection and treatment of OSA can reduce the severity of CI and slow their progression.
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Affiliation(s)
- M A Khoreva
- Altai State Medical University, Barnaul, Russia
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14
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Zhang M, Yu H, Wang F, Tang J, Liu N, Xue Y, Ren X, Shi L, Fu J. Electrical Activity During Slow-Wave Sleep and the Relationship With Enlarged Perivascular Spaces in Arteriosclerotic Cerebral Small Vessel Disease. J Clin Neurophysiol 2023; 40:79-85. [PMID: 34009853 DOI: 10.1097/wnp.0000000000000843] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE We sought to analyze EEG spectral power during slow-wave sleep among patients with arteriosclerotic cerebral small vessel disease (CSVD) compared with community-dwelling individuals. We also sought to determine the relationship between EEG activity and the severity of enlarged perivascular spaces (EPVSs). METHODS Consecutive subjects with arteriosclerotic CSVD ( n = 36) and community-dwelling individuals ( n = 26) between 50 and 80 years of age were included. Nocturnal polysomnography was performed, and EEG spectral analysis was conducted during slow-wave sleep using the F4/M1 and C4/M1 channel. Regionalized EPVSs in the basal ganglia and centrum semiovale were assessed on a validated 4-point visual rating scale (0 = none, 1 = 1-10, 2 = 11-20, 3 = 21-40, and 4 = >40) using MRI. RESULTS CSVD group showed lower delta:beta ratios in the frontal ( P = 0.017) and central ( P = 0.038) regions after adjusting for age, sex, mini-mental state examination score, and arousal index. The significance still remained in the frontal region when including age, sex, mini-mental state examination, and apnea-hypopnea index as covariates ( P = 0.037). Among patients with arteriosclerotic CSVD, decreased delta power ( P = 0.031) and theta power ( P = 0.034) in the frontal region were associated with a higher degree of EPVSs in the centrum semiovale rather than in the basal ganglia. Delta power in the central region showed an extremely weak association with EPVSs in the centrum semiovale ( P = 0.047). CONCLUSIONS Among patients with arteriosclerotic CSVD, the intrusion of high-frequency EEG activity into slow-wave sleep was identified, and slow-wave activity during slow-wave sleep might be negatively associated with the severity of EPVSs in the centrum semiovale. Further studies are required to corroborate the conclusions.
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Affiliation(s)
- Miaoyi Zhang
- Department of Neurology, North Huashan Hospital, Fudan University, Shanghai, China
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China; and
| | - Huan Yu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China; and
| | - Fei Wang
- Department of Neurology, The First People's Hospital of Jiashan, Jiaxing, Zhejiang Province, China
| | - Jie Tang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China; and
| | - Na Liu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China; and
| | - Yang Xue
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China; and
| | - Xue Ren
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China; and
| | - Langfeng Shi
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China; and
| | - Jianhui Fu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China; and
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15
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Choi JW, Lee KO, Jang YJ, Kim HK, Seo T, Roh YJ, Choo SO, Oh SH. High Mean Platelet Volume Is Associated with Cerebral White Matter Hyperintensities in Non-Stroke Individuals. Yonsei Med J 2023; 64:35-41. [PMID: 36579377 PMCID: PMC9826963 DOI: 10.3349/ymj.2022.0368] [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: 08/18/2022] [Revised: 11/09/2022] [Accepted: 11/09/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The mean platelet volume (MPV) is regarded as a marker for thrombosis, atherosclerosis, and inflammation in various vascular diseases. However, it still remains unclear whether plasma MPV is associated with cerebral white matter hyperintensities (WMH) and cerebral microvascular pathology in the elderly population. MATERIALS AND METHODS We examined whether MPV level is associated with the presence of cerebral WMH on brain magnetic resonance imaging from 870 non-stroke outpatient subjects. The subjects were divided into three groups according to the consecutive level of MPV (low T1, middle T2, and high T3 MPV tertile groups). To determine the association of MPV levels with the WMH, logistic regression and receiver operating characteristic curve analyses were conducted. RESULTS Subjects with higher MPV level were older and more likely to have hypertension, diabetes mellitus, and low renal function. Cerebral WMH were more prevalent in subjects with higher MPV level. After adjusting for confounding factors, moderate to severe cerebral WMH were significantly associated with high MPV tertile level. This association remained significant after adjusting for other cerebral vascular pathologies. T2 [odds ratio (OR): 1.49, 95% confidence interval (CI): 1.03-2.15] and T3 MPV tertile groups (OR: 1.51, 95%CI: 1.04-2.20) had more cerebral WMH lesions compared to T1 MPV tertile group. In addition, the subjects with higher Fazekas scores showed higher MPV level (p=0.020). CONCLUSION We found that high MPV level is independently associated with cerebral WMH. This result suggests that platelet activation plays a role in the development of cerebral WMH.
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Affiliation(s)
- Jung-Won Choi
- Department of Neurology, CHA Bundang Medical Center, School of Medicine CHA University, Seongnam, Korea
| | - Kee Ook Lee
- Department of Neurology, CHA Bundang Medical Center, School of Medicine CHA University, Seongnam, Korea.
| | - Ye-Ji Jang
- Department of Neurology, CHA Bundang Medical Center, School of Medicine CHA University, Seongnam, Korea
| | - Hyun-Kyung Kim
- Department of Neurology, CHA Bundang Medical Center, School of Medicine CHA University, Seongnam, Korea
| | - Taeho Seo
- Department of Neurology, CHA Bundang Medical Center, School of Medicine CHA University, Seongnam, Korea
| | - Yoo Jeong Roh
- Department of Neurology, CHA Bundang Medical Center, School of Medicine CHA University, Seongnam, Korea
| | - Seung-Ook Choo
- Department of Biomedical Laboratory Science, College of Natural Science Daejeon University, Daejeon, Korea
| | - Seung-Hun Oh
- Department of Neurology, CHA Bundang Medical Center, School of Medicine CHA University, Seongnam, Korea
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16
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Baril AA, Pinheiro AA, Himali JJ, Beiser A, Sanchez E, Pase MP, Seshadri S, Demissie S, Romero JR. Lighter sleep is associated with higher enlarged perivascular spaces burden in middle-aged and elderly individuals. Sleep Med 2022; 100:558-564. [PMID: 36308914 PMCID: PMC9815141 DOI: 10.1016/j.sleep.2022.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/31/2022] [Accepted: 10/10/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND While healthy sleep is suggested to promote glymphatic clearance in the brain, poorer sleep may be associated with higher enlarged perivascular spaces (ePVS) burden, potentially representing impaired perivascular drainage. This study aims to evaluate the association between ePVS burden and polysomnographic sleep characteristics in a large community-based sample. METHODS 552 dementia and stroke-free Framingham Heart Study participants (age: 58.6 ± 8.9 years; 50.4% men) underwent a full-night in-home polysomnography. Three years later on average, participants underwent a brain MRI. ePVS were rated in the basal ganglia and centrum semiovale, and dichotomized as low burden (<20 counts, grades 1 and 2) or high burden (>20 counts, grades 3 and 4). Logistic regression analyses relating sleep variables to subsequent ePVS burden were used, adjusted for age, sex, time interval between polysomnography and MRI, ApoE ε4 allele carrier status, hypertension, and smoking. RESULTS Longer N1 sleep and shorter N3 sleep duration were associated with higher ePVS burden in the centrum semiovale. When stratifying these associations by subpopulations, longer N1 sleep duration with ePVS burden was observed especially in older individuals and hypertensive participants. Associations between ePVS burden and other sleep characteristics such as total sleep time and REM sleep duration varied according to ApoE ε4 allele carrier status. CONCLUSIONS Lighter sleep, as characterized by longer N1 sleep and shorter slow-wave sleep, is associated with higher ePVS burden. These findings suggest that sleep architecture may be involved in glymphatic clearance and cerebral small vessel disease, which could be an important biological link between sleep and dementia risk.
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Affiliation(s)
- Andrée-Ann Baril
- The Framingham Heart Study, Framingham, USA; Douglas Mental Health University Institute, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada
| | - Adlin A Pinheiro
- The Framingham Heart Study, Framingham, USA; Department of Biostatistics, Boston University School of Public Health, Boston, USA
| | - Jayandra J Himali
- The Framingham Heart Study, Framingham, USA; Department of Biostatistics, Boston University School of Public Health, Boston, USA; Department of Neurology, Boston University School of Medicine, Boston, USA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, UT Health San Antonio, San Antonio, USA; Department of Population Health Sciences, University of Texas Health Science Center, San Antonio, TX, USA
| | - Alexa Beiser
- The Framingham Heart Study, Framingham, USA; Department of Biostatistics, Boston University School of Public Health, Boston, USA
| | - Erlan Sanchez
- Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Matthew P Pase
- The Framingham Heart Study, Framingham, USA; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, VIC, Australia; Harvard T.H. Chan School of Public Health, Boston, USA
| | - Sudha Seshadri
- The Framingham Heart Study, Framingham, USA; Department of Neurology, Boston University School of Medicine, Boston, USA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, UT Health San Antonio, San Antonio, USA
| | - Serkalem Demissie
- The Framingham Heart Study, Framingham, USA; Department of Biostatistics, Boston University School of Public Health, Boston, USA
| | - Jose R Romero
- The Framingham Heart Study, Framingham, USA; Department of Neurology, Boston University School of Medicine, Boston, USA.
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Xie Z, Zhuang Y, Zhang Z, Liu J. Presence of cerebral microbleeds is associated with cognitive decline in acromegaly. Front Oncol 2022; 12:948971. [PMID: 36505847 PMCID: PMC9731478 DOI: 10.3389/fonc.2022.948971] [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: 05/20/2022] [Accepted: 11/03/2022] [Indexed: 11/25/2022] Open
Abstract
Background Cognitive decline in acromegaly has gained increasing attention. Cerebral microbleeds (CMBs) as radiographic markers for microvascular injury have been linked to various types of cognitive decline. However, the association between CMB formation and acromegaly has not yet been quantified. This study is designed to investigate the prevalence and the radiographic patterns of CMBs and the association between cognitive function and acromegaly-related CMBs in growth hormone (GH)-secreting pituitary adenoma, which is characterized by acromegaly. Methods In a cohort of 55 patients with GH-secreting pituitary adenoma (acromegaly) and 70 healthy control (HC) patients, we determined the presence of CMBs using a 3.0-T MRI scanner. The numbers, locations, and grades of CMBs were determined via susceptibility-weighted imaging (SWI) and the Microbleed Anatomical Rating Scale. Obstructive sleep apnea (OSA) was assessed using the criteria of the American Academy of Sleep Medicine (AASM) Scoring Manual Version 2.2. The Montreal Cognitive Assessment (MoCA) was used to assess cognitive performance within 3 days of admission. The association between CMBs and cognitive function as well as clinical characteristics was explored. Results The incidence of CMBs was 29.1%, whereas that of OSA was 65.5% in acromegaly. There was a statistically significant difference in the prevalence of CMBs between subjects with and without acromegaly (29.1% and 5.3%, respectively) (p < 0.01). The age of acromegaly patients with CMBs was much younger compared with HCs with CMBs. Compared with HCs, a significant cognitive decline and the occurrence of OSA were demonstrated in patients with acromegaly (p < 0.01). Binary logistic regression analysis adjusted for age, education, and body mass index (BMI) revealed that CMB was an independent risk factor for cognitive impairment in patients with acromegaly (OR = 3.19, 95% CI 1.51-6.76, p = 0.002). Furthermore, in the logistic regression models adjusted for age, BMI, diabetes, and hypertension, OSA was independently associated with the occurrence of CMBs in patients with acromegaly (OR = 13.34, 95% CI 3.09-57.51, p = 0.001). Conclusions A significant increase of CMBs was demonstrated in patients with acromegaly, which may be a result of OSA in acromegaly. The present study indicated that increasing CMBs are responsible for cognitive decline in patients with acromegaly.
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Affiliation(s)
- Zhengxing Xie
- Department of Neurosurgery, The Affiliated Hospital of Jiangsu University, Zhenjiang, China,Neuro-Endoscope and Mini-Invasive Treatment Center, The Affiliated Hospital of Jiangsu University, Zhenjiang, China,Department of Neurosurgery, Wuxi No. 2 People’s Hospital, Wuxi, China,*Correspondence: Zhengxing Xie,
| | - Yan Zhuang
- Department of Neurosurgery, The Affiliated Hospital of Jiangsu University, Zhenjiang, China,Neuro-Endoscope and Mini-Invasive Treatment Center, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Zongqiang Zhang
- Department of Neurosurgery, Bingtuan Sishi Hospital, Yining, China
| | - Jieping Liu
- Department of Neurosurgery, The Affiliated Hospital of Jiangsu University, Zhenjiang, China,Neuro-Endoscope and Mini-Invasive Treatment Center, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
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Abd El-Razek R, Abou Hagar A, Orabi M, Moawad S, El-Samahy M. Impact of obstructive sleep apnea on platelet activation and development of silent brain infarctions. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00575-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
Obstructive sleep apnea (OSA) is a unique potent predictor for stroke compared to other predictors. By aiding in the adherence of leukocytes and platelets, soluble P-selectin (sP-selectin) contributes to the development of ischemic stroke. The objective of this study was to investigate the independent impact of OSA on platelet activation and development of silent brain infarction. Twenty-four OSA patients and 24 controls were studied in a case–control study, who underwent one-night polysomnography, magnetic resonance imaging for evaluation of silent brain infarctions (SBI), measurement of serum (sP-selectin) levels for assessment of increased platelet activation and C-reactive protein (CRP) serum levels.
Results
Out of 24 patients, 5 (20.8%) had mild OSA and 8 (33.3%) had moderate and 11 (45.8%) had severe OSA. Serum levels of sP-selectin were statistically significantly higher in moderate and severe groups (p < 0.001). Eleven (57.9%) patients in moderate and severe OSA had SBI. Fifty percent of patients with moderate OSA had elevated serum sP-selectin and 25.0% of them had SBI and 81.8% of severe OSA patients had elevated serum sP-selectin and 81.8% of them had SBI. Patients with mild OSA and controls had no SBI and normal serum sP-selectin level. CRP was statistically significantly higher in moderate and severe OSA groups (16.6% and 45.8%) than the mild and control groups (4.1% and 0%) (p < 0.001).
Conclusion
Moderate and severe obstructive sleep apnea were associated independently with elevated serum sP-selectin reflecting increased platelet function, elevated inflammatory marker CRP and an increased risk of silent brain infarctions.
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Zhang Y, Xia X, Zhang T, Zhang C, Liu R, Yang Y, Liu S, Li X, Yue W. Relationship between sleep disorders and the prognosis of neurological function after stroke. Front Neurol 2022; 13:1036980. [DOI: 10.3389/fneur.2022.1036980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThis study aims to investigate the effects of sleep disorders on the prognosis of neurological function after stroke and other factors affecting the prognosis after stroke.MethodWe designed a cohort study. A total of 1,542 patients with their first stroke were hospitalized in the department of neurology of Tianjin Huanhu Hospital from 2015.6.1 to 2016.12.31. We recorded the personal histories of patients. The MMSE (mini-mental state examination), MoCA (Montreal Cognitive Assessment), HAMD (Hamilton Depression Scale), National Institutes of Health Stroke Scale (NIHSS) score, mRS (Modified Rankin Scale), BI (Barthel Index), PSQI (Pittsburgh Sleep Quality Index), ESS (Epworth Sleepiness Scale), Berlin questionnaire, and nocturnal TST (Total sleep time) were assessed before discharge, 3 months, 6 months, and 4 years (2019–2020) after stroke.ResultLow sleep quality (OR 2.019, 95%CI 1.199–3.398, p = 0.008), nocturnal TST (<7 h) (OR 4.060, 95%CI 1.494–11.034, p = 0.006), nocturnal TST (>8 h) (OR 5.928, 95% CI 2.134–16.464, p = 0.001) were risk factors for poor neurological function recovery at 3 months after stroke. Nocturnal TST (<7 h) (OR 13.042, 95%-CI 2.576–66.027, p = 0.002) and nocturnal TST (>8 h) (OR 11.559, 95%-CI 2.108–63.390, p = 0.005) were risk factors for poor neurological function at 6 months after stroke. Nocturnal TST (<7 h) (OR 2.668, 95% CI 1.250–5.698, p = 0.011) and nocturnal TST (>8 h) (OR 2.516, 95% CI 1.080–5.861, p = 0.033) were risk factors for poor neurological function at 4 years after stroke. High risk of OSA (HR 1.582, 95%CI 1.244–2.012, p < 0.001) was a risk factor for all-cause death in patients followed up for 4 years after stroke.ConclusionLow sleep quality is associated with short-term poor neurological function after stroke. Unusual nocturnal TST (long or short) is associated with short-term or long-term poor neurological function after stroke. A high risk of OSA is associated with a higher risk of all-cause death after stroke.
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Shieu MM, Zaheed AB, Shannon C, Chervin RD, Conceicao A, Paulson HL, Braley TJ, Dunietz GL. Positive Airway Pressure and Cognitive Disorders in Adults With Obstructive Sleep Apnea: A Systematic Review of the Literature. Neurology 2022; 99:e334-e346. [PMID: 35523585 PMCID: PMC9421774 DOI: 10.1212/wnl.0000000000200383] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/25/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Alzheimer disease (AD) and other forms of dementia represent a rising global public health crisis. Because effective treatments to prevent, cure, or slow progression of dementia are unavailable, identification of treatable risk factors that increase dementia risk such as obstructive sleep apnea (OSA) could offer promising means to modify dementia occurrence or severity. Here, we systematically reviewed the impact of positive airway pressure (PAP) therapy on the incidence of cognitive disorders and cognitive decline among middle-aged and older adults with OSA. METHODS We performed a systematic search of MEDLINE, EMBASE, Scopus, and CINAHL before May 2021 to identify articles that focused on associations between PAP therapy use and cognitive disorders. We included studies that examined the effects of PAP treatment on (1) the incidence of cognitive disorders among individuals ≥40 years of age diagnosed with OSA and (2) the progression of cognitive decline among people with preexisting cognitive disorders and OSA. RESULTS We identified 11 studies (3 clinical trials and 8 observational studies). In these studies, 96% participants had OSA (n = 60,840) and 9% had baseline cognitive impairment (mild cognitive impairment [MCI] or AD) (n=5,826). Of all study participants, 43,970 obtained PAP therapy, and 16,400 were untreated or in a placebo group. Nine out of 11 studies reported a protective effect of PAP therapy on MCI and AD incidence, e.g., delayed age at MCI onset, reduced MCI or AD incidence, slower cognitive decline, or progression to AD. DISCUSSION These findings suggest a role for OSA as a modifiable risk factor for cognitive decline. Identification of modifiable risk factors is imperative for alleviating the impact of cognitive disorders on aging adults and their family members. Future research should build on this review and focus on PAP interventions as a potential means to alleviate the incidence of cognitive disorders and cognitive decline, particularly among ethnoracial groups who have been underrepresented and underinvestigated in the extant literature.
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Affiliation(s)
- Monica Moon Shieu
- From the Department of Neurology (M.M.S., R.D.C., A.C., T.J.B., G.L.D.), Division of Sleep Medicine, Department of Psychology (A.Z.), Taubman Health Sciences Library (C.S.), Department of Neurology (H.L.P.), Division of Cognitive Disorders, and Department of Neurology (T.J.B.), Division of Neuroimmunology & Division of Sleep Medicine, University of Michigan, Ann Arbor.
| | - Afsara Binte Zaheed
- From the Department of Neurology (M.M.S., R.D.C., A.C., T.J.B., G.L.D.), Division of Sleep Medicine, Department of Psychology (A.Z.), Taubman Health Sciences Library (C.S.), Department of Neurology (H.L.P.), Division of Cognitive Disorders, and Department of Neurology (T.J.B.), Division of Neuroimmunology & Division of Sleep Medicine, University of Michigan, Ann Arbor
| | - Carol Shannon
- From the Department of Neurology (M.M.S., R.D.C., A.C., T.J.B., G.L.D.), Division of Sleep Medicine, Department of Psychology (A.Z.), Taubman Health Sciences Library (C.S.), Department of Neurology (H.L.P.), Division of Cognitive Disorders, and Department of Neurology (T.J.B.), Division of Neuroimmunology & Division of Sleep Medicine, University of Michigan, Ann Arbor
| | - Ronald David Chervin
- From the Department of Neurology (M.M.S., R.D.C., A.C., T.J.B., G.L.D.), Division of Sleep Medicine, Department of Psychology (A.Z.), Taubman Health Sciences Library (C.S.), Department of Neurology (H.L.P.), Division of Cognitive Disorders, and Department of Neurology (T.J.B.), Division of Neuroimmunology & Division of Sleep Medicine, University of Michigan, Ann Arbor
| | - Alan Conceicao
- From the Department of Neurology (M.M.S., R.D.C., A.C., T.J.B., G.L.D.), Division of Sleep Medicine, Department of Psychology (A.Z.), Taubman Health Sciences Library (C.S.), Department of Neurology (H.L.P.), Division of Cognitive Disorders, and Department of Neurology (T.J.B.), Division of Neuroimmunology & Division of Sleep Medicine, University of Michigan, Ann Arbor
| | - Henry Lauris Paulson
- From the Department of Neurology (M.M.S., R.D.C., A.C., T.J.B., G.L.D.), Division of Sleep Medicine, Department of Psychology (A.Z.), Taubman Health Sciences Library (C.S.), Department of Neurology (H.L.P.), Division of Cognitive Disorders, and Department of Neurology (T.J.B.), Division of Neuroimmunology & Division of Sleep Medicine, University of Michigan, Ann Arbor
| | - Tiffany Joy Braley
- From the Department of Neurology (M.M.S., R.D.C., A.C., T.J.B., G.L.D.), Division of Sleep Medicine, Department of Psychology (A.Z.), Taubman Health Sciences Library (C.S.), Department of Neurology (H.L.P.), Division of Cognitive Disorders, and Department of Neurology (T.J.B.), Division of Neuroimmunology & Division of Sleep Medicine, University of Michigan, Ann Arbor
| | - Galit Levi Dunietz
- From the Department of Neurology (M.M.S., R.D.C., A.C., T.J.B., G.L.D.), Division of Sleep Medicine, Department of Psychology (A.Z.), Taubman Health Sciences Library (C.S.), Department of Neurology (H.L.P.), Division of Cognitive Disorders, and Department of Neurology (T.J.B.), Division of Neuroimmunology & Division of Sleep Medicine, University of Michigan, Ann Arbor
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Gao Y, Deng W, Sun J, Yue D, Zhang B, Feng Y, Han J, Shen F, Hu J, Fu Y. The Association of Nocturnal Blood Pressure Patterns and Other Influencing Factors With Lacunes and Enlarged Perivascular Spaces in Hypertensive Patients. Front Neurol 2022; 13:879764. [PMID: 35677332 PMCID: PMC9168463 DOI: 10.3389/fneur.2022.879764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeNocturnal blood pressure dipping patterns have been associated with an increased risk of Cerebral Small Vessel Disease (CSVD), which has not been well-studied. This study is aimed to explore the association of dipping patterns and other factors with lacunes and enlarged perivascular spaces (EPVS) in patients with hypertension.MethodsWe enrolled a total of 1,322 patients with essential hypertension in this study. Magnetic resonance imaging (MRI) scans and 24-h ambulatory blood pressure (BP) monitoring were completed. Nocturnal BP decline was calculated, and then dipping patterns were classified. Patients were classified into four groups according to the performance of lacunes and EPVS in the MRI scan for statistical analysis.Results(1) Nocturnal BP decline showed independent negative correlation with both lacunes and EPVS while mean systolic BP (mSBP) level showed an independent positive correlation with them (P < 0.05). (2) The frequency of reverse-dippers in the control group was significantly lower than that in other groups; the frequency of non-dippers in the lacunes group and EPVS group was significantly lower than that in the control group; the frequency of extreme-dippers in the EPVS group was significantly higher than that in the mixed (lacunes with EPVS) group (P < 0.05).ConclusionsBoth mSBP and dipping patterns might play an important role in developing lacunes and EPVS in patients with hypertension.
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Affiliation(s)
- Yang Gao
- Department of Neurology, The First Hospital of Jiaxing and The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Weiping Deng
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jialan Sun
- Department of Neurology, Pudong New Area Gongli Hospital, Shanghai, China
| | - Dongqi Yue
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bei Zhang
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yulan Feng
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
| | - Jun Han
- Department of Radiology, The First Hospital of Jiaxing and The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Fanxia Shen
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jin Hu
- Department of Neurology, The First Hospital of Jiaxing and The Affiliated Hospital of Jiaxing University, Jiaxing, China
- Jin Hu
| | - Yi Fu
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Yi Fu
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22
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Barisano G, Lynch KM, Sibilia F, Lan H, Shih NC, Sepehrband F, Choupan J. Imaging perivascular space structure and function using brain MRI. Neuroimage 2022; 257:119329. [PMID: 35609770 PMCID: PMC9233116 DOI: 10.1016/j.neuroimage.2022.119329] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/04/2022] [Accepted: 05/19/2022] [Indexed: 12/03/2022] Open
Abstract
In this article, we provide an overview of current neuroimaging methods for studying perivascular spaces (PVS) in humans using brain MRI. In recent years, an increasing number of studies highlighted the role of PVS in cerebrospinal/interstial fluid circulation and clearance of cerebral waste products and their association with neurological diseases. Novel strategies and techniques have been introduced to improve the quantification of PVS and to investigate their function and morphological features in physiological and pathological conditions. After a brief introduction on the anatomy and physiology of PVS, we examine the latest technological developments to quantitatively analyze the structure and function of PVS in humans with MRI. We describe the applications, advantages, and limitations of these methods, providing guidance and suggestions on the acquisition protocols and analysis techniques that can be applied to study PVS in vivo. Finally, we review the human neuroimaging studies on PVS across the normative lifespan and in the context of neurological disorders.
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Affiliation(s)
- Giuseppe Barisano
- Laboratory of Neuro Imaging, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, USA; Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, USA..
| | - Kirsten M Lynch
- Laboratory of Neuro Imaging, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, USA
| | - Francesca Sibilia
- Laboratory of Neuro Imaging, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, USA
| | - Haoyou Lan
- Laboratory of Neuro Imaging, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, USA; Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, USA
| | - Nien-Chu Shih
- Laboratory of Neuro Imaging, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, USA
| | - Farshid Sepehrband
- Laboratory of Neuro Imaging, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, USA
| | - Jeiran Choupan
- Laboratory of Neuro Imaging, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, USA
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Cerebral small vessel disease alters neurovascular unit regulation of microcirculation integrity involved in vascular cognitive impairment. Neurobiol Dis 2022; 170:105750. [DOI: 10.1016/j.nbd.2022.105750] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/09/2022] [Accepted: 05/08/2022] [Indexed: 12/25/2022] Open
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Chen YK, Liang WC, Yuan SL, Ni ZX, Li W, Liu YL, Qu JF. Circadian rhythms of blood pressure in hypertensive patients with cerebral microbleeds. Brain Behav 2022; 12:e2530. [PMID: 35234352 PMCID: PMC9014997 DOI: 10.1002/brb3.2530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 12/27/2021] [Accepted: 01/20/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Whether the circadian rhythms of blood pressure (BP) contribute to the presence of cerebral microbleeds (CMBs) remains unknown. This study aimed to assess the relationship between nocturnal BP and CMBs in hypertensive patients. METHODS This prospective case-control study recruited 51 hypertensive patients with CMBs and 51 hypertensive patients without CMBs, matched with age and gender, serving as controls. A 24-h ambulatory BP monitoring was conducted in all subjects. Differences in ambulatory BP parameters between the two groups were compared. Logistic regression analyzes were conducted to investigate the relationship between the ambulatory BP parameters and presence of CMBs. RESULTS Patients with CMBs had a significant higher nocturnal mean SBP and lower relative nocturnal SBP dipping rate. Two logistic models were constructed to explore the association between ABPM indices and the presence of CMBs, adjusted with history of ischemic stroke and smoking. In model 1, higher nocturnal mean SBP positively correlated with presence of CMBs [standardized β = 0.254, odds ratio (OR) = 1.029, p = .041]. In model 2, the relative nocturnal SBP dipping rate was negatively correlated with CMBs (standardized β = -.363, OR = 0.918, p = .007). Only patients with deep CMBs had significant higher nocturnal mean SBP and lower relative nocturnal SBP dipping rate in comparison with those without CMBs. CONCLUSIONS Higher nocturnal SBP and lower relative nocturnal SBP dipping rate may be associated with CMBs in hypertensive patients.
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Affiliation(s)
- Yang-Kun Chen
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, Southern Medical University), Dongguan, Guangdong Province, China
| | - Wen-Cong Liang
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, Southern Medical University), Dongguan, Guangdong Province, China.,Department of Neurology, Graduate School of Guangdong Medical University, Zhanjiang, Guangdong Province, China
| | - Shu-Lan Yuan
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, Southern Medical University), Dongguan, Guangdong Province, China.,Department of Neurology, Graduate School of Guangdong Medical University, Zhanjiang, Guangdong Province, China
| | - Zhuo-Xin Ni
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, Southern Medical University), Dongguan, Guangdong Province, China
| | - Wei Li
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, Southern Medical University), Dongguan, Guangdong Province, China
| | - Yong-Lin Liu
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, Southern Medical University), Dongguan, Guangdong Province, China
| | - Jian-Feng Qu
- Department of Neurology, Dongguan People's Hospital (Affiliated Dongguan Hospital, Southern Medical University), Dongguan, Guangdong Province, China
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25
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Wang XX, Cao QC, Teng JF, Wang RF, Yang ZT, Wang MG, Cao ZH. MRI-visible enlarged perivascular spaces: imaging marker to predict cognitive impairment in older chronic insomnia patients. Eur Radiol 2022; 32:5446-5457. [PMID: 35286409 DOI: 10.1007/s00330-022-08649-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/27/2022] [Accepted: 02/12/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Perivascular spaces (PVS), components of the glymphatic system in the brain, have been known to be important conduits for clearing metabolic waste, and this process mainly increases during sleep. Sleep disruption might result in PVS dysfunction and cognitive impairment. In this study, we aim to explore whether MRI-visible enlarged perivascular spaces (EPVS) could be imaging markers to predict cognitive impairment in chronic insomnia patients. METHOD We obtained data from 156 patients with chronic insomnia and 79 age-matched healthy individuals. Using T2-weighted MRI images, visible EPVS in various brain regions were measured and analyzed. The associations between EPVS numbers and cerebrospinal fluid (CSF) β-amyloid 42 (Aβ42), total tau (t-tau), and phosphorylated tau (p-tau) level in chronic insomnia patients were evaluated. RESULT Our results showed that MRI-visible EPVS in the frontal cortex, centrum semiovale, basal ganglia, and hippocampus of chronic insomnia patients with impaired cognition (ICG) significantly increased than that in normal cognition (NCG) patients. The increased MRI-visible EPVS in the frontal cortex, centrum semiovale, and basal ganglia were also associated with the increased CSF Aβ42, t-tau, and p-tau level in ICG patients. MRI-visible EPVS in the basal ganglia and centrum semiovale had high sensitivity and specificity in distinguishing ICG chronic insomnia patients from those with NCG. CONCLUSION Our study indicated that MRI-visible EPVS in the basal ganglia and centrum semiovale might be valuable imaging markers to predict cognitive impairment in chronic insomnia patients. It will be meaningful to discern those cognitive decline patients in preclinical stage and take some measures to prevent disease progression. KEY POINTS • Increased MRI-visible EPVS were associated with the increased CSF Aβ42, t-tau, and p-tau level in older chronic insomnia patients with impaired cognition.
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Affiliation(s)
- Xin-Xin Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
| | - Qin-Chen Cao
- Department of Radiation Therapy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Jun-Fang Teng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Rui-Fang Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Medical Key Laboratory of Molecular Imaging, Zhengzhou, 450052, Henan, China
| | - Zi-Tao Yang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Meng-Ge Wang
- Department of Respiratory and Sleep, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Zheng-Hao Cao
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
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26
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Chong PLH, Garic D, Shen MD, Lundgaard I, Schwichtenberg AJ. Sleep, cerebrospinal fluid, and the glymphatic system: A systematic review. Sleep Med Rev 2022; 61:101572. [PMID: 34902819 PMCID: PMC8821419 DOI: 10.1016/j.smrv.2021.101572] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 10/14/2021] [Accepted: 11/10/2021] [Indexed: 02/03/2023]
Abstract
Current theories of the glymphatic system (GS) hypothesize that it relies on cerebrospinal fluid (CSF) circulation to disseminate growth factors and remove metabolic waste from the brain with increased CSF production and circulation during sleep; thereby, linking sleep disturbance with elements of CSF circulation and GS exchange. However, our growing knowledge of the relations between sleep, CSF, and the GS are plagued by variability in sleep and CSF measures across a wide array of pathologies. Hence, this review aims to summarize the dynamic relationships between sleep, CSF-, and GS-related features in samples of typically developing individuals and those with autoimmune/inflammatory, neurodegenerative, neurodevelopmental, sleep-related, neurotraumatic, neuropsychiatric, and skull atypicalities. One hundred and ninety articles (total n = 19,129 participants) were identified and reviewed for pathology, CSF circulation and related metrics, GS function, and sleep. Numerous associations were documented between sleep problems and CSF metabolite concentrations (e.g., amyloid-beta, orexin, tau proteins) and increased CSF volumes or pressure. However, these relations were not universal, with marked differences across pathologies. It is clear that elements of CSF circulation/composition and GS exchange represent pathways influenced by sleep; however, carefully designed studies and advances in GS measurement are needed to delineate the nuanced relationships.
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Affiliation(s)
| | - D. Garic
- University of North Carolina, Chapel Hill, NC
| | - M. D. Shen
- University of North Carolina, Chapel Hill, NC
| | - I. Lundgaard
- Department of Experimental Medicine Science, Lund University, Lund, Sweden,Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
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27
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Li X, Qin RR, Chen J, Jiang HF, Tang P, Wang YJ, Xu DW, Xu T, Yuan TF. Neuropsychiatric symptoms and altered sleep quality in cerebral small vessel disease. Front Psychiatry 2022; 13:882922. [PMID: 36051552 PMCID: PMC9424898 DOI: 10.3389/fpsyt.2022.882922] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sleep disturbance and neuropsychiatric symptoms are common clinical symptoms of cerebral small vessel disease (CSVD), but the underlying mechanism is unclear. Here, we investigated the relationship between sleep quality and neuropsychiatric performance in patients with CSVD. METHODS A total of 30 patients with CSVD and 35 healthy controls (HCs) were recruited. The 13-item Beck Depression Inventory (BDI-13), Beck Anxiety Inventory (BAI), and Symptom Check List 90 (SCL90) were used to assess depression, anxiety, and other psychological symptoms, respectively. Sleep quality was assessed using Pittsburgh Sleep Quality Index (PSQI), and cognitive function was tested using Montreal Cognitive Assessment (MoCA). RESULTS When compared to the HC group, the patients with CSVD showed increased anxiety and neuropsychiatric symptoms, worse sleep quality, and impaired cognition (p < 0.05). The prevalence of comorbid poor sleep quality in the patients with CSVD was approximately 46%. The patients with CSVD with poor sleep quality also had more severe neuropsychiatric symptoms. After controlling for demographic variables, sex and anxiety significantly predicted sleep quality. CONCLUSION This study suggests that the prevalence of CSVD with poor sleep quality is high, and that sex and anxiety are independent risk factors for CSVD comorbid sleep quality.
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Affiliation(s)
- Xi Li
- Department of Neurology, Affiliated Tongzhou Hospital of Nantong University, Nantong, China.,School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Rong-Rong Qin
- Department of Neurology, Affiliated Tongzhou Hospital of Nantong University, Nantong, China
| | - Jian Chen
- Department of Neurology, Affiliated Tongzhou Hospital of Nantong University, Nantong, China
| | - Hai-Fei Jiang
- Department of Neurology, Affiliated Tongzhou Hospital of Nantong University, Nantong, China
| | - Pan Tang
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Yu-Jing Wang
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Dong-Wu Xu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Tao Xu
- Department of Neurology, Affiliated Tongzhou Hospital of Nantong University, Nantong, China.,Department of Anesthesiology, Affiliated Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ti-Fei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Co-innovation Center of Neuroregeneration, Nantong University, Nantong, China.,Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
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28
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Javaheri S, Peker Y, Yaggi HK, Bassetti CLA. Obstructive sleep apnea and stroke: The mechanisms, the randomized trials, and the road ahead. Sleep Med Rev 2021; 61:101568. [PMID: 34906778 DOI: 10.1016/j.smrv.2021.101568] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022]
Abstract
When considered separately from cardiovascular disease, stroke is the third leading cause of death in the U.S. and is the leading cause of long-term disability in adults. New approaches that can be offered to the majority of ischemic stroke patients, can be continued throughout post-stroke care, can limit stroke severity, and can complement or even enhance rehabilitation, would transform ischemic stroke recovery. The treatment of obstructive sleep apnea (OSA) in patients with acute ischemic stroke may represent one such approach. This manuscript reviews the epidemiologic studies of the bidirectional association between OSA and stroke, and the mechanisms and molecular signatures of OSA leading to transient ischemic attack and stroke as well as the randomized controlled trials and observational cohort studies examining continuous positive airway treatment efficacy on the impact of stroke outcomes. Finally, the insights these studies provide on future research are also discussed.
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Affiliation(s)
- Shahrokh Javaheri
- Division of Pulmonary and Sleep Medicine, Bethesda North Hospital, Cincinnati, OH, USA; Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Cardiology, The Ohio State University, Columbus, OH, USA.
| | - Yüksel Peker
- Department of Pulmonary Medicine, Koc University School of Medicine, Istanbul, Turkey; Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, Lund, Sweden; Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - H Klar Yaggi
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA; Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Claudio L A Bassetti
- Department of Neurology, Inselspital, University of Bern, Switzerland; Department of Neurology, Sechenow University Faculty of Medicine, Moscow, Russia
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Lee WJ, Jung KH, Nam HW, Lee YS. Effect of obstructive sleep apnea on cerebrovascular compliance and cerebral small vessel disease. PLoS One 2021; 16:e0259469. [PMID: 34767578 PMCID: PMC8589195 DOI: 10.1371/journal.pone.0259469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/19/2021] [Indexed: 11/18/2022] Open
Abstract
Reduced cerebrovascular compliance is the major mechanism of cerebral small vessel disease (SVD). Obstructive sleep apnea (OSA) also promotes SVD development, but the underlying mechanism was not elucidated. We investigated the association among OSA, cerebrovascular compliance, and SVD parameters. This study retrospectively included individuals ≥ 50 years of age, underwent overnight polysomnographic (PSG) for the evaluation of OSA, and performed MRI and transcranial Doppler (TCD) within 12 months of interval without a neurological event between the evaluations. TCD parameters for the cerebrovascular compliance included middle cerebral artery pulsatility index (MCA PI) and mean MCA resistance index ratio (MRIR). SVD parameters included white matter hyperintensity (WMH) volume, number of lacunes, enlarged perivascular space (ePVS) score, and the presence of microbleeds or lacunes. Ninety-seven individuals (60.8% male, mean age 70.0±10.5 years) were included. MRIR was associated with higher respiratory distress index (B = 0.003; 95% confidence interval [CI] 0.001-0.005; P = 0.021), while MCA PI was not associated with any of the PSG markers for OSA severity. Apnea-hypopnea index was associated with the log-transformed total WMH volume (B = 0.008; 95% confidence interval [CI] 0.001-0.016; P = 0.020), subcortical WMH volume (B = 0.015; 95% CI 0.007-0.022; P<0.001), total ePVS score (B = 0.024; 95% CI 0.003-0.045; P = 0.026), and centrum semiovale ePVS score (B = 0.026; 95% CI 0.004-0.048; P = 0.019), and oxygen-desaturation index with periventricular WMH volume, independently from age, MCA PI, and MRIR. This study concluded that OSA is associated with reduced cerebrovascular compliance and also with SVD independently from cerebrovascular compliance. Underlying pathomechanistic link might be region specific.
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Affiliation(s)
- Woo-Jin Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Hyun-Woo Nam
- Department of Neurology, College of Medicine Seoul National University, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
| | - Yong-Seok Lee
- Department of Neurology, College of Medicine Seoul National University, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
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Lysen TS, Yilmaz P, Dubost F, Ikram MA, de Bruijne M, Vernooij MW, Luik AI. Sleep and perivascular spaces in the middle-aged and elderly population. J Sleep Res 2021; 31:e13485. [PMID: 34549850 PMCID: PMC9285071 DOI: 10.1111/jsr.13485] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/13/2021] [Accepted: 09/01/2021] [Indexed: 12/29/2022]
Abstract
Sleep has been hypothesised to facilitate waste clearance from the brain. We aimed to determine whether sleep is associated with perivascular spaces on brain magnetic resonance imaging (MRI), a potential marker of impaired brain waste clearance, in a population-based cohort of middle-aged and elderly people. In 559 participants (mean [SD] age 62 [6] years, 52% women) from the population-based Rotterdam Study, we measured total sleep time, sleep onset latency, wake after sleep onset and sleep efficiency with actigraphy and polysomnography. Perivascular space load was determined with brain MRI in four regions (centrum semiovale, basal ganglia, hippocampus, and midbrain) via a validated machine learning algorithm using T2-weighted MR images. Associations between sleep characteristics and perivascular space load were analysed with zero-inflated negative binomial regression models adjusted for various confounders. We found that higher actigraphy-estimated sleep efficiency was associated with a higher perivascular space load in the centrum semiovale (odds ratio 1.10, 95% confidence interval 1.04-1.16, p = 0.0008). No other actigraphic or polysomnographic sleep characteristics were associated with perivascular space load in other brain regions. We conclude that, contrary to our hypothesis, associations of sleep with perivascular space load in this middle-aged and elderly population remained limited to an association of a high actigraphy-estimated sleep efficiency with a higher perivascular space load in the centrum semiovale.
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Affiliation(s)
- Thom S Lysen
- Department of Epidemiology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Pinar Yilmaz
- Department of Epidemiology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Florian Dubost
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands.,Department of Neurology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Marleen de Bruijne
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands.,Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
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Zhang M, Yu H, Tang W, Ding D, Tang J, Liu N, Xue Y, Ren X, Shi L, Fu J. Decreased nocturnal heart rate variability and potentially related brain regions in arteriosclerotic cerebral small vessel disease. BMC Neurol 2021; 21:361. [PMID: 34530764 PMCID: PMC8447504 DOI: 10.1186/s12883-021-02388-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/30/2021] [Indexed: 01/17/2023] Open
Abstract
Background To assess heart rate variability (HRV) among patients with arteriosclerotic cerebral small vessel disease (CSVD) by comparing with control subjects, and to determine whether HRV parameters were related to structural alterations in brain regions involved in autonomic regulation among CSVD patients. Methods We consecutively recruited subjects aged between 50 and 80 years who visited the Stroke Prevention Clinic of our hospital and have completed brain magnetic resonance imaging examination from September 1, 2018 to August 31, 2019. Polysomnography and synchronous analyses of HRV were then performed in all participants. Multivariable binary logistic regression was used to identify the relationship between HRV parameters and CSVD. Participants were invited to further undergo three-dimensional brain volume scan, and the voxel based morphometry (VBM) analysis was used to identify gray matter atrophy. Results Among 109 participants enrolled in this study, 63 were assigned to the arteriosclerotic CSVD group and 46 to the control group. Lower standard deviation of normal-to-normal intervals (SDNN, OR = 0.943, 95% CI 0.903 to 0.985, P = 0.009) and higher ratio of low to high frequency power (LF/HF, OR = 4.372, 95% CI 1.033 to 18.508, P = 0.045) during the sleep period were associated with CSVD, independent of traditional cerebrovascular risk factors and sleep disordered breathing. A number of 24 CSVD patients and 21 controls further underwent three-dimensional brain volume scan and VBM analysis. Based on VBM results, SDNN during the awake time (β = 0.544, 95% CI 0.211 to 0.877, P = 0.001) and the sleep period (β = 0.532, 95% CI 0.202 to 0.862, P = 0.001) were both positively related with gray matter volume within the right inferior frontal gyrus only among CSVD patients. Conclusions Decreased nocturnal HRV is associated with arteriosclerotic CSVD independent of traditional cerebrovascular risk factors and sleep disordered breathing. The structural atrophy of some brain regions associated with cardiac autonomic regulation sheds light on the potential relationship. Trial registration Trial registration number: ChiCTR1800017902. Date of registration: 20 Aug 2018.
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Affiliation(s)
- Miaoyi Zhang
- Department of Neurology, North Huashan Hospital, Fudan University, No.108 Lu Xiang Road, Shanghai, 201900, China.,Department of Neurology, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Huan Yu
- Department of Neurology, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Weijun Tang
- Department of Neurology, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Ding Ding
- Department of Neurology, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Jie Tang
- Department of Neurology, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Na Liu
- Department of Neurology, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Yang Xue
- Department of Neurology, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Xue Ren
- Department of Neurology, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Langfeng Shi
- Department of Neurology, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Jianhui Fu
- Department of Neurology, North Huashan Hospital, Fudan University, No.108 Lu Xiang Road, Shanghai, 201900, China. .,Department of Neurology, Huashan Hospital, Fudan University, No.12 Wulumuqi Zhong Road, Shanghai, 200040, China.
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Lloret A, Esteve D, Lloret MA, Monllor P, López B, León JL, Cervera-Ferri A. Is Oxidative Stress the Link Between Cerebral Small Vessel Disease, Sleep Disruption, and Oligodendrocyte Dysfunction in the Onset of Alzheimer's Disease? Front Physiol 2021; 12:708061. [PMID: 34512381 PMCID: PMC8424010 DOI: 10.3389/fphys.2021.708061] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/28/2021] [Indexed: 01/07/2023] Open
Abstract
Oxidative stress is an early occurrence in the development of Alzheimer’s disease (AD) and one of its proposed etiologic hypotheses. There is sufficient experimental evidence supporting the theory that impaired antioxidant enzymatic activity and increased formation of reactive oxygen species (ROS) take place in this disease. However, the antioxidant treatments fail to stop its advancement. Its multifactorial condition and the diverse toxicological cascades that can be initiated by ROS could possibly explain this failure. Recently, it has been suggested that cerebral small vessel disease (CSVD) contributes to the onset of AD. Oxidative stress is a central hallmark of CSVD and is depicted as an early causative factor. Moreover, data from various epidemiological and clinicopathological studies have indicated a relationship between CSVD and AD where endothelial cells are a source of oxidative stress. These cells are also closely related to oligodendrocytes, which are, in particular, sensitive to oxidation and lead to myelination being compromised. The sleep/wake cycle is another important control in the proliferation, migration, and differentiation of oligodendrocytes, and sleep loss reduces myelin thickness. Moreover, sleep plays a crucial role in resistance against CSVD, and poor sleep quality increases the silent markers of this vascular disease. Sleep disruption is another early occurrence in AD and is related to an increase in oxidative stress. In this study, the relationship between CSVD, oligodendrocyte dysfunction, and sleep disorders is discussed while focusing on oxidative stress as a common occurrence and its possible role in the onset of AD.
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Affiliation(s)
- Ana Lloret
- INCLIVA, CIBERFES, Department of Physiology, Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Daniel Esteve
- INCLIVA, CIBERFES, Department of Physiology, Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Maria Angeles Lloret
- Department of Clinical Neurophysiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Paloma Monllor
- INCLIVA, CIBERFES, Department of Physiology, Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Begoña López
- Department of Neurology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - José Luis León
- Departament of Neuroradiology, Ascires Biomedical Group, Hospital Clinico Universitario, Valencia, Spain
| | - Ana Cervera-Ferri
- Department of Anatomy and Human Embryology, University of Valencia, Valencia, Spain
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Raptis DG, Sinani O, Rapti GG, Papanikolaou A, Dadouli K, Ntellas P, Kapsalaki EZ, Malli F, Gourgoulianis KI, Xiromerisiou G. Clinically Silent Small Vessel Disease of the Brain in Patients with Obstructive Sleep Apnea Hypopnea Syndrome. Diagnostics (Basel) 2021; 11:diagnostics11091673. [PMID: 34574014 PMCID: PMC8469951 DOI: 10.3390/diagnostics11091673] [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: 07/22/2021] [Revised: 09/02/2021] [Accepted: 09/10/2021] [Indexed: 12/24/2022] Open
Abstract
Obstructive sleep apnea hypopnea syndrome (OSAHS) is associated with increased risk of cerebrovascular disease. The aim of the present study was to investigate the association between the presence of the small vessel disease (SVD) of the brain in patients with OSAHS. The study included 24 patients with moderate to severe OSAHS and 34 healthy volunteers. All the subjects underwent magnetic resonance imaging (MRI) of the brain, in order to sought periventricular white matter (PVWM), deep white matter (DWM) and brainstem SVD. Among patients with OSAHS, 79.1% had SVD (grade 1-3, Fazekas score) in DWM and 91.7% in PVWM while 22.4% had brainstem-white matter hyperintensities (B-WMH). Patients with OSAHS had a much higher degree of SVD in the DWM and PVWM compared to the control group (p < 0.001). The multivariate analysis showed an independent significant association of OSAHS with SVD (DWM and PVWM) (p = 0.033, OR 95% CI: 8.66 (1.19-63.08) and: p = 0.002, OR 95% CI: 104.98 (5.15-2141)). The same analysis showed a moderate association of OSAHS with B-WMH (p = 0.050, OR 15.07 (0.97-234.65)). Our study demonstrated an independent significant association of OSAHS with SVD and a moderate association of OSAHS with B-WMH.
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Affiliation(s)
- Dimitrios G. Raptis
- Respiratory Medicine Department, School of Medicine, University of Thessaly, 41110 Larissa, Greece; (D.G.R.); (G.G.R.); (K.I.G.)
| | - Olga Sinani
- Faculty of Medicine, School of Health Sciences, University of Thessaly, 41222 Larissa, Greece; (O.S.); (A.P.)
| | - Georgia G. Rapti
- Respiratory Medicine Department, School of Medicine, University of Thessaly, 41110 Larissa, Greece; (D.G.R.); (G.G.R.); (K.I.G.)
| | - Aikaterini Papanikolaou
- Faculty of Medicine, School of Health Sciences, University of Thessaly, 41222 Larissa, Greece; (O.S.); (A.P.)
| | - Katerina Dadouli
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 41222 Larissa, Greece;
| | - Panagiotis Ntellas
- Department of Medical Oncology, University Hospital of Ioannina, 45500 Ioannina, Greece;
| | - Eftychia Z. Kapsalaki
- Department of Diagnostic Radiology, Faculty of Medicine, General University Hospital of Larissa, University of Thessaly, 41110 Larissa, Greece;
| | - Foteini Malli
- Respiratory Medicine Department, School of Medicine, University of Thessaly, 41110 Larissa, Greece; (D.G.R.); (G.G.R.); (K.I.G.)
- Respiratory Disorders Lab, Faculty of Nursing, University of Thessaly, 41500 Larissa, Greece
- Correspondence: ; Tel.: +30-241-068-4612; Fax: +30-241-350-1563
| | - Konstantinos I. Gourgoulianis
- Respiratory Medicine Department, School of Medicine, University of Thessaly, 41110 Larissa, Greece; (D.G.R.); (G.G.R.); (K.I.G.)
| | - Georgia Xiromerisiou
- Department of Neurology, School of Medicine, University of Thessaly, 41110 Larissa, Greece;
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Sleep-disordered breathing and cerebral small vessel disease-acute and 6 months after ischemic stroke. Sleep Breath 2021; 26:1107-1113. [PMID: 34476728 DOI: 10.1007/s11325-021-02482-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 08/03/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Sleep-disordered breathing (SDB) occurs frequently after stroke and is associated with poor functional outcome and increased mortality. The purpose of this study was to detect changes in SDB over time after acute ischemic stroke and investigate relationships between SDB and stroke etiologies with focus on cerebral small vessel disease. METHODS From May 2015 to August 2016, we conducted an observational study of 99 patients with mild to moderate stroke (median age: 68 years, range 36-88; 56% men). Polysomnography was performed within 7 days of stroke onset (n = 91) and after 6 months (n = 52). The strokes were classified using the etiological TOAST classification. Total small vessel disease (SVD) scores were calculated based on MRIs. RESULTS SDB, defined as an apnea-hypopnea index (AHI) ≥ 15, was found in 56% of patients in the acute state and in 44% at follow-up. AHI decreased over time (median change 4.7, 95% confidence interval [95% CI] 0.5-8.9; p = 0.03). Patients with AHI ≥ 15 in both the acute state and at follow-up had higher SVD score at follow-up (p = 0.003). AHI was not associated with ischemic stroke subgroups according to the TOAST classification. DISCUSSION In conclusion, 6 months after stroke, AHI decreased, but 44% still had AHI ≥ 15. Persistent SDB in both the acute state and at follow-up was associated with a higher SVD score, but not to the TOAST subgroups. SDB evaluation should be offered to stroke patients, and the effect of SDB on cerebral small vessel disease needs to be further investigated using the well-defined SVD score. TRIAL REGISTRATION clinicaltrials.gov NCT02111408, April 11, 2014.
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Barisano G, Sheikh-Bahaei N, Law M, Toga AW, Sepehrband F. Body mass index, time of day and genetics affect perivascular spaces in the white matter. J Cereb Blood Flow Metab 2021; 41:1563-1578. [PMID: 33183133 PMCID: PMC8221772 DOI: 10.1177/0271678x20972856] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/21/2020] [Accepted: 10/18/2020] [Indexed: 12/17/2022]
Abstract
The analysis of cerebral perivascular spaces (PVS) using magnetic resonance imaging (MRI) allows to explore in vivo their contributions to neurological disorders. To date the normal amount and distribution of PVS in healthy human brains are not known, thus hampering our ability to define with confidence pathogenic alterations. Furthermore, it is unclear which biological factors can influence the presence and size of PVS on MRI. We performed exploratory data analysis of PVS volume and distribution in a large population of healthy individuals (n = 897, age = 28.8 ± 3.7). Here we describe the global and regional amount of PVS in the white matter, which can be used as a reference for clinicians and researchers investigating PVS and may help the interpretation of the structural changes affecting PVS in pathological states. We found a relatively high inter-subject variability in the PVS amount in this population of healthy adults (range: 1.31-14.49 cm3). The PVS volume was higher in older and male individuals. Moreover, we identified body mass index, time of day, and genetics as new elements significantly affecting PVS in vivo under physiological conditions, offering a valuable foundation to future studies aimed at understanding the physiology of perivascular flow.
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Affiliation(s)
- Giuseppe Barisano
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, USA
| | - Nasim Sheikh-Bahaei
- Department of Radiology, Keck Hospital of USC, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Meng Law
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Neurological Surgery, Keck Hospital of USC, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Neuroscience, Monash University, Melbourne, Australia
- Department of Radiology, Alfred Health, Monash University, Melbourne, Australia
| | - Arthur W Toga
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Farshid Sepehrband
- Laboratory of Neuro Imaging, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Baek MS, Han K, Kwon HS, Lee YH, Cho H, Lyoo CH. Risks and Prognoses of Alzheimer's Disease and Vascular Dementia in Patients With Insomnia: A Nationwide Population-Based Study. Front Neurol 2021; 12:611446. [PMID: 34025548 PMCID: PMC8137901 DOI: 10.3389/fneur.2021.611446] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/13/2021] [Indexed: 11/13/2022] Open
Abstract
This study aimed to investigate the risk and prognosis of Alzheimer's disease (AD) and vascular dementia (VaD) in patients with insomnia using the National Health Insurance Service database covering the entire population of the Republic of Korea from 2007 to 2014. In total, 2,796,871 patients aged 40 years or older with insomnia were enrolled, and 5,593,742 controls were matched using a Greedy digit match algorithm. Mortality and the rate of admission to a long-term care facility were estimated using multivariable Cox analysis. Of all patients with insomnia, 138,270 (4.94%) and 26,706 (0.96%) were newly diagnosed with AD and VaD, respectively. The incidence rate ratios for AD and VaD were 1.73 and 2.10, respectively, in patients with insomnia compared with those without. Higher mortality rates and long-term care facility admission rates were also observed in patients with dementia in the insomnia group. Known cardiovascular risk factors showed interactions with the effects of insomnia on the risk of AD and VaD. However, the effects of insomnia on the incidence of AD and VaD were consistent between the groups with and without cardiovascular risk factors. Insomnia is a medically modifiable and policy-accessible risk factor and prognostic marker of AD and VaD.
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Affiliation(s)
- Min Seok Baek
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Seoul, South Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
| | - Hyuk-Sung Kwon
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
| | - Yong-Ho Lee
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hanna Cho
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chul Hyoung Lyoo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Jia Y, Liu C, Li H, Li X, Wu J, Zhao Y, Xu M, Yu H, Guan Z, Sun S, Zhang C, Duan Z. Enlarged Perivascular Space and Its Correlation with Polysomnography Indicators of Obstructive Sleep Apnea. Nat Sci Sleep 2021; 13:863-872. [PMID: 34211302 PMCID: PMC8242141 DOI: 10.2147/nss.s305465] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/27/2021] [Indexed: 12/26/2022] Open
Abstract
PURPOSE There is increasing evidence of a causal interaction between obstructive sleep apnea (OSA) and white matter hyperintensity (WMH). WMH and enlarged perivascular space (EPVS) are the neuroimaging markers for cerebral small vessel disease (CSVD). Thus, this study aimed to determine whether a contextual relationship existed between OSA and EPVS. PARTICIPANTS AND METHODS In this study, 107 participants underwent 1-night polysomnography, brain magnetic resonance imaging (MRI) and health screening examinations and were classified as 63 OSA patients (mild, moderate, and severe groups), and 44 healthy controls. We assessed the sleep characteristics in OSA group, quantified the total EPVS from MRI and related them to the measures of polysomnography-obtained sleep parameters. RESULTS Polysomnography revealed that 63 OSA patients had sleep architecture alteration. A higher proportion of N2 phase sleep (N2%), lower percentage of N3 sleep (N3%) and REM sleep (REM%), as well as increased arousal index (AI), oxygen desaturation index (ODI) and decreased lowest arterial oxygen saturation (LSaO2) were detected. The results also indicated a higher prevalence and a larger number of EPVS, and a lower Mini Mental State Scale (MMSE) scale score in OSA group. LSaO2, N3% and REM% were negatively correlated with the total EPVS, whereas ODI, AI and N2% were positively correlated with the total EPVS. CONCLUSION The findings suggested that OSA patients had sleep disturbances with a higher incidence and more severe EPVS. Furthermore, the EPVS in OSA might be secondary to sleep disturbances, intermittent hypoxemia and the respiratory event-related hemodynamic changes. Thus, our findings highlighted that increased risk for EPVS in OSA is a potential contributor to increased stroke risk in OSA.
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Affiliation(s)
- Yanlu Jia
- Department of Neurology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, 450000, People's Republic of China
| | - Chunling Liu
- Department of Neurology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, 450000, People's Republic of China
| | - Hui Li
- Department of Neurology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, 450000, People's Republic of China
| | - Xiaonan Li
- Department of Neurology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, 450000, People's Republic of China
| | - Jun Wu
- Department of Neurology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, 450000, People's Republic of China
| | - Yimin Zhao
- Department of Neurology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, 450000, People's Republic of China
| | - Mengya Xu
- Department of Neurology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, 450000, People's Republic of China
| | - Haitao Yu
- Department of Neurology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, 450000, People's Republic of China
| | - Zhitong Guan
- Department of Neurology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, 450000, People's Republic of China
| | - Shuning Sun
- Department of Neurology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, 450000, People's Republic of China
| | - Chao Zhang
- Department of Neurology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, 450000, People's Republic of China
| | - Zhiyi Duan
- Department of Neurology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, 450000, People's Republic of China
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Kainulainen S, Duce B, Korkalainen H, Leino A, Huttunen R, Kalevo L, Arnardottir ES, Kulkas A, Myllymaa S, Töyräs J, Leppänen T. Increased nocturnal arterial pulsation frequencies of obstructive sleep apnoea patients is associated with an increased number of lapses in a psychomotor vigilance task. ERJ Open Res 2020; 6:00277-2020. [PMID: 33263035 PMCID: PMC7682668 DOI: 10.1183/23120541.00277-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/28/2020] [Indexed: 12/28/2022] Open
Abstract
Objectives Besides hypoxaemia severity, heart rate variability has been linked to cognitive decline in obstructive sleep apnoea (OSA) patients. Thus, our aim was to examine whether the frequency domain features of a nocturnal photoplethysmogram (PPG) can be linked to poor performance in the psychomotor vigilance task (PVT). Methods PPG signals from 567 suspected OSA patients, extracted from Type 1 diagnostic polysomnography, and corresponding results of PVT were retrospectively examined. The frequency content of complete PPGs was determined, and analyses were conducted separately for men (n=327) and women (n=240). Patients were grouped into PVT performance quartiles based on the number of lapses (reaction times ≥500 ms) and within-test variation in reaction times. The best-performing (Q1) and worst-performing (Q4) quartiles were compared due the lack of clinical thresholds in PVT. Results We found that the increase in arterial pulsation frequency (APF) in both men and women was associated with a higher number of lapses. Higher APF was also associated with higher within-test variation in men, but not in women. Median APF (β=0.27, p=0.01), time spent under 90% saturation (β=0.05, p<0.01), female sex (β=1.29, p<0.01), older age (β=0.03, p<0.01) and subjective sleepiness (β=0.07, p<0.01) were significant predictors of belonging to Q4 based on lapses. Only female sex (β=0.75, p<0.01) and depression (β=0.91, p<0.02) were significant predictors of belonging to Q4 based on the within-test variation. Conclusions In conclusion, increased APF in PPG provides a possible polysomnography indicator for deteriorated vigilance especially in male OSA patients. This finding highlights the connection between cardiorespiratory regulation, vigilance and OSA. However, our results indicate substantial sex-dependent differences that warrant further prospective studies.
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Affiliation(s)
- Samu Kainulainen
- Dept of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Brett Duce
- Sleep Disorders Centre, Dept of Respiratory and Sleep Medicine, Princess Alexandra Hospital, Brisbane, Australia.,Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Henri Korkalainen
- Dept of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Akseli Leino
- Dept of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Riku Huttunen
- Dept of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Laura Kalevo
- Dept of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Erna S Arnardottir
- Dept of Computer Science, Reykjavik University, Reykjavik, Iceland.,Internal Medicine Services, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Antti Kulkas
- Dept of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Dept of Clinical Neurophysiology, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Sami Myllymaa
- Dept of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Juha Töyräs
- Dept of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Timo Leppänen
- Dept of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
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Benveniste H, Elkin R, Heerdt PM, Koundal S, Xue Y, Lee H, Wardlaw J, Tannenbaum A. The glymphatic system and its role in cerebral homeostasis. J Appl Physiol (1985) 2020; 129:1330-1340. [PMID: 33002383 DOI: 10.1152/japplphysiol.00852.2019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The brain's high bioenergetic state is paralleled by high metabolic waste production. Authentic lymphatic vasculature is lacking in brain parenchyma. Cerebrospinal fluid (CSF) flow has long been thought to facilitate central nervous system detoxification in place of lymphatics, but the exact processes involved in toxic waste clearance from the brain remain incompletely understood. Over the past 8 yr, novel data in animals and humans have begun to shed new light on these processes in the form of the "glymphatic system," a brain-wide perivascular transit passageway dedicated to CSF transport and interstitial fluid exchange that facilitates metabolic waste drainage from the brain. Here we will discuss glymphatic system anatomy and methods to visualize and quantify glymphatic system (GS) transport in the brain and also discuss physiological drivers of its function in normal brain and in neurodegeneration.
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Affiliation(s)
- Helene Benveniste
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
| | - Rena Elkin
- Departments of Computer Science and Applied Mathematics & Statistics, Stony Brook University, Stony Brook, New York
| | - Paul M Heerdt
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
| | - Sunil Koundal
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
| | - Yuechuan Xue
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
| | - Hedok Lee
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
| | - Joanna Wardlaw
- Brain Research Imaging Centre, Centre for Clinical Brain Sciences, Dementia Research Institute at the University of Edinburgh, Edinburgh, United Kingdom
| | - Allen Tannenbaum
- Departments of Computer Science and Applied Mathematics & Statistics, Stony Brook University, Stony Brook, New York
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Association between obstructive sleep apnea and risk of post-stroke depression: A hospital-based study in ischemic stroke patients. J Stroke Cerebrovasc Dis 2020; 29:104876. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.104876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/04/2020] [Accepted: 04/07/2020] [Indexed: 01/01/2023] Open
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Woo HG, Song TJ, Jung JS, Oh SW, Lee SC, Seok JM, Yang KI. Association between the high risk for obstructive sleep apnea and intracranial carotid artery calcification in patients with acute ischemic stroke. Sleep Breath 2020; 25:299-307. [PMID: 32562170 DOI: 10.1007/s11325-020-02117-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/21/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is an independent risk factor for stroke. Furthermore, intracranial carotid artery calcification (ICAC) is a marker for subclinical atherosclerosis and future cardiovascular events. We investigated the association between the high risk for OSA and ICAC in patients with acute ischemic stroke. METHODS We retrospectively investigated 73 patients who were admitted to the hospital with acute ischemic stroke in the internal carotid artery (ICA) territory due to large-artery atherosclerosis. The risk for OSA was assessed using the Berlin Questionnaire, and patients were classified into low-risk (LR-OSA) and high-risk groups (HR-OSA). We compared the burden of ICAC between the two groups. Univariable and multivariable analyses were conducted to investigate the association of high risk for OSA with the presence of calcium in intracranial ICA. RESULTS The HR-OSA group of 35 patients (48%) was significantly older and had a higher rate of hypertension and diabetes mellitus than the LR-OSA group. The HR-OSA group had more frequent ICAC (92% vs. 63%, p < 0.001), higher Agatston score (162.0 vs. 8.5, p < 0.001), and greater total volume of ICAC (261.2 mm3 vs. 20.1 mm3, p < 0.001) in the intracranial ICA. Presence of calcium in symptomatic intracranial ICA was positively correlated with age (odds ratio, OR, 1.432; 95% confidence interval, CI, 1.098-1.868) and HR-OSA (OR, 18.272; 95% CI, 0.500-668.401) in multivariable logistic regression analysis. CONCLUSIONS This study showed that the presence of calcium in symptomatic intracranial ICA was related to high risk for OSA in patients with acute ischemic stroke.
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Affiliation(s)
- Ho Geol Woo
- Departments of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Jo Sung Jung
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, South Korea
| | - Se Won Oh
- Department of Radiology, Eunpyeong St. Mary's Hospital, Catholic University of Korea, Seoul, South Korea
| | - Seung Cheol Lee
- Sleep Disorders Center, Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, 31151, South Korea
| | - Jin Myoung Seok
- Sleep Disorders Center, Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, 31151, South Korea
| | - Kwang Ik Yang
- Sleep Disorders Center, Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, 31151, South Korea.
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Zong X, Lian C, Jimenez J, Yamashita K, Shen D, Lin W. Morphology of perivascular spaces and enclosed blood vessels in young to middle-aged healthy adults at 7T: Dependences on age, brain region, and breathing gas. Neuroimage 2020; 218:116978. [PMID: 32447015 PMCID: PMC7485170 DOI: 10.1016/j.neuroimage.2020.116978] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 05/16/2020] [Accepted: 05/18/2020] [Indexed: 12/30/2022] Open
Abstract
Perivascular spaces (PVSs) are fluid-filled spaces surrounding penetrating blood vessels in the brain and are an integral pathway of the glymphatic system. A PVS and the enclosed blood vessel are commonly visualized as a single vessel-like complex (denoted as PVSV) in high-resolution MRI images. Quantitative characterization of the PVSV morphology in MRI images in healthy subjects may serve as a reference for detecting disease related PVS and/or blood vessel alterations in patients with brain diseases. To this end, we evaluated the age dependences, spatial heterogeneities, and dynamic properties of PVSV morphological features in 45 healthy subjects (21–55 years old), using an ultra-high-resolution three-dimensional transverse relaxation time weighted MRI sequence (0.41 × 0.41 × 0.4 mm3) at 7T. Quantitative PVSV parameters, including apparent diameter, count, volume fraction (VF), and relative contrast to noise ratio (rCNR) were calculated in the white matter and subcortical structures. Dynamic changes were induced by carbogen breathing which are known to induce vasodilation and increase the blood oxygenation level in the brain. PVSV count and VF significantly increased with age in basal ganglia (BG), so did rCNR in BG, midbrain, and white matter (WM). Apparent PVSV diameter also showed a positive association with age in the three brain regions, although it did not reach statistical significance. The PVSV VF and count showed large inter-subject variations, with coefficients of variation ranging from 0.17 to 0.74 after regressing out age and gender effects. Both apparent diameter and VF exhibited significant spatial heterogeneity, which cannot be explained solely by radio-frequency field inhomogeneities. Carbogen breathing significantly increased VF in BG and WM, and rCNR in thalamus, BG, and WM compared to air breathing. Our results are consistent with gradual dilation of PVSs with age in healthy adults. The PVSV morphology exhibited spatial heterogeneity and large inter-subject variations and changed during carbogen breathing compared to air breathing.
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Affiliation(s)
- Xiaopeng Zong
- Biomedical Research Imaging Center, Chapel Hill, NC, USA; Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Chunfeng Lian
- Biomedical Research Imaging Center, Chapel Hill, NC, USA; Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jordan Jimenez
- Biomedical Research Imaging Center, Chapel Hill, NC, USA
| | - Koji Yamashita
- Biomedical Research Imaging Center, Chapel Hill, NC, USA; Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dinggang Shen
- Biomedical Research Imaging Center, Chapel Hill, NC, USA; Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Weili Lin
- Biomedical Research Imaging Center, Chapel Hill, NC, USA; Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Wang J, Chen X, Liao J, Zhou L, Han H, Tao J, Lu Z. Non breathing-related sleep fragmentation and imaging markers in patients with atherosclerotic cerebral small vessel disease (CSVD): a cross-sectional case-control study. BMC Neurol 2020; 20:98. [PMID: 32183737 PMCID: PMC7076927 DOI: 10.1186/s12883-020-01647-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 02/19/2020] [Indexed: 12/22/2022] Open
Abstract
Background Sleep fragmentation was shown to be positively associated with cognitive impairment in patients with cerebral small vessel disease (CSVD); however, the underlying mechanisms are not well characterized. In this study, we sought to clarify this issue by investigating the relationship between non breathing-related sleep fragmentation and brain imaging markers in patients with CSVD. Methods Eighty-four CSVD patients and 24 age- and sex-matched healthy controls were prospectively recruited. All subjects underwent 3.0 T superconducting magnetic resonance imaging and overnight polysomnography. Polysomnography parameters including sleep onset latency (SOL), total sleep time (TST); sleep efficiency (SE), wake after sleep onset (WASO), percentage of each sleep stage (N1, N2, N3 and rapid eye movement [REM]), arousal index (ArI), periodic limb movement in sleep index (PLSMI), and periodic limb movement related arousal index (PLMAI) were compared between CSVD patients and healthy controls. The relationship between arousal index and CSVD markers was explored in the CSVD group. Results On polysomnography, CSVD patients showed significantly higher ArI, WASO, PLSMI, and PLMAI, and lower sleep efficiency and N− 3 ratio compared to healthy controls (p < 0.05). On ordinal logistic regression, higher ArI showed a positive association with the severity of periventricular white matter hyperintensity (odds ratio [OR] 1.121, 95% confidence interval [CI] 0.138–2.185) and perivascular space (OR 2.108, 95% CI 1.032–4.017) in CSVD patients, after adjusting for potential confounding variables. Conclusions These preliminary results indicate that non breathing-related sleep fragmentation is common and related to the pathological markers of CSVD patients. Future prospective research is required to determine the causal relationship between sleep parameters and CSVD pathology.
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Affiliation(s)
- Jihui Wang
- Department of Psychiatry, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, China
| | - Xiaodong Chen
- Department of Neurology, the Third Affiliated Hospital, Sun Yat-sen University, No. 60, Tianhe Road, Tianhe District, Guangzhou, 510630, China
| | - Jinchi Liao
- Department of Neurology, the Third Affiliated Hospital, Sun Yat-sen University, No. 60, Tianhe Road, Tianhe District, Guangzhou, 510630, China
| | - Li Zhou
- Department of Rehabilitative Medicine, the First Affiliated Hospital of Clinical Medicine of Guangdong Pharmaceutical University, Guangzhou, 510080, China
| | - Hongying Han
- Department of Psychiatry, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, China
| | - Jiong Tao
- Department of Psychiatry, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, China
| | - Zhengqi Lu
- Department of Neurology, the Third Affiliated Hospital, Sun Yat-sen University, No. 60, Tianhe Road, Tianhe District, Guangzhou, 510630, China.
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Perivascular spaces in the brain: anatomy, physiology and pathology. Nat Rev Neurol 2020; 16:137-153. [PMID: 32094487 DOI: 10.1038/s41582-020-0312-z] [Citation(s) in RCA: 364] [Impact Index Per Article: 91.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2020] [Indexed: 02/06/2023]
Abstract
Perivascular spaces include a variety of passageways around arterioles, capillaries and venules in the brain, along which a range of substances can move. Although perivascular spaces were first identified over 150 years ago, they have come to prominence recently owing to advances in knowledge of their roles in clearance of interstitial fluid and waste from the brain, particularly during sleep, and in the pathogenesis of small vessel disease, Alzheimer disease and other neurodegenerative and inflammatory disorders. Experimental advances have facilitated in vivo studies of perivascular space function in intact rodent models during wakefulness and sleep, and MRI in humans has enabled perivascular space morphology to be related to cognitive function, vascular risk factors, vascular and neurodegenerative brain lesions, sleep patterns and cerebral haemodynamics. Many questions about perivascular spaces remain, but what is now clear is that normal perivascular space function is important for maintaining brain health. Here, we review perivascular space anatomy, physiology and pathology, particularly as seen with MRI in humans, and consider translation from models to humans to highlight knowns, unknowns, controversies and clinical relevance.
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Riba-Llena I, Álvarez-Sabin J, Romero O, Santamarina E, Sampol G, Maisterra O, Ferré Á, Montaner J, Quintana M, Delgado P. Nighttime hypoxia affects global cognition, memory, and executive function in community-dwelling individuals with hypertension. J Clin Sleep Med 2020; 16:243-250. [PMID: 31992414 DOI: 10.5664/jcsm.8174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The objective of this study was to determine which respiratory and architectural sleep parameters are related to cognitive function and cognitive status (mild cognitive impairment [MCI] versus normal cognitive aging [NCA]) in community-dwelling individuals with hypertension. Additionally, it aimed to determine whether the results changed in the presence or absence of vascular brain lesions (silent brain infarcts and extensive white matter hyperintensities [WMHs]). METHODS In a cohort of individuals with hypertension and without previous stroke or dementia, we conducted in-hospital polysomnography including electroencephalography, electro-oculography, electromyography, and magnetic resonance imaging to assess silent brain infarcts and WMHs. Cognitive testing was carried out with a screening test (Dementia Rating Scale version 2 [DRS-2]) and a complete cognitive visit. RESULTS This study included 158 participants with a median age of 65.0 years; 32.3% were females, and the median apnea-hypopnea index was 22.3 events/h. MCI was diagnosed in 24 study participants, and the rest had NCA. Regarding respiratory parameters, total DRS-2 scores (β; 95% CI) 0.121; 0.026, 0.215 were positively associated with mean O₂ saturation, whereas total (-0.022; -0.036, -0.009), executive function (-0.016; -0.026, -0.006) and memory (-0.017; -0.029, -0.004) DRS-2 scores were all negatively associated with the percent of time with oxygen saturation < 90% after correcting for education, vascular risk factors, and magnetic resonance imaging lesions. Regarding sleep architecture, Attention DRS-2 scores (0.0153; 0.001, 0.306) were independently associated with total sleep time. Similar results were obtained in the absence of silent brain infarcts or WMHs in the stratified analysis. None of the sleep parameters were associated with cognitive status. CONCLUSIONS Low oxygen saturation contributes to cognitive performance, and this effect appears even in the absence of vascular brain lesions in individuals with hypertension.
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Affiliation(s)
- Iolanda Riba-Llena
- Neurovascular Research Laboratory, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Neurology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Álvarez-Sabin
- Neurology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Odile Romero
- Multidisciplinary Sleep Unit, Department of Neurophysiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Estevo Santamarina
- Neurology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gabriel Sampol
- CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.,Multidisciplinary Sleep Unit, Respiratory Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Olga Maisterra
- Neurology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Álex Ferré
- Multidisciplinary Sleep Unit, Department of Neurophysiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Quintana
- Neurology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pilar Delgado
- Neurovascular Research Laboratory, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Zhao M, Guan L, Wang Y. The Association of Autonomic Nervous System Function With Ischemic Stroke, and Treatment Strategies. Front Neurol 2020; 10:1411. [PMID: 32038467 PMCID: PMC6987371 DOI: 10.3389/fneur.2019.01411] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/24/2019] [Indexed: 12/11/2022] Open
Abstract
Acute ischemic stroke, especially minor stroke, and transient ischemic attack have high risks of recurrence and exacerbation into severe ischemic strokes. It remains challenging to perform risk stratification and screen high-risk groups for initiation of early treatment in these patients. Moreover, with the growing population of patients with chronic small vessel disease, the mechanisms and clinical implications require further investigation. Traditional tools such as the ABCD2 score (age, blood pressure, clinical features, duration of symptoms, diabetes) have only moderate predictive value in patients with transient ischemic attack or minor stroke. By contrast, measurement of changes in heart rate variability (HRV) is an important and novel tool for risk stratification and outcome prediction in patients with cardiovascular diseases, as it reflects the overall level of autonomic nervous system dysfunction. Thus, abnormal HRV may be useful for prognosis and improve stratification of stroke patients with diverse risks. HRV may also partially explain autonomic nervous dysfunction and other manifestations during the process of chronic cerebral small vessel disease. In summary, measurement of HRV may contribute to early initiation of interventions in acute or chronic stroke patients using novel treatments involving rebalancing of autonomic nervous system function.
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Affiliation(s)
- Mengxi Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ling Guan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yilong Wang
- Department of Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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Lauer A, Ay H, Bianchi M, Charidimou A, Boulouis G, Ayres A, Vashkevich A, Schwab KM, Singhal AB, Viswanathan A, Rost NS, Goldstein JN, Rosand J, Schwamm LH, Greenberg SM, Gurol ME. Cerebral Small Vessel Diseases and Sleep Related Strokes. J Stroke Cerebrovasc Dis 2020; 29:104606. [PMID: 31937490 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104606] [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: 10/22/2019] [Revised: 12/13/2019] [Accepted: 12/15/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND PURPOSE Sleep related Stroke (SRS) is common and has been associated with cerebral small vessel diseases (SVD) in ischemic strokes (ISs). We tested the hypothesis that SRS is associated with SVD in both ischemic and hemorrhagic stroke. METHODS Prospectively collected data from patients consecutively enrolled after intracerebral hemorrhage (ICH) related to SVD or after IS were analyzed. Symptom onset was recorded as SRS versus awake. Each ICH was grouped according to lobar and deep locations. The IS cohort was etiologically characterized based on the Causative Classification of Stroke system. Frequencies of SRS within and between ICH and IS cohorts as well as its associations (etiology, risk factors) were analyzed. RESULTS We analyzed 1812 IS (mean age 67.9 years ± 15.9 years, 46.4% female) and 1038 ICH patients (mean age 72.5 years ± 13.0 years, 45.4% female). SRS was significantly more common among SVD-related ICH patients (n = 276, 26.6%) when compared to all IS (n = 363, 20.0%, P < .001) and in both, small artery occlusion (SAO) related IS and lobar ICH within the respective IS and ICH cohorts (16.3% SRS versus 9.1% awake for SAO within all IS, P < .001; and 57.1% SRS versus 47.7% awake for lobar bleeds within all ICH, P = .008). These associations remained significant after controlling for age, sex and risk factors. CONCLUSIONS SRS was associated with SVD. The SAO etiology and cerebral amyloid angiopathy related lobar ICH suggest that the presence of SVD can interact with sleep or arousal related hemodynamic changes to cause ischemic and hemorrhagic stroke.
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Affiliation(s)
- Arne Lauer
- Stroke Service, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, Massachusetts
| | - Hakan Ay
- Stroke Service, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, Massachusetts
| | - Matt Bianchi
- Stroke Service, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, Massachusetts
| | - Andreas Charidimou
- Stroke Service, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, Massachusetts
| | - Gregoire Boulouis
- Stroke Service, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, Massachusetts
| | - Alison Ayres
- Stroke Service, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, Massachusetts
| | - Anastasia Vashkevich
- Stroke Service, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, Massachusetts
| | - Kristin M Schwab
- Stroke Service, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, Massachusetts
| | - Aneesh B Singhal
- Stroke Service, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, Massachusetts
| | - Anand Viswanathan
- Stroke Service, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, Massachusetts
| | - Natalia S Rost
- Stroke Service, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, Massachusetts
| | - Joshua N Goldstein
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jonathan Rosand
- Stroke Service, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, Massachusetts
| | - Lee H Schwamm
- Stroke Service, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, Massachusetts
| | - Steven M Greenberg
- Stroke Service, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, Massachusetts
| | - Mahmut Edip Gurol
- Stroke Service, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, Massachusetts.
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Wang J, Chen X, Men X, Chen M, Tao J, Lu Z. Chronic Insomnia Is Associated with Higher Circulating Interleukin-8 in Patients with Atherosclerotic Cerebral Small Vessel Disease. Nat Sci Sleep 2020; 12:93-99. [PMID: 32104118 PMCID: PMC7023852 DOI: 10.2147/nss.s239030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/23/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Chronic inflammatory responses and leukocyte infiltration are classical pathological features of cerebral small vessel disease (CSVD). To date, limited evidence of a relationship between chronic insomnia and inflammatory responses in patients with CSVD has been uncovered. The purpose of the present study was to investigate the potential relationship between chronic insomnia and pro-inflammatory cytokine levels in patients with atherosclerotic CSVD (A-CSVD). METHODS In total, 76 A-CSVD patients with or without chronic insomnia (CI) confirmed using magnetic resonance (MR) were prospectively recruited. Overnight polysomnography (PSG) was performed and serum levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), IL-6, IL-17A, IL-8, and IL-12 assessed. Cytokine levels were compared between CSVD+CI (study group) and CSVD without CI (control group) patients, and the correlations between PSG parameters and cytokine levels were explored in all patients via multiple linear regression analyses. RESULTS The serum IL-8 level of the study group (12.3±4.4 pg/mL) was significantly higher than that of the control group (7.5±2.2 pg/mL; P<0.05). PSG measurements showed that patients in the study group had significantly higher sleep onset latency (SOL), arousal index (ArI) and wake after sleep onset (WASO) as well as lower total sleep time (TST), sleep efficiency (SE) and stage 3 NREM sleep (N-3) ratio, compared with the control group (P<0.05). Multiple linear regression analyses led to the identification of ArI (β=0.026, P<0.05) and TST (β=-0.054, P<0.05) as significant positive and negative predictors of the IL-8 level, respectively. CONCLUSION Chronic insomnia, in particular, sleep fragmentation and short sleep duration, may be involved in promotion of serum IL-8 expression in patients with atherosclerotic CSVD.
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Affiliation(s)
- Jihui Wang
- Department of Psychiatry, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, People's Republic of China
| | - Xiaodong Chen
- Department of Neurology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, People's Republic of China
| | - Xuejiao Men
- Department of Neurology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, People's Republic of China
| | - Minhua Chen
- Department of Psychiatry, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, People's Republic of China
| | - Jiong Tao
- Department of Psychiatry, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, People's Republic of China
| | - Zhengqi Lu
- Department of Neurology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, People's Republic of China
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Chokesuwattanaskul A, Lertjitbanjong P, Thongprayoon C, Bathini T, Sharma K, Mao MA, Cheungpasitporn W, Chokesuwattanaskul R. Impact of obstructive sleep apnea on silent cerebral small vessel disease: a systematic review and meta-analysis. Sleep Med 2019; 68:80-88. [PMID: 32028230 DOI: 10.1016/j.sleep.2019.11.1262] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/28/2019] [Accepted: 11/27/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cerebral small vessel disease (CSVD) is a well-known cause of vascular dementia, a leading medical morbidity in the aging population. Obstructive sleep apnea (OSA) has been validated as a cardiovascular risk factor. However, the relationship between these two clinical syndromes is not well established. We aimed to assess the association between OSA and CSVD. METHODS Databases were searched from inception through May 2019. Studies that reported incidence or odd ratios of CSVD in patients with OSA were included. Effect estimates from the individual studies were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird. RESULTS A total of 14 observational studies comprising of 4335 patients were included into the analysis. Compared to patients without OSA, patients with OSA were significantly associated with CSVD magnetic resonance imaging (MRI) findings of white matter hyperintensity (WMH) and asymptomatic lacunar infarction (ALI) with a pooled OR of 2.31 (95% confidence interval [CI], 1.46-3.66, I2 = 79%) and 1.78 (95% CI, 1.06-3.01, I2 = 41%), respectively. However, there was no significant association between OSA and findings of cerebral microbleeds (CMBs), with a pooled odds ratio (OR) of 2.15 (95% CI, 0.64-7.29, I2 = 55%). CONCLUSIONS Our study demonstrated the association between OSA and CSVD MRI findings of white matter hyperintensity (WMH) and asymptomatic lacunar infarction (ALI) when compared to patients without OSA. The absence of an association of CMBs findings with OSA could be due either by a lower sensitivity of neuroimaging techniques utilized to detect CMBs or a potentially different pathogenesis of CMBs.
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Affiliation(s)
- Anthipa Chokesuwattanaskul
- Division of Neurology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
| | | | | | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ, USA
| | - Konika Sharma
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA
| | - Michael A Mao
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, 32224, USA
| | | | - Ronpichai Chokesuwattanaskul
- King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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50
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Ward SA, Pase MP. Advances in pathophysiology and neuroimaging: Implications for sleep and dementia. Respirology 2019; 25:580-592. [DOI: 10.1111/resp.13728] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/02/2019] [Accepted: 10/16/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Stephanie A. Ward
- School of Public Health and Preventive MedicineMonash University Melbourne VIC Australia
- Department of Geriatric MedicinePrince of Wales Hospital Sydney NSW Australia
- Centre for Healthy Brain Ageing (CHeBA), School of PsychiatryUniversity of New South Wales Sydney NSW Australia
| | - Matthew P. Pase
- Melbourne Dementia Research CentreThe Florey Institute of Neuroscience and Mental Health Melbourne VIC Australia
- Faculty of Medicine, Dentistry and Health ScienceThe University of Melbourne Melbourne VIC Australia
- Centre for Human PsychopharmacologySwinburne University of Technology Melbourne VIC Australia
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