1
|
Desai R, Singh S, Mellacheruvu SP, Mohammed AS, Soni R, Perera A, Makarla VA, Santhosh S, Siddiqui MA, Mohammed BK, Mohammed ZUR, Gandhi Z, Vyas A, Jain A, Sachdeva R, Kumar G. Recurrent/Subsequent Stroke and Associated Outcomes in Geriatric Patients with OSA and Prior Stroke Events: A Retrospective Study Using the 2019 National Inpatient Sample. J Pers Med 2023; 13:jpm13050782. [PMID: 37240952 DOI: 10.3390/jpm13050782] [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: 03/31/2023] [Revised: 04/22/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023] Open
Abstract
Background: Obstructive sleep apnea (OSA) increases the risk of stroke and cardiovascular diseases. However, its impact on geriatric patients with a prior history of stroke/transient ischemic attack (TIA) has not been adequately studied. Methods: We utilized the 2019 National Inpatient Sample in the US to identify geriatric patients with OSA (G-OSA) who had a prior history of stroke/TIA. We then compared subsequent stroke (SS) rates among sex and race subgroups. We also compared the demographics and comorbidities of SS+ and SS- groups and utilized logistic regression models to assess outcomes. Results: Out of 133,545 G-OSA patients admitted with a prior history of stroke/TIA, 4.9% (6520) had SS. Males had a higher prevalence of SS, while Asian-Pacific Islanders and Native Americans had the highest prevalence of SS, followed by Whites, Blacks, and Hispanics. The SS+ group had higher all-cause in-hospital mortality rates, with Hispanics showing the highest rate compared to Whites and Blacks (10.6% vs. 4.9% vs. 4.4%, p < 0.001), respectively. Adjusted analysis for covariates showed that complicated and uncomplicated hypertension (aOR 2.17 [95% CI 1.78-2.64]; 3.18 [95% CI 2.58-3.92]), diabetes with chronic complications (aOR 1.28 [95% CI 1.08-1.51]), hyperlipidemia (aOR 1.24 [95% CI 1.08-1.43]), and thyroid disorders (aOR 1.69 [95% CI 1.14-2.49]) were independent predictors of SS. The SS+ group had fewer routine discharges and higher healthcare costs. Conclusions: Our study shows that about 5% of G-OSA patients with a prior history of stroke/TIA are at risk of hospitalization due to SS, which is associated with higher mortality and healthcare utilization. Complicated and uncomplicated hypertension, diabetes with chronic complications, hyperlipidemia, thyroid disorders, and admission to rural hospitals predict subsequent stroke.
Collapse
Affiliation(s)
- Rupak Desai
- Division of Cardiology, Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA 30033, USA
| | - Sandeep Singh
- Department of Internal Medicine, University Hospital of North Midlands NHS Foundation Trust, Stoke-on-Trent ST4 6QG, UK
| | | | | | - Roshni Soni
- Department of General Medicine, GMERS Medical College, Gotri, Vadodara 390021, India
| | - Ayodya Perera
- International Faculty of Medicine, Tbilisi State Medical University, Tbilisi 0186, Georgia
| | | | - Sarayu Santhosh
- Department of Internal Medicine, Adichunchanagiri Institute of Medical Sciences, Rajiv Gandhi University of Health Sciences, B.G. Nagara, Bengaluru 560041, India
| | - Muneeb Ali Siddiqui
- College of Osteopathic Medicine, William Carey University, Hattiesburg, MS 39401, USA
| | - Bilal Khan Mohammed
- Department of Clinical Research, Duke University Medical Center, Durham, NC 27710, USA
| | | | - Zainab Gandhi
- Department of Internal Medicine, Wyoming Valley Medical Center, Wilkes-Barre, PA 18711, USA
| | - Ankit Vyas
- Department of Internal Medicine, Baptist Hospitals Of Southeast Texas, Beaumont, TX 77701, USA
| | - Akhil Jain
- Department of Internal Medicine, Mercy Catholic Medical Center, Darby, PA 19153, USA
| | - Rajesh Sachdeva
- Division of Cardiology, Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA 30033, USA
| | - Gautam Kumar
- Division of Cardiology, Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA 30033, USA
- Division of Cardiology, Emory University School of Medicine, Atlanta VA Medical Center, Atlanta, GA 30322, USA
| |
Collapse
|
2
|
Muacevic A, Adler JR, Prange E, Celso B. Trending Weight Loss Between Usual Care and Bariatric Surgery Among Higher Weight Persons With Obstructive Sleep Apnea. Cureus 2022; 14:e32052. [PMID: 36600828 PMCID: PMC9803588 DOI: 10.7759/cureus.32052] [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: 09/07/2022] [Accepted: 11/29/2022] [Indexed: 12/05/2022] Open
Abstract
Background This study aimed to investigate the actual weight change documented as a goal of treatment after patients were newly diagnosed with obstructive sleep apnea (OSA). We hypothesized that patients with OSA and classified as overweight and obese based on BMI would fail to achieve significant weight loss over a two- to five-year period. Methodology This retrospective review included adults aged 18 years or older who were newly diagnosed with OSA in 2015, as indicated by a full nocturnal polysomnogram and using the 4% rule for the definition of hypopnea. Data collected were between January 01, 2015, and December 31, 2020. Patients received either usual care for weight reduction or bariatric surgery to assess the overall weight loss and identify barriers. Statistical analysis included independent t-tests, Mann-Whitney U tests and related samples McNemar change statistics, Cox proportional hazards regression, and Kaplan-Meier curves to analyze age, gender, ethnicity, and weight differences between usual care and bariatric surgery groups. Results The number of participants included for usual care and bariatric surgery was 100 and 24, respectively. Over five years, 87% of the usual care patients remained in the same BMI classification, 7% lowered their classification, and 6% raised theirs. For usual care patients, the average net weight per individual of 2.19 kg gained represented a 1.96% weight change. Bariatric patients lost an average net weight of 30.40 kg (22.39%). Cox proportional hazards regression showed that the overall model fit was statistically significant (χ2 = 55.40, degrees of freedom [df] = 9, and P-value < 0.001). The significant variables were time-dependent weight change and ethnicity. The Kaplan-Meier curve revealed that weight loss reduced over time in treatment. Conclusions This study confirmed that despite the direction to lose weight, only 7% of OSA patients lowered their BMI classification. Patient instruction and provider-driven weight loss strategies seem equally ineffective to achieve sustained weight reduction among high-risk groups. More research is needed to investigate optimal strategies that include interprofessional collaborative practices for sustained weight loss.
Collapse
|
3
|
A Health Communication Assessment of Web-based Obstructive Sleep Apnea Patient Education Materials. ATS Sch 2022; 3:48-63. [PMID: 35634002 PMCID: PMC9131885 DOI: 10.34197/ats-scholar.2021-0055oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/14/2021] [Indexed: 11/18/2022] Open
Abstract
Background Objective Methods Results Conclusion
Collapse
|
4
|
Questionnaire and Portable Sleep Test Screening of Sleep Disordered Breathing in Acute Stroke and TIA. J Clin Med 2021; 10:jcm10163568. [PMID: 34441863 PMCID: PMC8396899 DOI: 10.3390/jcm10163568] [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: 05/12/2021] [Revised: 07/17/2021] [Accepted: 07/20/2021] [Indexed: 12/27/2022] Open
Abstract
Sleep disordered breathing (SDB) is highly prevalent, but frequently unrecognized among stroke patients. Polysomnography (PSG) is difficult to perform soon after a stroke. We evaluated the use of screening questionnaires and portable sleep testing (PST) for patients with acute stroke, subarachnoid hemorrhage, or transient ischemic attack to expedite SDB diagnosis and management. We performed a single-center retrospective analysis of a quality improvement study on SDB screening of consecutive daytime, weekday, adult admissions to a stroke unit. We excluded patients who were unable to communicate and lacked available family members. Patients were screened with the Epworth Sleepiness Scale, Berlin Questionnaire, and STOP-BANG Questionnaire and underwent overnight PST and/or outpatient PSG. The 4-item STOP Questionnaire was derived from STOP-BANG for a secondary analysis. We compared the sensitivity and specificity of the questionnaires for the diagnosis of at least mild SDB (apnea hypopnea index (AHI) ≥5) on PST and correlated AHI measurements between PST and PSG using the Spearman correlation. Out of sixty-eight patients included in the study, 54 (80%) were diagnosed with SDB. Only one (1.5%) had a previous SDB diagnosis. Thirty-three patients completed all questionnaires and a PST. The STOP-BANG questionnaire had the highest sensitivity for at least mild SDB (0.81, 95% CI (confidence interval): 0.65–0.92) but a low specificity (0.33, 95% CI 0.10, 0.65). The discrimination of all questionnaires was overall poor (C statistic range 0.502–0.640). There was a strong correlation (r = 0.71) between the AHI results estimated using PST and outpatient PSG among 28 patients. The 4-item STOP Questionnaire was the easiest to administer and had a comparable or better sensitivity than the other questionnaires. Inpatient PSTs were useful for screening in the acute setting to facilitate an early diagnosis of SDB and to establish further outpatient evaluations with sleep medicine.
Collapse
|
5
|
Abijay CA, Tomkies A, Rayasam S, Johnson RF, Mitchell RB. Children With Down Syndrome and Obstructive Sleep Apnea: Outcomes After Tonsillectomy. Otolaryngol Head Neck Surg 2021; 166:557-564. [PMID: 34253070 DOI: 10.1177/01945998211023102] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate outcomes of tonsillectomy and predictors for persistent obstructive sleep apnea (OSA) in children with Down syndrome in an ethnically diverse population. STUDY DESIGN Case series with chart review. SETTING UT Southwestern/Children's Medical Center Dallas. METHODS Polysomnographic, clinical, and demographic characteristics of children with Down syndrome ages 1 to 18 years were collected, including pre- and postoperative polysomnography. Simple and multivariable regression models were used for predictors for persistent OSA. P≤ .05 was considered significant. RESULTS Eighty-one children were included with a mean age of 6.6 years, 44 of 81 (54%) males, and 53 of 81 (65%) Hispanic. Preoperatively, 60 of 81 (74%) patients had severe OSA. Posttonsillectomy improvements occurred for apnea-hypopnea index (27.9 to 14.0, P < .001), arousal index (25.2 to 18.8, P = .004), percent time with oxygen saturations <90% (8.8% to 3.4%, P = .003), and oxygen nadir (81.4% to 85%, P < .001). Forty-seven children (58%) had persistent OSA. Fifteen children (18.5%) had increased apnea-hypopnea index postoperatively: 2 from mild to moderate, 2 from mild to severe, and 2 from moderate to severe obstructive sleep apnea. Persistent OSA predictors were asthma (odds ratio, 4.77; 95% CI, 1.61-14.09; P = .005) and increasing age (odds ratio, 1.25; 95% CI, 1.09-1.43; P = .001). CONCLUSION Children with Down syndrome are at high risk for persistent OSA after tonsillectomy with about 20% worsening after tonsillectomy. Asthma and increasing age are predictors for persistent OSA in children with Down syndrome.
Collapse
Affiliation(s)
| | - Anna Tomkies
- Department of Otolaryngology Head and Neck Surgery, University of Texas Southwestern Medical Center Dallas, Dallas, Texas, USA
| | - Swathi Rayasam
- Department of Otolaryngology Head and Neck Surgery, Division of Pediatric Otolaryngology, UT Southwestern and Children's Medical Center Dallas, Dallas, Texas, USA
| | - Romaine F Johnson
- Department of Otolaryngology Head and Neck Surgery, Division of Pediatric Otolaryngology, UT Southwestern and Children's Medical Center Dallas, Dallas, Texas, USA
| | - Ron B Mitchell
- Department of Otolaryngology Head and Neck Surgery, UT Southwestern and Children's Medical Center Dallas, Dallas, Texas, USA
| |
Collapse
|
6
|
Jean-Louis G, Robbins R, Williams NJ, Allegrante JP, Rapoport DM, Cohall A, Ogedegbe G. Tailored Approach to Sleep Health Education (TASHE): a randomized controlled trial of a web-based application. J Clin Sleep Med 2020; 16:1331-1341. [PMID: 32329437 DOI: 10.5664/jcsm.8510] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
STUDY OBJECTIVES In a randomized controlled trial, we compared the effect of the Tailored Approach to Sleep Health Education (TASHE) on obstructive sleep apnea (OSA) self-efficacy among community-dwelling blacks in New York City. METHODS Study participants were 194 blacks at high risk for OSA based on the Apnea Risk Evaluation System. TASHE intervention was delivered via a Wi-Fi-enabled tablet, programmed to provide online access to culturally and linguistically tailored information designed to address unique barriers to OSA care among blacks. Blacks in the attention-controlled arm received standard sleep information via the National Sleep Foundation website. Blacks in both arms accessed online sleep information for 2 months. Outcomes (OSA health literacy, self-efficacy, knowledge and beliefs, and sleep hygiene) were assessed at baseline, at 2 months, and at 6 months. RESULTS We compared outcomes in both arms based on intention-to-treat analysis using adjusted Generalized Linear Mixed Modeling. TASHE exposure significantly increased OSA self-efficacy (OSA outcome expectation [β = .5; 95% CI: .1-.9] and OSA treatment efficacy [β = 0.4; 95% CI: .0-.8]) at 2 months but not at 6 months. Additionally, TASHE exposure improved sleep hygiene at 6 months (β = 6.7; 95% CI: 2.2-11.3) but not at 2 months. CONCLUSIONS Community-dwelling blacks exposed to TASHE materials reported increased OSA self-efficacy compared with standard sleep health education. Stakeholder-engaged, theory-based approaches, as demonstrated in the TASHE intervention, can be used successfully to deliver effective sleep health messages. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; URL: https://clinicaltrials.gov/ct2/show/NCT02507089; Identifier: NCT02507089.
Collapse
Affiliation(s)
- Girardin Jean-Louis
- Department of Population Health, Center for Healthful Behavioral Change, NYU Grossman School of Medicine, New York, New York.,Department of Psychiatry, NYU Grossman School of Medicine, New York, New York
| | - Rebecca Robbins
- Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Natasha J Williams
- Department of Population Health, Center for Healthful Behavioral Change, NYU Grossman School of Medicine, New York, New York
| | - John P Allegrante
- Columbia University Teachers College, New York, New York.,Columbia University Mailman School of Public Health, New York, New York
| | | | - Alwyn Cohall
- Columbia University Mailman School of Public Health, New York, New York
| | - Gbenga Ogedegbe
- Department of Population Health, Center for Healthful Behavioral Change, NYU Grossman School of Medicine, New York, New York
| |
Collapse
|
7
|
Jackson CL, Walker JR, Brown MK, Das R, Jones NL. A workshop report on the causes and consequences of sleep health disparities. Sleep 2020; 43:zsaa037. [PMID: 32154560 PMCID: PMC7420527 DOI: 10.1093/sleep/zsaa037] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/16/2020] [Indexed: 01/10/2023] Open
Abstract
Sleep deficiencies, which include insufficient or long sleep duration, poor sleep quality, and irregular timing of sleep, are disproportionately distributed among populations that experience health disparities in the United States. Sleep deficiencies are associated with a wide range of suboptimal health outcomes, high-risk health behaviors, and poorer overall functioning and well-being. This report focuses on sleep health disparities (SHDs), which is a term defined as differences in one or more dimensions of sleep health on a consistent basis that adversely affect designated disadvantaged populations. SHDs appear to share many of the same determinants and causal pathways observed for health outcomes with well-known disparities. There also appears to be common behavioral and biological mechanisms that connect sleep with poorer health outcomes, suggesting a link between SHDs and other health disparities observed within these designated populations. In 2018, the National Institute on Minority Health and Health Disparities, the National Heart, Lung, and Blood Institute, and the Office of Behavioral and Social Sciences Research convened a workshop with experts in sleep, circadian rhythms, and health disparities to identify research gaps, challenges, and opportunities to better understand and advance research to address SHDs. The major strategy to address SHDs is to promote integration between health disparity causal pathways and sleep and circadian-related mechanisms in research approaches and study designs. Additional strategies include developing a comprehensive, integrative conceptual model, building transdisciplinary training and research infrastructure, and designing as well as testing multilevel, multifactorial interventions to address SHDs.
Collapse
Affiliation(s)
- Chandra L Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
- Intramural Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Jenelle R Walker
- Center for Translation Research and Implementation Science, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Marishka K Brown
- Division of Lung Diseases, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Rina Das
- Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Nancy L Jones
- Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| |
Collapse
|
8
|
Barletta P, Abreu AR, Ramos AR, Dib SI, Torre C, Chediak AD. Role of Obstructive Sleep Apnea in Cognitive Impairment. INTERNATIONAL JOURNAL OF HEAD AND NECK SURGERY 2019; 10:57-61. [PMID: 34305353 PMCID: PMC8302067 DOI: 10.5005/jp-journals-10001-1373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Obstructive sleep apnea (OSA) is a prevalent sleep related breathing disorder characterized by repetitive collapse of the upper airways leading to intermittent hypoxia and sleep disruption. Clinically relevant neurocognitive, metabolic and cardiovascular disease often occurs in OSA. Systemic hypertension, coronary artery disease, type 2 diabetes mellitus, cerebral vascular infarctions and atrial fibrillation are among the most often cited conditions with causal connections to OSA. Emerging science suggest that untreated and undertreated OSA increases the risk of developing cognitive impairment, including vascular dementia and neurodegenerative disorders, like Alzheimer’s disease. As with OSA, cardiovascular disease and type 2 diabetes mellitus, the incidence of dementia increases with age. Given our rapidly aging population, dementia prevalence will significantly increase. The aim of this treatise is to review current literature linking OSA to dementia and explore putative mechanisms by which OSA might facilitate the development and progression of dementia.
Collapse
Affiliation(s)
- Pamela Barletta
- Sleep Disorders Center, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Alexandre R Abreu
- Sleep Disorders Center, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Alberto R Ramos
- Sleep Disorders Center, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Salim I Dib
- Sleep Disorders Center, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Carlos Torre
- Sleep Disorders Center, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Alejandro D Chediak
- Sleep Disorders Center, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
9
|
Schneeberger AR, Seixas A, Schweinfurth N, Lang UE, Cajochen C, Bux DA, Richards S, Jean-Louis G, Huber CG. Differences in Insomnia Symptoms between Immigrants and Non-Immigrants in Switzerland attributed to Emotional Distress: Analysis of the Swiss Health Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E289. [PMID: 30669632 PMCID: PMC6352062 DOI: 10.3390/ijerph16020289] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 01/07/2019] [Accepted: 01/09/2019] [Indexed: 02/07/2023]
Abstract
Migration can be a stressful experience and may lead to poor health and behavioral changes. The immigrant population in Switzerland is disproportionately burdened by several negative health outcomes, chief among these is mental health issues. The aim of the study was to investigate whether sleep disturbances are more prevalent among immigrants compared to non-immigrants and whether emotional distress might explain sleep differences. Based on the Swiss Health Survey 2012 dataset, we analyzed the data of 17,968 people, of which 3406 respondents were immigrants. We examined variables including insomnia symptoms, emotional distress and clinical and socio-demographic data using unadjusted and adjusted generalized linear models. Compared to non-immigrants, immigrants suffer significantly more often from insomnia symptoms. Immigrants also endured higher levels of emotional distress. Higher values of emotional distress are related to other symptoms of sleep disorders. Immigrants with emotional distress were at significant risk of sleep disturbances. Sleep disparities between immigrants and non-immigrants may be influenced by emotional distress. Migration health care should address emotional distress, a more proximal and modifiable factor, as a possible cause of insomnia symptoms in immigrants.
Collapse
Affiliation(s)
- Andres R Schneeberger
- Psychiatrische Dienste Graubuenden (PDGR), Loestrasse 220, 7000 Chur, Switzerland.
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine (AECOM), 3331 Bainbridge Avenue, Bronx, NY 10467, USA.
- Psychiatrische Universitaetsklinik (PUK), Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Universitaet Zuerich, Lenggstrasse 31, 8032 Zurich, Switzerland.
| | - Azizi Seixas
- Center for Healthful Behavior Change, Department of Population Health, NYU School of Medicine, Translational Research Building, 227 East 30th Street, Floor 7, New York, NY 10016, USA.
| | - Nina Schweinfurth
- Universitaere Psychiatrische Kliniken Basel, Universitaet Basel, Switzerland (UPK), Wilhelm Klein-Strasse 27, 4012 Basel, Switzerland.
| | - Undine E Lang
- Universitaere Psychiatrische Kliniken Basel, Universitaet Basel, Switzerland (UPK), Wilhelm Klein-Strasse 27, 4012 Basel, Switzerland.
| | - Christian Cajochen
- Universitaere Psychiatrische Kliniken Basel, Universitaet Basel, Switzerland (UPK), Wilhelm Klein-Strasse 27, 4012 Basel, Switzerland.
| | - Donald A Bux
- Psychiatrische Dienste Graubuenden (PDGR), Loestrasse 220, 7000 Chur, Switzerland.
| | - Shannique Richards
- Center for Healthful Behavior Change, Department of Population Health, NYU School of Medicine, Translational Research Building, 227 East 30th Street, Floor 7, New York, NY 10016, USA.
| | - Girardin Jean-Louis
- Center for Healthful Behavior Change, Department of Population Health, NYU School of Medicine, Translational Research Building, 227 East 30th Street, Floor 7, New York, NY 10016, USA.
| | - Christian G Huber
- Universitaere Psychiatrische Kliniken Basel, Universitaet Basel, Switzerland (UPK), Wilhelm Klein-Strasse 27, 4012 Basel, Switzerland.
| |
Collapse
|
10
|
Jehan S, Farag M, Zizi F, Pandi-Perumal SR, Chung A, Truong A, Jean-Louis G, Tello D, McFarlane SI. Obstructive sleep apnea and stroke. SLEEP MEDICINE AND DISORDERS : INTERNATIONAL JOURNAL 2018; 2:120-125. [PMID: 30680373 PMCID: PMC6340906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Obstructive Sleep Apnea (OSA) is a common co-morbid condition in stroke patients. It represents a very important risk factor for stroke in addition to the other established ones such as hypertension, cardiovascular disease (CVD), hyperlipidemia, atrial fibrillation (AF), type 2 diabetes mellitus (T2DM), stress, smoking, and heavy drinking. Although in the United States the prevalence of OSA has somewhat decreased from the previous years, globally its prevalence remains constant, or in some cases, is on the rise. In this review we present the epidemiology for OSA in stroke populations and discuss the risk factors for stroke as well as the underlying pathogenetic mechanisms linking OSA, stroke and CVD. We also emphasize the more thorough evaluation and control of OSA in order to prevent the disabling side effects of a stroke, which not only compromises the physical and mental health of a person and increases the burden on families, but also adds a severe burden to national health economics. OSA should always be considered when assessing a patient with transient ischemic attacks (TIA). Work up and treatment for OSA will not only help prevent stroke with its devastating consequences, but will also help prevent CVD, and ameliorate co-morbid conditions such as diabetes and hypertension in these vulnerable populations.
Collapse
Affiliation(s)
- Shazia Jehan
- Department of Population Health, New York University School of Medicine, USA
| | - Mahmoud Farag
- Department of Surgery, SUNY Downstate Medical Center, USA
| | - Ferdinand Zizi
- Department of Population Health, New York University School of Medicine, USA
| | | | - Alicia Chung
- Department of Population Health, New York University School of Medicine, USA
| | - Anrew Truong
- Department of Medicine, SUNY Downstate Medical Center, USA
| | | | - Daniela Tello
- Department of Medicine, SUNY Downstate Medical Center, USA
| | | |
Collapse
|
11
|
Ramos AR, Figueredo P, Shafazand S, Chediak AD, Abreu AR, Dib SI, Torre C, Wallace DM. Obstructive Sleep Apnea Phenotypes and Markers of Vascular Disease: A Review. Front Neurol 2017; 8:659. [PMID: 29259576 PMCID: PMC5723309 DOI: 10.3389/fneur.2017.00659] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/22/2017] [Indexed: 12/15/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a chronic and heterogeneous disorder that leads to early mortality, stroke, and cardiovascular disease (CVD). OSA is defined by the apnea–hypopnea index, which is an index of OSA severity that combines apneas (pauses in breathing) and hypopneas (partial obstructions in breathing) associated with hypoxemia. Yet, other sleep metrics (i.e., oxygen nadir, arousal frequency), along with clinical symptoms and molecular markers could be better predictors of stroke and CVD outcomes in OSA. The recent focus on personalized medical care introduces the possibility of a unique approach to the treatment of OSA based on its phenotypes, defined by pathophysiological mechanisms and/or clinical presentation. We summarized what is known about OSA and its phenotypes, and review the literature on factors or intermediate markers that could increase stroke risk and CVD in patients with OSA. The OSA phenotypes where divided across three different domains (1) clinical symptoms (i.e., daytime sleepiness), (2) genetic/molecular markers, and (3) experimental data-driven approach (e.g., cluster analysis). Finally, we further highlight gaps in the literature framing a research agenda.
Collapse
Affiliation(s)
- Alberto R Ramos
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, United States.,Sleep Disorders Center, Miller School of Medicine, Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States
| | - Pedro Figueredo
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Shirin Shafazand
- Sleep Disorders Center, Miller School of Medicine, Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States.,Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Alejandro D Chediak
- Sleep Disorders Center, Miller School of Medicine, Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States.,Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Alexandre R Abreu
- Sleep Disorders Center, Miller School of Medicine, Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States.,Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Salim I Dib
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, United States.,Sleep Disorders Center, Miller School of Medicine, Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States
| | - Carlos Torre
- Sleep Disorders Center, Miller School of Medicine, Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States.,Department of Otolaryngology - Head and Neck Surgery, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Douglas M Wallace
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, United States.,Sleep Disorders Center, Bruce W. Carter VA Medical Center, Miami, FL, United States
| |
Collapse
|
12
|
Sleep Health's first year. Sleep Health 2015; 1:223-224. [PMID: 29073394 DOI: 10.1016/j.sleh.2015.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|