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Biose IJ, Bakare AB, Wang H, Gressett TE, Bix GJ. Sleep apnea and ischemic stroke- a perspective for translational preclinical modelling. Sleep Med Rev 2024; 75:101929. [PMID: 38581800 DOI: 10.1016/j.smrv.2024.101929] [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: 08/11/2023] [Revised: 03/13/2024] [Accepted: 03/24/2024] [Indexed: 04/08/2024]
Abstract
Obstructive sleep apnea (OSA) is associated with ischemic stroke. There is, however, a lack of knowledge on the exact cause-effect relationship, and preclinical models of OSA for experimental ischemic stroke investigations are not well characterized. In this review, we discuss sleep apnea and its relationship with stroke risk factors. We consider how OSA may lead to ischemic stroke and how OSA-induced metabolic syndrome and hypothalamic-pituitary axis (HPA) dysfunction could serve as therapeutic targets to prevent ischemic stroke. Further, we examine the translational potential of established preclinical models of OSA. We conclude that metabolic syndrome and HPA dysfunction, which are often overlooked in the context of experimental stroke and OSA studies, are crucial for experimental consideration to improve the body of knowledge as well as the translational potential of investigative efforts.
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Affiliation(s)
- I J Biose
- Department of Pharmacology, Cardiovascular Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, USA.
| | - A B Bakare
- School of Medicine, Tulane University, New Orleans, LA, 70112, USA.
| | - H Wang
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA.
| | - T E Gressett
- School of Medicine, Tulane University, New Orleans, LA, 70112, USA; Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA.
| | - G J Bix
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA; Tulane Brain Institute, Tulane University, New Orleans, LA, 70112, USA; Department of Neurology, Tulane University School of Medicine, New Orleans, LA, 70112, USA; Department of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, LA, 70112, USA; Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70122, USA.
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Schipper F, van Sloun RJG, Grassi A, Brouwer J, van Meulen F, Overeem S, Fonseca P. Maximum a posteriori detection of heartbeats from a chest-worn accelerometer. Physiol Meas 2024; 45:035009. [PMID: 38430565 DOI: 10.1088/1361-6579/ad2f5e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 03/01/2024] [Indexed: 03/04/2024]
Abstract
Objective. Unobtrusive long-term monitoring of cardiac parameters is important in a wide variety of clinical applications, such as the assesment of acute illness severity and unobtrusive sleep monitoring. Here we determined the accuracy and robustness of heartbeat detection by an accelerometer worn on the chest.Approach. We performed overnight recordings in 147 individuals (69 female, 78 male) referred to two sleep centers. Two methods for heartbeat detection in the acceleration signal were compared: one previously described approach, based on local periodicity, and a novel extended method incorporating maximumaposterioriestimation and a Markov decision process to approach an optimal solution.Main results. The maximumaposterioriestimation significantly improved performance, with a mean absolute error for the estimation of inter-beat intervals of only 3.5 ms, and 95% limits of agreement of -1.7 to +1.0 beats per minute for heartrate measurement. Performance held during posture changes and was only weakly affected by the presence of sleep disorders and demographic factors.Significance. The new method may enable the use of a chest-worn accelerometer in a variety of applications such as ambulatory sleep staging and in-patient monitoring.
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Affiliation(s)
- Fons Schipper
- Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Philips Research, Philips, Eindhoven, The Netherlands
| | - Ruud J G van Sloun
- Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Philips Research, Philips, Eindhoven, The Netherlands
| | - Angela Grassi
- Philips Research, Philips, Eindhoven, The Netherlands
| | - Jan Brouwer
- Philips Research, Philips, Eindhoven, The Netherlands
| | - Fokke van Meulen
- Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Kempenhaeghe Center for Sleep Medicine, Heeze, The Netherlands
| | - Sebastiaan Overeem
- Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Kempenhaeghe Center for Sleep Medicine, Heeze, The Netherlands
| | - Pedro Fonseca
- Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Philips Research, Philips, Eindhoven, The Netherlands
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Yang X, Lippert J, Dekkers M, Baillieul S, Duss SB, Reichlin T, Brill AK, Bernasconi C, Schmidt MH, Bassetti CL. Impact of Comorbid Sleep-Disordered Breathing and Atrial Fibrillation on the Long-Term Outcome After Ischemic Stroke. Stroke 2024; 55:586-594. [PMID: 38275115 PMCID: PMC10896199 DOI: 10.1161/strokeaha.123.042856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 11/13/2023] [Accepted: 12/01/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) and atrial fibrillation (AF) are highly prevalent in patients with stroke and are recognized as independent risk factors for stroke. Little is known about the impact of comorbid SDB and AF on long-term outcomes after stroke. METHODS In this prospective cohort study, 353 patients with acute ischemic stroke or transient ischemic attacks were analyzed. Patients were screened for SDB by respiratory polygraphy during acute hospitalization. Screening for AF was performed using a 7-day ECG up to 3× in the first 6 months. Follow-up visits were scheduled at 1, 3, 12, 24, and 36 months poststroke. Cox regression models adjusted for various factors (age, sex, body mass index, hypertension, diabetes, dyslipidemia, and heart failure) were used to assess the impact of comorbid SDB and AF on subsequent death or cerebro-cardiovascular events. RESULTS Among 353 patients (299 ischemic stroke and 54 transient ischemic attacks), median age, 67 (interquartile range, 57-74) years with 63% males. Moderate-to-severe SDB (apnea-hypopnea index score, ≥15/h) was present in 118 (33.4%) patients. Among the 56 (15.9%) patients with AF, 28 had comorbid moderate-to-severe SDB and AF. Over 36 months, there were 12 deaths and 67 recurrent cerebro-cardiovascular events. Patients with comorbid moderate-to-severe SDB and AF had a higher risk of subsequent death or cerebro-cardiovascular events compared with those with only moderate-to-severe SDB without AF (hazard ratio, 2.49 [95% CI, 1.18-5.24]) and to those without moderate-to-severe SDB or AF (hazard ratio, 2.25 [95% CI, 1.12-4.50]). However, no significant difference was found between the comorbid moderate-to-severe SDB and AF group and the group with only AF without moderate-to-severe SDB (hazard ratio, 1.64 [95% CI, 0.62-4.36]). CONCLUSIONS Comorbid moderate-to-severe SDB and AF significantly increase the risk of long-term mortality or recurrent cerebro-cardiovascular events after acute ischemic stroke. Considering both conditions as cumulative and modifiable cerebro-cardiovascular risk factors is of interest for the management of acute stroke. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02559739.
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Affiliation(s)
- Xiaoli Yang
- Department of Neurology (X.Y., J.L., M.D., S.B.D., C.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
- Interdisciplinary Sleep-Wake-Epilepsy-Center (X.Y., J.L., M.D., S.B.D., A.-K.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Julian Lippert
- Department of Neurology (X.Y., J.L., M.D., S.B.D., C.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
- Interdisciplinary Sleep-Wake-Epilepsy-Center (X.Y., J.L., M.D., S.B.D., A.-K.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Martijn Dekkers
- Department of Neurology (X.Y., J.L., M.D., S.B.D., C.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
- Interdisciplinary Sleep-Wake-Epilepsy-Center (X.Y., J.L., M.D., S.B.D., A.-K.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Sebastien Baillieul
- Grenoble Alpes University, HP2 Laboratory, INSERM U1300 and Grenoble Alpes University Hospital, France (S.B.)
| | - Simone B. Duss
- Department of Neurology (X.Y., J.L., M.D., S.B.D., C.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology (T.R.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Anne-Kathrin Brill
- Interdisciplinary Sleep-Wake-Epilepsy-Center (X.Y., J.L., M.D., S.B.D., A.-K.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
- Department of Pulmonary Medicine and Allergology (A.-K.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Corrado Bernasconi
- Department of Neurology (X.Y., J.L., M.D., S.B.D., C.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Markus H. Schmidt
- Department of Neurology (X.Y., J.L., M.D., S.B.D., C.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
- Interdisciplinary Sleep-Wake-Epilepsy-Center (X.Y., J.L., M.D., S.B.D., A.-K.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Claudio L.A. Bassetti
- Department of Neurology (X.Y., J.L., M.D., S.B.D., C.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
- Interdisciplinary Sleep-Wake-Epilepsy-Center (X.Y., J.L., M.D., S.B.D., A.-K.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
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Dimitriadis K, Stathakopoulou C, Pyrpyris N, Beneki E, Adamopoulou E, Soulaidopoulos S, Leontsinis I, Kasiakogias A, Papanikolaou A, Tsioufis P, Aznaouridis K, Tsiachris D, Aggeli K, Tsioufis K. Interventional management of mitral regurgitation and sleep disordered breathing: "Catching two birds with one stone". Sleep Med 2024; 113:157-164. [PMID: 38029624 DOI: 10.1016/j.sleep.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/09/2023] [Accepted: 11/11/2023] [Indexed: 12/01/2023]
Abstract
Sleep disordered breathing (SDB), mostly constituting of obstructive and central sleep apnea (OSA and CSA, respectively), is highly prevalent in the general population, and even more among patients with cardiovascular disease, heart failure (HF) and valvular heart disease, such as mitral regurgitation (MR). The coexistence of HF, MR and SDB is associated with worse cardiovascular outcomes and increased morbidity and mortality. Pulmonary congestion, as a result of MR, can exaggerate and worsen the clinical status and symptoms of SDB, while OSA and CSA, through various mechanisms that impair left ventricular dynamics, can promote left ventricular remodelling, mitral annulus dilatation and consequently MR. Regarding treatment, positive airway pressure devices used to ameliorate symptoms in SDB also seem to result in a reduction of MR severity, MR jet fraction and an improvement of left ventricular ejection fraction. However, surgical and transcatheter interventions for MR, and especially transcatheter edge to edge mitral valve repair (TEER), seem to also have a positive effect on SDB, by reducing OSA and CSA-related severity indexes and improving symptom control. The purpose of this review is to provide a comprehensive analysis of the common pathophysiology between SDB and MR, as well as to discuss the available evidence regarding the effect of SDB treatment on MR and the effect of mitral valve surgery or transcatheter repair on both OSA and CSA.
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Affiliation(s)
- Kyriakos Dimitriadis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece.
| | - Christina Stathakopoulou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Nikolaos Pyrpyris
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Eirini Beneki
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Elena Adamopoulou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Stergios Soulaidopoulos
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Ioannis Leontsinis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Alexandros Kasiakogias
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Aggelos Papanikolaou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Panagiotis Tsioufis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Konstantinos Aznaouridis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Dimitris Tsiachris
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Konstantina Aggeli
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
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Berjaoui C, Tesfasilassie Kibrom B, Ghayyad M, Joumaa S, Talal Al Labban N, Nazir A, Kachouh C, Akanmu Moradeyo A, Wojtara M, Uwishema O. Unveiling the sleep-cardiovascular connection: Novel perspectives and interventions-A narrative review. Health Sci Rep 2023; 6:e1773. [PMID: 38107151 PMCID: PMC10723785 DOI: 10.1002/hsr2.1773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/27/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Sleep is an important neurophysiological condition that is intricately linked to general health, laying the basis for both physiological and psychological well-being. A thorough examination of sleep disorders and cardiovascular health demonstrates their deep relationship, emphasizing the numerous diagnostic tools and treatment techniques available. Aim This study aims to examine the impact, mechanisms, diagnostic techniques, treatment strategies, implications, and healthcare interventions of the sleep-cardiovascular connection, to better understand the relationship between sleep disorders and cardiovascular health. Methods The paper reviews key studies conducted from 2015-till date, investigating the impact of sleep disorders on the cardiovascular system. It looked into data relating to cardiovascular outcomes based on the degree of sleep disorders, considered potential confounding factors, and addressed current research constraints. Results The findings highlight a strong link between sleep problems and poor cardiovascular outcomes. Emerging diagnostic tools, such as enhanced sleep-related technology and biomarkers, open up new avenues for determining the impact of sleep disturbances on cardiovascular health. In addition, the research discusses several treatment options, ranging from cognitive behavioral therapy to pharmaceutical therapies, and their potential benefits in addressing sleep-related cardiovascular risks. Conclusion The complex association between sleep disturbances and cardiovascular health emphasizes the need to recognize sleep as a critical component of overall well-being. Thus collaboration among medical disciplines, as well as individualized therapies, are critical to improving patient care. Moreover, Understanding and managing the consequences of sleep problems on cardiovascular health can lead to more effective interventions, better outcomes, and improved public health as research advances.
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Affiliation(s)
- Christin Berjaoui
- Department of MedicineOli Health Magazine Organization, Research, and EducationKigaliRwanda
- Department of Medicine, Faculty of MedicineBeirut Arab UniversityBeirutLebanon
| | - Bethlehem Tesfasilassie Kibrom
- Department of MedicineOli Health Magazine Organization, Research, and EducationKigaliRwanda
- Department of Medicine, College of Health SciencesAddis Ababa UniversityAddis AbabaEthiopia
| | - Mohammad Ghayyad
- Department of MedicineOli Health Magazine Organization, Research, and EducationKigaliRwanda
- Department of Medicine, Faculty of MedicineBeirut Arab UniversityBeirutLebanon
| | - Safaa Joumaa
- Department of MedicineOli Health Magazine Organization, Research, and EducationKigaliRwanda
- Department of Medicine, Faculty of Medical ScienceLebanese UniversityBeirutLebanon
| | - Nihal Talal Al Labban
- Department of MedicineOli Health Magazine Organization, Research, and EducationKigaliRwanda
- Department of Medicine, Faculty of MedicineBeirut Arab UniversityBeirutLebanon
| | - Abubakar Nazir
- Department of MedicineOli Health Magazine Organization, Research, and EducationKigaliRwanda
- Department of MedicineKing Edward Medical UniversityLahorePakistan
| | - Charbel Kachouh
- Department of MedicineOli Health Magazine Organization, Research, and EducationKigaliRwanda
- Department of MedicineSaint‐Joseph UniversityBeirutLebanon
| | - Abdulrahmon Akanmu Moradeyo
- Department of MedicineOli Health Magazine Organization, Research, and EducationKigaliRwanda
- Department of Medicine and SurgeryLadoke Akintola University of TechnologyOgbomoshoNigeria
| | - Magda Wojtara
- Department of MedicineOli Health Magazine Organization, Research, and EducationKigaliRwanda
| | - Olivier Uwishema
- Department of MedicineOli Health Magazine Organization, Research, and EducationKigaliRwanda
- Department of MedicineClinton Global Initiative UniversityNew YorkNew YorkUSA
- Department of MedicineKaradeniz Technical UniversityTrabzonTurkey
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Hendriks JM, Lee G, Linz D. Sleeping Beauty unravelled - Detection of sleep apnoea in patients with atrial fibrillation. IJC HEART & VASCULATURE 2023; 47:101237. [PMID: 37576073 PMCID: PMC10422655 DOI: 10.1016/j.ijcha.2023.101237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 06/25/2023] [Accepted: 06/27/2023] [Indexed: 08/15/2023]
Affiliation(s)
- Jeroen M. Hendriks
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Gerry Lee
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, United Kingdom
| | - Dominik Linz
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, The Netherlands
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Intrinsic Cardiac Neuromodulation in the Management of Atrial Fibrillation- A Potential Missing Link? Life (Basel) 2023; 13:life13020383. [PMID: 36836740 PMCID: PMC9966489 DOI: 10.3390/life13020383] [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: 12/20/2022] [Revised: 01/14/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
Atrial fibrillation (AF) is the most common supraventricular arrhythmia that is linked with higher cardiovascular morbidity and mortality. Recent evidence has demonstrated that catheter-based pulmonary vein isolation (PVI) is not only a viable alternative but may be superior to antiarrhythmic drug therapy for long-term freedom from symptomatic AF episodes, a reduction in the arrhythmia burden, and healthcare resource utilization with a similar risk of adverse events. The intrinsic cardiac autonomic nervous system (ANS) has a significant influence on the structural and electrical milieu, and imbalances in the ANS may contribute to the arrhythmogenesis of AF in some individuals. There is now increasing scientific and clinical interest in various aspects of neuromodulation of intrinsic cardiac ANS, including mapping techniques, ablation methods, and patient selection. In the present review, we aimed to summarize and critically appraise the currently available evidence for the neuromodulation of intrinsic cardiac ANS in AF.
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Ifedili I, Ingram E, Blount C, Kayali S, Heckle M, Levine YC. Vagal milieu or electrophysiologic substrate? The link between atrial fibrillation and obstructive sleep apnea. Exp Biol Med (Maywood) 2022; 247:1827-1832. [PMID: 36112833 PMCID: PMC9679354 DOI: 10.1177/15353702221120289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Atrial fibrillation is the most common cardiac arrhythmia with its prevalence expected to increase to 12.1 million people in the United States by 2030. Chronic underlying conditions that affect the heart and lungs predispose patients to develop atrial fibrillation. Obstructive sleep apnea is strongly associated with atrial fibrillation. Several pathophysiological mechanisms have been proposed to elucidate this relationship which includes electrophysiological substrate modification and the contribution of the autonomic nervous system. In this comprehensive review, we highlight important relationships and plausible causality between obstructive sleep apnea and atrial fibrillation which will improve our understanding in the evaluation, management, and prevention of atrial fibrillation. This is the most updated comprehensive review of the relationship between obstructive sleep apnea and atrial fibrillation.
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Affiliation(s)
- Ikechukwu Ifedili
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Eva Ingram
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Courtland Blount
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Sharif Kayali
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Mark Heckle
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA,Methodist Le Bonheur Healthcare, Memphis, TN 38104, USA
| | - Yehoshua C Levine
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA,Methodist Le Bonheur Healthcare, Memphis, TN 38104, USA,Yehoshua C Levine.
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Aktuelle Entwicklungen in der Schlafforschung und Schlafmedizin – eine Einschätzung der AG „Herz- und Kreislauferkrankungen“. SOMNOLOGIE 2022. [DOI: 10.1007/s11818-022-00379-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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