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Gregori-Pla C, Delgado-Mederos R, Cotta G, Giacalone G, Maruccia F, Avtzi S, Prats-Sánchez L, Martínez-Domeño A, Camps-Renom P, Martí-Fàbregas J, Durduran T, Mayos M. Microvascular cerebral blood flow fluctuations in association with apneas and hypopneas in acute ischemic stroke. NEUROPHOTONICS 2019; 6:025004. [PMID: 31037244 PMCID: PMC6477863 DOI: 10.1117/1.nph.6.2.025004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 04/04/2019] [Indexed: 06/09/2023]
Abstract
In a pilot study on acute ischemic stroke (AIS) patients, unexpected periodic fluctuations in microvascular cerebral blood flow (CBF) had been observed. Motivated by the relative lack of information about the impact of the emergence of breathing disorders in association with stroke on cerebral hemodynamics, we hypothesized that these fluctuations are due to apneic and hypopneic events. A total of 28 patients were screened within the first week after stroke with a pulse oximeter. Five (18%) showed fluctuations of arterial blood oxygen saturation ( ≥ 3 % ) and were included in the study. Near-infrared diffuse correlation spectroscopy (DCS) was utilized bilaterally to measure the frontal lobe CBF alongside respiratory polygraphy. Biphasic CBF fluctuations were observed with a bilateral increase of 27.1 % ± 17.7 % and 29.0 % ± 17.4 % for the ipsilesional and contralesional hemispheres, respectively, and a decrease of - 19.3 % ± 9.1 % and - 21.0 % ± 8.9 % for the ipsilesional and contralesional hemispheres, respectively. The polygraph revealed that, in general, the fluctuations were associated with apneic and hypopneic events. This study motivates us to investigate whether the impact of altered respiratory patterns on cerebral hemodynamics can be detrimental in AIS patients.
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Affiliation(s)
- Clara Gregori-Pla
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
| | - Raquel Delgado-Mederos
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Department of Neurology (Stroke Unit), Barcelona, Spain
| | - Gianluca Cotta
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
| | - Giacomo Giacalone
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
- San Raffaele Scientific Institute, Milan, Italy
| | - Federica Maruccia
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
- Universitat Autònoma de Barcelona, Neurotraumatology and Neurosurgery Research Unit, Vall d’Hebron University Research Institute, Barcelona, Spain
| | - Stella Avtzi
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
| | - Luís Prats-Sánchez
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Department of Neurology (Stroke Unit), Barcelona, Spain
| | - Alejandro Martínez-Domeño
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Department of Neurology (Stroke Unit), Barcelona, Spain
| | - Pol Camps-Renom
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Department of Neurology (Stroke Unit), Barcelona, Spain
| | - Joan Martí-Fàbregas
- Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Department of Neurology (Stroke Unit), Barcelona, Spain
| | - Turgut Durduran
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - Mercedes Mayos
- Hospital de la Santa Creu i Sant Pau, Sleep Unit, Department of Respiratory Medicine, Barcelona, Spain
- CIBER Enfermedades Respiratorias (CB06/06), Madrid, Spain
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Zirak P, Gregori-Pla C, Blanco I, Fortuna A, Cotta G, Bramon P, Serra I, Mola A, Solà-Soler J, Giraldo-Giraldo BF, Durduran T, Mayos M. Characterization of the microvascular cerebral blood flow response to obstructive apneic events during night sleep. NEUROPHOTONICS 2018; 5:045003. [PMID: 30681667 PMCID: PMC6215085 DOI: 10.1117/1.nph.5.4.045003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 10/10/2018] [Indexed: 05/09/2023]
Abstract
Obstructive apnea causes periodic changes in cerebral and systemic hemodynamics, which may contribute to the increased risk of cerebrovascular disease of patients with obstructive sleep apnea (OSA) syndrome. The improved understanding of the consequences of an apneic event on the brain perfusion may improve our knowledge of these consequences and then allow for the development of preventive strategies. Our aim was to characterize the typical microvascular, cortical cerebral blood flow (CBF) changes in an OSA population during an apneic event. Sixteen patients (age 58 ± 8 years , 75% male) with a high risk of severe OSA were measured with a polysomnography device and with diffuse correlation spectroscopy (DCS) during one night of sleep with 1365 obstructive apneic events detected. All patients were later confirmed to suffer from severe OSA syndrome with a mean of 83 ± 15 apneas and hypopneas per hour. DCS has been shown to be able to characterize the microvascular CBF response to each event with a sufficient contrast-to-noise ratio to reveal its dynamics. It has also revealed that an apnea causes a peak increase of microvascular CBF ( 30 ± 17 % ) at the end of the event followed by a drop ( - 20 ± 12 % ) similar to what was observed in macrovascular CBF velocity of the middle cerebral artery. This study paves the way for the utilization of DCS for further studies on these populations.
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Affiliation(s)
- Peyman Zirak
- ICFO-Institut de Ciències Fotòniques, Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Clara Gregori-Pla
- ICFO-Institut de Ciències Fotòniques, Barcelona Institute of Science and Technology, Barcelona, Spain
- Address all correspondence to: Clara Gregori-Pla, E-mail:
| | - Igor Blanco
- ICFO-Institut de Ciències Fotòniques, Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Ana Fortuna
- Hospital de la Santa Creu i Sant Pau, Department of Respiratory Medicine, Sleep Unit, Barcelona, Spain
| | - Gianluca Cotta
- ICFO-Institut de Ciències Fotòniques, Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Pau Bramon
- ICFO-Institut de Ciències Fotòniques, Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Isabel Serra
- Centre de Recerca Matemàtica (CRM), Bellaterra, Spain
| | - Anna Mola
- Hospital de la Santa Creu i Sant Pau, Department of Respiratory Medicine, Sleep Unit, Barcelona, Spain
| | - Jordi Solà-Soler
- Universitat Politècnica de Catalunya (UPC)-Barcelona Tech, Department of Automatic Control (ESAII), Barcelona, Spain
- The Barcelona Institute of Science and Technology, Institute for Bioengineering of Catalonia (IBEC), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza, Spain
| | - Beatriz F. Giraldo-Giraldo
- Universitat Politècnica de Catalunya (UPC)-Barcelona Tech, Department of Automatic Control (ESAII), Barcelona, Spain
- The Barcelona Institute of Science and Technology, Institute for Bioengineering of Catalonia (IBEC), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza, Spain
| | - Turgut Durduran
- ICFO-Institut de Ciències Fotòniques, Barcelona Institute of Science and Technology, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Mercedes Mayos
- Hospital de la Santa Creu i Sant Pau, Department of Respiratory Medicine, Sleep Unit, Barcelona, Spain
- CIBER Enfermedades Respiratorias (CibeRes) (CB06/06), Madrid, Spain
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Gregori-Pla C, Cotta G, Blanco I, Zirak P, Giovannella M, Mola A, Fortuna A, Durduran T, Mayos M. Cerebral vasoreactivity in response to a head-of-bed position change is altered in patients with moderate and severe obstructive sleep apnea. PLoS One 2018. [PMID: 29538409 PMCID: PMC5851619 DOI: 10.1371/journal.pone.0194204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Motivation Obstructive sleep apnea (OSA) can impair cerebral vasoreactivity and is associated with an increased risk of cerebrovascular disease. Unfortunately, an easy-to-use, non-invasive, portable monitor of cerebral vasoreactivity does not exist. Therefore, we have evaluated the use of near-infrared diffuse correlation spectroscopy to measure the microvascular cerebral blood flow (CBF) response to a mild head-of-bed position change as a biomarker for the evaluation of cerebral vasoreactivity alteration due to chronic OSA. Furthermore, we have monitored the effect of two years of continuous positive airway pressure (CPAP) treatment on the cerebral vasoreactivity. Methodology CBF was measured at different head-of-bed position changes (supine to 30° to supine) in sixty-eight patients with OSA grouped according to severity (forty moderate to severe, twenty-eight mild) and in fourteen control subjects without OSA. A subgroup (n = 13) with severe OSA was measured again after two years of CPAP treatment. Results All patients and controls showed a similar CBF response after changing position from supine to 30° (p = 0.819), with a median (confidence interval) change of -17.5 (-10.3, -22.9)%. However, when being tilted back to the supine position, while the control group (p = 0.091) and the mild patients with OSA (p = 0.227) recovered to the initial baseline, patients with moderate and severe OSA did not recover to the baseline (9.8 (0.8, 12.9)%, p < 0.001) suggesting altered cerebral vasoreactivity. This alteration was correlated with OSA severity defined by the apnea-hypopnea index, and with mean nocturnal arterial oxygen saturation. The CBF response was normalized after two years of CPAP treatment upon follow-up measurements. Conclusion In conclusion, microvascular CBF response to a head-of-bed challenge measured by diffuse correlation spectroscopy suggests that moderate and severe patients with OSA have altered cerebral vasoreactivity related to OSA severity. This may normalize after two years of CPAP treatment.
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Affiliation(s)
- Clara Gregori-Pla
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
- * E-mail:
| | - Gianluca Cotta
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
| | - Igor Blanco
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
| | - Peyman Zirak
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
| | - Martina Giovannella
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
| | - Anna Mola
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ana Fortuna
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Turgut Durduran
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Mercedes Mayos
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- CIBER Enfermedades Respiratorias (CibeRes) (CB06/06), Madrid, Spain
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Samaja M, Milano G. Editorial - Hypoxia and Reoxygenation: From Basic Science to Bedside. Front Pediatr 2015; 3:86. [PMID: 26539421 PMCID: PMC4609843 DOI: 10.3389/fped.2015.00086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 09/30/2015] [Indexed: 12/30/2022] Open
Affiliation(s)
- Michele Samaja
- Department of Health Science, University of Milan , Milan , Italy
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