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Mohamed B, Yarlagadda K, Self Z, Simon A, Rigueiro F, Sohooli M, Eisenschenk S, Doré S. Obstructive Sleep Apnea and Stroke: Determining the Mechanisms Behind their Association and Treatment Options. Transl Stroke Res 2024; 15:239-332. [PMID: 36922470 DOI: 10.1007/s12975-023-01123-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/02/2023] [Accepted: 01/02/2023] [Indexed: 03/18/2023]
Abstract
Sleep-disordered breathing (SDB) can be a sequela of stroke caused by vascular injury to vital respiratory centers, cerebral edema, and increased intracranial pressure of space-occupying lesions. Likewise, obstructive sleep apnea (OSA) contributes to increased stroke risk through local mechanisms such as impaired ischemic cerebrovascular response and systemic effects such as promoting atherosclerosis, hypercoagulability, cardiac arrhythmias, vascular-endothelial dysfunction, and metabolic syndrome. The impact of OSA on stroke outcomes has been established, yet it receives less attention in national guidelines on stroke management than hyperglycemia and blood pressure dysregulation. Furthermore, whether untreated OSA worsens stroke outcomes is not well-described in the literature. This scoping review provides an updated investigation of the correlation between OSA and stroke, including inter-relational pathophysiology. This review also highlights the importance of OSA treatment and its role in stroke outcomes. Knowledge of pathophysiology, the inter-relationship between these common disorders, and the impact of OSA therapy on outcomes affect the clinical management of patients with acute ischemic stroke. In addition, understanding the relationship between stroke outcomes and pre-existing OSA will allow clinicians to predict outcomes while treating acute stroke.
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Affiliation(s)
- Basma Mohamed
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Keerthi Yarlagadda
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Zachary Self
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Alexandra Simon
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Frank Rigueiro
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Maryam Sohooli
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Stephan Eisenschenk
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Sylvain Doré
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA.
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, 32610, USA.
- Departments of Neurology, Psychiatry, Pharmaceutics, and Neuroscience, Center for Translational Research in Neurodegenerative Disease, McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, 32610, USA.
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Hinder D, Schams SC, Knaus C, Tschopp K. Home sleep apnea testing with peripheral arterial tonometry to assess outcome in upper airway stimulation. J Clin Sleep Med 2022; 18:2197-2205. [PMID: 35689596 PMCID: PMC9435336 DOI: 10.5664/jcsm.10082] [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: 12/22/2021] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To determine whether home sleep apnea testing with peripheral arterial tonometry (HSAT-PAT) can be used in upper airway stimulation to evaluate therapy success. METHODS Data analysis from 50 consecutive patients receiving upper airway stimulation was performed. Baseline values were measured by polysomnography and HSAT-PAT. Follow-up was performed during and after titration (3-6 months) by polysomnography and HSAT-PAT and after 1 year by HSAT-PAT only. Primary outcome measures were reduction in the apnea-hypopnea index and oxygen desaturation index. In addition, an analysis of night-to-night variability for HSAT-PAT was performed. RESULTS All 50 patients completed their posttitration visit (3-6 months) and 41 patients completed the 1-year follow-up. In HSAT-PAT after 1 year, the mean apnea-hypopnea index (desaturation 3%) was reduced from 29.5 ± 17.1 events/h to 19.9 ± 13.1 events/h (P < .01) and the oxygen desaturation index (desaturation 4%) was reduced from 17.8 ± 12.6 events/h to 10.2 ± 8.3 events/h (P < .01). Therapy adherence after 1 year was high (6.6 ± 1.9 hours per night) and led to improvement in daytime sleepiness, meaning a reduction in the Epworth Sleepiness Scale score from 12.8 ± 5.4 to 5.9 ± 4.0 (P < .01). Analysis of night-to-night variability showed similar apnea-hypopnea index values between the 2 nights. CONCLUSIONS Upper airway stimulation was able to reduce the apnea-hypopnea index and oxygen desaturation index after 1 year, as assessed by full-night efficacy studies with HSAT-PAT. In addition, improvements in self-reported outcome parameters were observed. The importance of publishing the scoring criteria is highlighted and whether data are based on full-night efficacy studies or a selected period of time from a sleep study. This is a prerequisite for comparing data with other trials in the emerging field of upper airway stimulation. CITATION Hinder D, Schams SC, Knaus C, Tschopp K. Home sleep apnea testing with peripheral arterial tonometry to assess outcome in upper airway stimulation. J Clin Sleep Med. 2022;18(9):2197-2205.
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Affiliation(s)
- Dominik Hinder
- Address correspondence to: Dominik Hinder, MD, Department of Otorhinolaryngology, Head and Neck Surgery, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland;
| | | | - Christoph Knaus
- Department of Otorhinolaryngology, Head and Neck Surgery, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Kurt Tschopp
- Department of Otorhinolaryngology, Head and Neck Surgery, Cantonal Hospital Baselland, Liestal, Switzerland
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Herkenrath SD, Treml M, Hagmeyer L, Matthes S, Randerath WJ. Severity stages of obesity-related breathing disorders - a cross-sectional cohort study. Sleep Med 2022; 90:9-16. [PMID: 35051737 DOI: 10.1016/j.sleep.2021.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION There is a general underappreciation of the spectrum of obesity-related breathing disorders and their consequences. We therefore compared characteristics of obese patients with eucapnic obstructive sleep apnea (OSA), OSA with obesity-related sleep hypoventilation (ORSH) or obesity hypoventilation syndrome (OHS) to identify the major determinants of hypoventilation. PATIENTS AND METHODS In this prospective, diagnostic study (NCT04570540), obese patients with OSA, ORSH or OHS were characterized applying polysomnography with transcutaneous capnometry, blood gas analyses, bodyplethysmography and measurement of hypercapnic ventilatory response (HCVR). Pathophysiological variables known to contribute to hypoventilation and differing significantly between the groups were specified as potential independent variables in a multivariable logistic regression to identify major determinants of hypoventilation. RESULTS Twenty, 43 and 19 patients were in the OSA, ORSH and OHS group, respectively. BMI was significantly lower in OSA as compared to OHS. The extent of SRBD was significantly higher in OHS as compared to OSA or ORSH. Patients with ORSH or OHS showed a significantly decreased forced expiratory volume in 1 s and forced vital capacity compared to OSA. HCVR was significantly lower in OHS and identified as the major determinant of hypoventilation in a multivariable logistic regression (Nagelkerke R2 = 0.346, p = 0.050, odds ratio (95%-confidence interval) 0.129 (0.017-1.004)). CONCLUSION Although there were differences in BMI, respiratory mechanics and severity of upper airway obstruction between groups, our data support HCVR as the major determinant of obesity-associated hypoventilation.
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Affiliation(s)
- Simon D Herkenrath
- Bethanien Hospital, Clinic for Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Solingen, Germany; Institute for Pneumology at the University of Cologne, Germany
| | - Marcel Treml
- Institute for Pneumology at the University of Cologne, Germany
| | - Lars Hagmeyer
- Bethanien Hospital, Clinic for Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Solingen, Germany; Institute for Pneumology at the University of Cologne, Germany
| | - Sandhya Matthes
- Bethanien Hospital, Clinic for Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Solingen, Germany
| | - Winfried J Randerath
- Bethanien Hospital, Clinic for Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Solingen, Germany; Institute for Pneumology at the University of Cologne, Germany.
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Hu T, Gu Y, Xu Y, Yu J, Wu F, Chen R. Incidence of Stroke and Mortality in Chinese Patients with Sleep-Breathing Disorders: A Clinical Population-Based (CPB) Study. Med Sci Monit 2019; 25:10129-10135. [PMID: 31884509 PMCID: PMC6948286 DOI: 10.12659/msm.918120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Sleep-breathing disorders are associated with inflammatory, metabolic, and vascular diseases. The objective of this study was to investigate the incidence of stroke and death in patients with sleep-breathing disorders. MATERIAL AND METHODS The anthropometric characteristics, demographic data, and incidence of stroke of 1492 Chinese patients with mild, moderate, or severe sleep apnea were collected. The apnea-hypopnea index was used to define sleep-breathing disorders. Imaging modalities were used to validate the diagnosis of stroke. Death during hospitalization or during follow-up was noted. Multivariate analysis was performed for the incidence of stroke and mortality at the 95% of confidence level. RESULTS Among enrolled patients, 401 (27%) patients had at least 1 event of stroke. Patients who had at least 1 event of stroke were more likely to be younger (p<0.0001), female (p=0.0013), and to have comorbidities. Among enrolled patients, 127 died due to stroke or other diseases. Sixteen of the patients who died had no stroke event(s) and 111 patients who died had at least 1 event of stroke. Stroke events (p=0.023) and biomedical burden of patients were associated with the death of patients with sleep-breathing disorders. CONCLUSIONS Age, sex, and the other existing disease(s) of patients with sleep-breathing disorders may be associated with stroke event(s). Also, stroke event(s) and comorbidities may be associated with mortality in this Chinese population.
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Affiliation(s)
- Tao Hu
- Department of Respiratory Medicine, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland).,Department of Respiratory Medicine, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, China (mainland)
| | - Yang Gu
- Department of Respiratory Medicine, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, China (mainland)
| | - Yan Xu
- Department of Respiratory Medicine, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, China (mainland)
| | - Juebo Yu
- Department of Otolaryngology, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, China (mainland)
| | - Feng Wu
- Department of Respiratory Medicine, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, China (mainland)
| | - Rui Chen
- Department of Respiratory Medicine, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
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Reuter H, Herkenrath S, Treml M, Halbach M, Steven D, Frank K, Castrogiovanni A, Kietzmann I, Baldus S, Randerath WJ. Sleep-disordered breathing in patients with cardiovascular diseases cannot be detected by ESS, STOP-BANG, and Berlin questionnaires. Clin Res Cardiol 2018; 107:1071-1078. [PMID: 29845331 DOI: 10.1007/s00392-018-1282-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/15/2018] [Indexed: 12/11/2022]
Abstract
Sleep-disordered breathing (SDB) is highly prevalent in patients with cardiovascular diseases (CVD) and associated with poor outcome. At least 50% of heart failure (HF) patients present with SDB, equally divided in obstructive sleep apnea (OSA) and central sleep apnea (CSA). CVD patients with SDB do not always present with typical SDB symptoms. Therefore, we asked whether established questionnaires allow for the reliable detection of SDB. In this prospective cohort study, 89 CVD patients (54 male, 59 ± 15 years, BMI 30 ± 6 kg/m2) in stable clinical state underwent an ambulatory polygraphy. SDB was defined as an apnea-hypopnea index (AHI) ≥ 15/h. We evaluated the Epworth Sleepiness Scale (ESS), STOP-BANG and Berlin questionnaires as well as anthropometric data and comorbidities regarding their ability to predict SDB. The ESS showed no correlation with SDB. The sensitivity of the Berlin Questionnaire to detect SDB was 73%, specificity was 42%. The STOP-BANG questionnaire showed a sensitivity of 97% while specificity was 13%. Coronary heart disease and/or history of myocardial infarction, hyperuricemia and age significantly contributed to a logistic regression model predicting presence of SDB. However, our regression model explains only 36% of the variance regarding the presence or absence of SDB. The approach to find variables, which would allow an early and reliable differentiation between patients with CVD and coexistence or absence of SDB, failed. Thus, as CVD patients show a high SDB prevalence and poor outcome, only a systematic screening based on measures of respiration-related parameters (i.e., respiratory flow, blood oxygen saturation, etc.) allows for a reliable SDB assessment.
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Affiliation(s)
- Hannes Reuter
- Clinic III for Internal Medicine, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Evangelisches Klinikum Köln-Weyertal, Weyertal 76, 50931, Cologne, Germany
| | - Simon Herkenrath
- Institute for Pneumology at the University of Cologne, Aufderhöher Str. 169-175, 42699, Solingen, Germany
- Bethanien Hospital gGmbH, Solingen, Aufderhöher Str. 169-175, 42699, Solingen, Germany
| | - Marcel Treml
- Institute for Pneumology at the University of Cologne, Aufderhöher Str. 169-175, 42699, Solingen, Germany
| | - Marcel Halbach
- Clinic III for Internal Medicine, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Daniel Steven
- Clinic III for Internal Medicine, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Konrad Frank
- Clinic III for Internal Medicine, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | | | - Ilona Kietzmann
- Institute for Pneumology at the University of Cologne, Aufderhöher Str. 169-175, 42699, Solingen, Germany
| | - Stephan Baldus
- Clinic III for Internal Medicine, Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Winfried J Randerath
- Institute for Pneumology at the University of Cologne, Aufderhöher Str. 169-175, 42699, Solingen, Germany.
- Bethanien Hospital gGmbH, Solingen, Aufderhöher Str. 169-175, 42699, Solingen, Germany.
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S3-Leitlinie Nicht erholsamer Schlaf/Schlafstörungen – Kapitel „Schlafbezogene Atmungsstörungen“. SOMNOLOGIE 2016. [DOI: 10.1007/s11818-016-0093-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Sacchetti M, Della Marca G. Are stroke cases affected by sleep disordered breathings all the same? Med Hypotheses 2014; 83:217-23. [DOI: 10.1016/j.mehy.2014.04.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/10/2014] [Accepted: 04/16/2014] [Indexed: 01/14/2023]
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Lally F, Thakkar A, Roffe C. Sleep apnoea and stroke. SOMNOLOGIE 2011. [DOI: 10.1007/s11818-011-0523-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chen CY, Hsu CC, Pei YC, Yu CC, Chen YS, Chen CL. Nocturia is an independent predictor of severe obstructive sleep apnea in patients with ischemic stroke. J Neurol 2010; 258:189-94. [DOI: 10.1007/s00415-010-5705-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 08/09/2010] [Indexed: 11/29/2022]
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Abstract
The topic of hypoxaemia after stroke was last reviewed in this journal in 2001. Since then a lot of new information on the subject has been published, and while some questions have been resolved, new problems have emerged. This article discusses new research in the light of what is already known and outlines areas of persisting uncertainty.
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