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Marzouqah R, Dharmakulaseelan L, Colelli DR, Lindo CJ, Costa YS, Jairam T, Xiong K, Murray BJ, Chen JL, Thorpe K, Yunusova Y, Boulos MI. Strengthening oropharyngeal muscles as an approach to treat post-stroke obstructive sleep apnea: A feasibility randomised controlled trial. J Sleep Res 2024; 33:e14086. [PMID: 37909249 DOI: 10.1111/jsr.14086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/13/2023] [Accepted: 10/15/2023] [Indexed: 11/02/2023]
Abstract
This study aimed to determine the feasibility of a randomised controlled trial (RCT) evaluating oropharyngeal exercise (OPE) intervention as an alternative therapy for obstructive sleep apnea (OSA) in patients with stroke or transient ischaemic attack (TIA). Despite the high prevalence of OSA in this population, the standard therapy, continuous positive airway pressure (CPAP), is often poorly tolerated. Thirty stroke/TIA patients with OSA unable to tolerate CPAP were randomly assigned to an oropharyngeal exercise or sham exercise protocol. They performed exercises for 6 weeks, 5 days per week, 30 minutes twice per day. Feasibility was ascertained by the proportion of enrolled patients who completed more than 80% of the OPE regimen. Isometric tongue pressures, apnea-hypopnea index (AHI), oxygen desaturation index (ODI), daytime sleepiness, and quality of life (QOL) outcomes were collected at baseline, post-training (6-week follow-up), and retention (10-week follow-up) to document preliminary efficacy. Adherence to study exercises was excellent, with 83% of participants completing more than 80% of the exercises. The isometric tongue pressures were observed to improve in the oropharyngeal exercise group (compared with the sham group), along with a decrease in OSA severity (measured by the AHI and ODI), reduced daytime sleepiness, and enhanced quality of life outcomes following the exercise programme. Only the effects on posterior isometric tongue pressure and daytime sleepiness remained significantly different between groups at the retention session. In conclusion, an RCT evaluating the efficacy of oropharyngeal exercises on post-stroke/TIA OSA is feasible and our preliminary results suggest a clinically meaningful effect.
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Affiliation(s)
- Reeman Marzouqah
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- University Health Network - KITE, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Laavanya Dharmakulaseelan
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - David R Colelli
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - C J Lindo
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Yakdehikandage S Costa
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Trevor Jairam
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Kathy Xiong
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Brian J Murray
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Joyce L Chen
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Yana Yunusova
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- University Health Network - KITE, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mark I Boulos
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
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Zhou Y, Jin X, Liu X, Tang J, Song L, Zhu Y, Zhai W, Wang X. Correlation between obstructive sleep apnea and hypoperfusion in patients with acute cerebral infarction. Front Neurol 2024; 15:1363053. [PMID: 38651100 PMCID: PMC11033380 DOI: 10.3389/fneur.2024.1363053] [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: 12/29/2023] [Accepted: 03/28/2024] [Indexed: 04/25/2024] Open
Abstract
Purpose To explore the relationship between obstructive sleep apnea (OSA) and hypoperfusion during ultra-early acute cerebral infarction. Patients and methods Data were retrospectively collected from patients admitted to our hospital with acute cerebral infarction between January 2020 and January 2022, who underwent comprehensive whole-brain computed tomography perfusion imaging and angiography examinations within 6 h of onset. The F-stroke software automatically assessed and obtained relevant data (Tmax). The patients underwent an initial screening for sleep apnea. Based on their Apnea-Hypopnea Index (AHI), patients were categorized into an AHI ≤15 (n = 22) or AHI >15 (n = 25) group. The pairwise difference of the time-to-maximum of the residue function (Tmax) > 6 s volume was compared, and the correlation between AHI, mean pulse oxygen saturation (SpO2), oxygen desaturation index (ODI), percentage of time with oxygen saturation < 90% (T90%), and the Tmax >6 s volume was analyzed. Results The Tmax >6 s volume in the AHI > 15 group was significantly larger than that in the AHI ≤ 15 group [109 (62-157) vs. 59 (21-106) mL, p = 0.013]. Spearman's correlation analysis revealed Tmax >6 s volume was significantly correlated with AHI, mean SpO2, ODI, and T90% in the AHI > 15 group, however, no significant correlations were observed in the AHI ≤ 15 group. Controlling for the site of occlusion and Multiphase CT angiography (mCTA) score, AHI (β = 0.919, p < 0.001), mean SpO2 (β = -0.460, p = 0.031), ODI (β = 0.467, p = 0.032), and T90% (β =0.478, p = 0.026) remained associated with early hypoperfusion in the AHI > 15 group. Conclusion In patients with acute cerebral infarction and AHI > 15, AHI, mean SpO2, ODI and T90% were associated with early hypoperfusion. However, no such relationship exists among patients with AHI ≤ 15.
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Affiliation(s)
| | | | | | | | | | | | | | - Xianhui Wang
- Department of Neurology, First People’s Hospital of Taicang, Taicang City, Jiangsu Province, China
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Baillieul S, Denis C, Barateau L, Arquizan C, Detante O, Pépin JL, Dauvilliers Y, Tamisier R. The multifaceted aspects of sleep and sleep-wake disorders following stroke. Rev Neurol (Paris) 2023; 179:782-792. [PMID: 37612191 DOI: 10.1016/j.neurol.2023.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/25/2023]
Abstract
Sleep-wake disorders (SWD) are acknowledged risk factors for both ischemic stroke and poor cardiovascular and functional outcome after stroke. SWD are frequent following stroke, with sleep apnea (SA) being the most frequent SWD affecting more than half of stroke survivors. While sleep disturbances and SWD are frequently reported in the acute phase, they may persist in the chronic phase after an ischemic stroke. Despite the frequency and risk associated with SWD following stroke, screening for SWD remains rare in the clinical setting, due to challenges in the assessment of post-stroke SWD, uncertainty regarding the optimal timing for their diagnosis, and a lack of clear treatment guidelines (i.e., when to treat and the optimal treatment strategy). However, little evidence support the feasibility of SWD treatment even in the acute phase of stroke and its favorable effect on long-term cardiovascular and functional outcomes. Thus, sleep health recommendations and SWD treatment should be systematically embedded in secondary stroke prevention strategy. We therefore propose that the management of SWD associated with stroke should rely on a multidisciplinary approach, with an integrated diagnostic, treatment, and follow-up strategy. The challenges in the field are to improve post-stroke SWD diagnosis, prognosis and treatment, through a better appraisal of their pathophysiology and temporal evolution.
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Affiliation(s)
- S Baillieul
- Université Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, 38000 Grenoble, France.
| | - C Denis
- National Reference Centre for Orphan Diseases Narcolepsy Rare Hypersomnias, Sleep Disorders Unit, Department of Neurology, CHU de Montpellier, University of Montpellier, Montpellier, France
| | - L Barateau
- National Reference Centre for Orphan Diseases Narcolepsy Rare Hypersomnias, Sleep Disorders Unit, Department of Neurology, CHU de Montpellier, University of Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier (INM), University of Montpellier, Inserm, Montpellier, France
| | - C Arquizan
- Department of Neurology, Hôpital Gui-de-Chauliac, Montpellier, France; Inserm U1266, Paris, France
| | - O Detante
- Neurology Department, Grenoble Alpes University Hospital, Grenoble, France
| | - J-L Pépin
- Université Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, 38000 Grenoble, France
| | - Y Dauvilliers
- National Reference Centre for Orphan Diseases Narcolepsy Rare Hypersomnias, Sleep Disorders Unit, Department of Neurology, CHU de Montpellier, University of Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier (INM), University of Montpellier, Inserm, Montpellier, France
| | - R Tamisier
- Université Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, 38000 Grenoble, France
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de Bergeyck R, Geoffroy PA. Insomnia in neurological disorders: Prevalence, mechanisms, impact and treatment approaches. Rev Neurol (Paris) 2023; 179:767-781. [PMID: 37620177 DOI: 10.1016/j.neurol.2023.08.008] [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: 07/14/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023]
Abstract
Insomnia is more prevalent in neurological disorders compared to the general population, with rates ranging from 11 to 74.2% in neurodegenerative disorders, 20 to 37% in vascular diseases, 13.3 to 50% in inflammatory diseases, 28.9 to 74.4% in epilepsy, and nearly 70% in migraines. Insomnia in neurological disorders stems from a variety of factors, encompassing physical and neuropsychiatric factors, behavioral patterns, and disruptions in the biological clock and circadian rhythm. There are bidirectional connections between neurological disorders and insomnia. Insomnia in neurological disorders worsens symptoms, resulting in heightened depressive symptoms, elevated mortality rates, reduced quality of life, and intensified acute symptoms. Managing comorbid sleep disorders, especially in the presence of psychiatric comorbidities, is crucial. Cognitive behavioral therapy for insomnia (CBT-I) is the first-line recommendation for insomnia management in neurological disorders. Other treatments are second-line strategies. Melatonin may demonstrate effectiveness in addressing insomnia, with soporific and chronobiotic effects. Furthermore, it has the potential to alleviate "sundowning" and behavioral disturbances, while generally being well-tolerated. Other treatment options that may be of interest include morning bright light therapy, sedative antidepressants, new orexin dual antagonists and levodopa specifically indicated for Parkinson's disease. Benzodiazepines and z-drugs can be used primarily during acute phases to prevent pharmacotolerance and minimize side effects. However, they should be avoided in patients with neurological disorders and not used in patients over 75 years old due to the risk of falls and confusion. In neurological disorders, insomnia has a profound impact on daytime functioning, making its management crucial. Effective treatment can result in improved outcomes, and additional research is necessary to investigate alternative therapeutic options and enhance patient care.
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Affiliation(s)
- R de Bergeyck
- Centre ChronoS, GHU Paris - Psychiatry Neurosciences, 1, rue Cabanis, 75014 Paris, France.
| | - P A Geoffroy
- Centre ChronoS, GHU Paris - Psychiatry Neurosciences, 1, rue Cabanis, 75014 Paris, France; Département de psychiatrie et d'addictologie, DMU Neurosciences, GHU Paris Nord, hôpital Bichat-Claude-Bernard, AP-HP, 75018 Paris, France; Université Paris Cité, NeuroDiderot, Inserm U1141, 75019 Paris, France; CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, 5, rue Blaise-Pascal, 67000 Strasbourg, France
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Frange C, Elias RM, Siengsukon C, Coelho FMS. Physical activity for obstructive sleep apnea after stroke? A pilot study assessing the contribution of body fluids. Sleep Breath 2023; 27:1343-1350. [PMID: 36327028 DOI: 10.1007/s11325-022-02735-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/10/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) and physical inactivity are common after stroke. Physical inactivity can lead to/or exacerbate edema following stroke, and the resultant overnight fluid shift may increase the risk of OSA. We aimed to investigate the effect of physical activity on nocturnal rostral fluid shift, sleep pattern, and edematous state of hemiparetic patients. METHODS Neck circumference (tape measured) and arms, legs, and trunk fluid volume (bioelectrical impedance spectrum analyzer) were measured before and after 2 polysomnography (PSG) examinations. In the lab, a whole night PSG was performed after the intervention. The intervention consisted of inactivity (lying down and sitting) or activity (standing, performing calf muscle contractions while standing, walking, and climbing stairs) between 13 and 21 h, after the randomization of the participants. With a 7-day interval, participants crossed over to the other group. RESULTS From 126 eligible participants, 8 with hemiparetic post-first-ever ischemic stroke at the subacute phase were recruited (age: 53.2 ± 16.2; 6 women). Physical activity reduced AHI from 19 to 13 n°/h and wake after sleep onset from 76.5 to 60.3 min and increased fluid volume of paretic and non-paretic arms and trunk before sleep compared to inactivity. CONCLUSION An acute bout of physical activity reduced OSA classification based on AHI (from moderate to mild) and sleep fragmentation. Our results provide preliminary evidence of a possible link between physical activity in patients after stroke as an intervention to counteract OSA severity and improve sleep.
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Affiliation(s)
- Cristina Frange
- Neurology and Neurosurgery Department, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
| | - Rosilene Motta Elias
- Nephrology Division, Department of Medicine of the Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Catherine Siengsukon
- Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kanasas, USA
| | - Fernando Morgadinho Santos Coelho
- Neurology and Neurosurgery Department, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
- Psychobiolgy Department, UNIFESP, São Paulo, Brazil
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Korostovtseva L, Bochkarev M, Amelina V, Nikishkina U, Osipenko S, Vasilieva A, Zheleznyakov V, Zabroda E, Gordeev A, Golovkova-Kucheryavaia M, Yanishevskiy S, Sviryaev Y, Konradi A. Sleep-Disordered Breathing and Prognosis after Ischemic Stroke: It Is Not Apnea-Hypopnea Index That Matters. Diagnostics (Basel) 2023; 13:2246. [PMID: 37443640 DOI: 10.3390/diagnostics13132246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Sleep-disordered breathing (SDB) is highly prevalent after stroke and is considered to be a risk factor for poor post-stroke outcomes. The aim of this observational study was to evaluate the effect of nocturnal respiratory-related indices based on nocturnal respiratory polygraphy on clinical outcomes (including mortality and non-fatal events) in patients with ischemic stroke. METHODS A total of 328 consecutive patients (181 (55%) males, mean age 65.8 ± 11.2 years old) with confirmed ischemic stroke admitted to a stroke unit within 24 h after stroke onset were included in the analysis. All patients underwent standard diagnostic and treatment procedures, and sleep polygraphy was performed within the clinical routine in the first 72 h after admission. The long-term outcomes were assessed by cumulative endpoint (death of any cause, new non-fatal myocardial infarction, new non-fatal stroke/transient ischemic attack, emergency revascularization, emergency hospitalization due to the worsening of cardiovascular disease). A Cox-regression analysis was applied to evaluate the effects of nocturnal respiratory indices on survival. RESULTS The mean follow-up period comprised 12 months (maximal-48 months). Patients with unfavourable outcomes demonstrated a higher obstructive apnea-hypopnea index, a higher hypoxemia burden assessed as a percent of the time with SpO2 < 90%, a higher average desaturation drop, and a higher respiratory rate at night. Survival time was significantly lower (30.6 (26.5; 34.7) versus 37.9 (34.2; 41.6) months (Log Rank 6.857, p = 0.009)) in patients with higher hypoxemia burden (SpO2 < 90% during ≥2.1% versus <2.1% of total analyzed time). However, survival time did not differ depending on the SDB presence assessed by AHI thresholds (either ≥5 or ≥15/h). The multivariable Cox proportional hazards regression (backward stepwise analysis) model demonstrated that the parameters of hypoxemia burden were significantly associated with survival time, independent of age, stroke severity, stroke-related medical interventions, comorbidities, and laboratory tests. CONCLUSION Our study demonstrates that the indices of hypoxemia burden have additional independent predictive value for long-term outcomes (mortality and non-fatal cardiovascular events) after ischemic stroke.
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Affiliation(s)
| | - Mikhail Bochkarev
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia
| | - Valeria Amelina
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia
- Department of Clinical Psychology, Herzen State Pedagogical University, 191186 St. Petersburg, Russia
| | | | - Sofia Osipenko
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia
- Medical Faculty, Pavlov University, 197022 St. Petersburg, Russia
| | | | | | - Ekaterina Zabroda
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia
- Biology Faculty, Saint Petersburg State University, 199034 St. Petersburg, Russia
| | - Alexey Gordeev
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia
- Biology Faculty, Saint Petersburg State University, 199034 St. Petersburg, Russia
| | | | | | - Yurii Sviryaev
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia
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Patel UK, Rao A, Manihani GSD, Patel N, George C, Vijayakumar JS, Evangeline SH, Alam MR, Ghuman K, Francis SZ, Pandya I, Reddy C, Parikh T, Shah S. Prevalence and Outcomes of Depression, Obstructive Sleep Apnea, and Concurrent Anxiety (DOCA) in Stroke Survivors: Insights From a Nationwide Study. Cureus 2023; 15:e41968. [PMID: 37588321 PMCID: PMC10427155 DOI: 10.7759/cureus.41968] [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: 06/03/2023] [Accepted: 07/15/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Many individuals will also experience psychological side effects after a stroke episode, such as symptoms of depression, anxiety (generalized anxiety disorder (GAD)), and/or specific phobias, considerably decreasing their quality of life (QOL). OBJECTIVE This study aimed to evaluate the prevalence of depression, obstructive sleep apnea (OSA), and concurrent anxiety (DOCA) and their outcomes (morbidity, disability (All Patient Refined Diagnosis Related Group (APRDRG) - loss of function), and discharge disposition) among acute ischemic stroke (AIS) hospitalizations. METHODS A cross-sectional study used the National Inpatient Sample (NIS) from 2003-2017. Adults with hospitalizations with AIS were extracted, and DOCA was identified using ICD-9/10-CM codes. Weighted analysis using a chi-square test and mixed-effect multivariable survey logistic regression was used to assess the prevalence and role of DOCA in predicting outcomes. RESULTS Out of 5,690,773 AIS hospitalizations, 2.7%, 3.1%, and 4.4% had depression, OSA, and GAD, respectively. In AIS patients, females had a higher prevalence of depression (3.4% vs. 2.3%) and GAD (5.9% vs. 3.0%) and a quality of life lower prevalence of OSA (2.2% vs 4.4%) in comparison to males (p<0.0001). Caucasians had a higher prevalence of depression, OSA, and GAD in comparison to others (African Americans/Hispanics/Asians/Native Americans). Depressed patients had a higher prevalence of morbidity (9% vs. 8% vs 5% vs. 7%), disability (46% vs. 46% vs. 35% vs. 37%), transfer to non-home (69% vs. 58% vs. 61% vs. 63%) in comparison with OSA, GAD, and non-DOCA patients, respectively (p<0.0001). Depression was associated with a 40% higher chance of severe disability (aOR 1.40; 95% CI 1.38-41), morbidity (1.36; 1.33-1.38), and discharge to non-home (1.54; 1.52-1.56). OSA and GAD had higher odds of non-home discharge amongst post-AIS hospitalizations. CONCLUSION DOCA is associated with poor outcomes among post-AIS patients. Prompt recognition by screening and timely management of DOCA may mitigate the adverse outcomes.
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Affiliation(s)
- Urvish K Patel
- Department of Public Health and Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Alankruta Rao
- Department of Medicine, Krishna Institute of Medical Sciences, Karad, IND
| | | | - Neel Patel
- Department of Public Health and Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Cilgy George
- Department of Neurology, Rajagiri Hospital, Aluva, IND
| | - Jai Sriram Vijayakumar
- Department of Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, IND
| | | | - Mohammad R Alam
- Department of Internal Medicine, Arghakhanchi District Hospital, Sandhikharka, NPL
| | - Kulbir Ghuman
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Stephan Z Francis
- Department of Internal Medicine, Saba University School of Medicine, The Bottom, BES
| | - Ishani Pandya
- Department of Medicine, Grodno State Medical University, Grodno, BLR
| | - Chandrakanth Reddy
- Department of Radiology, M.N. Raju Medical College and Hospital, Sangareddy, IND
| | - Tapan Parikh
- Department of Psychiatry, Feinberg School of Medicine, Chicago, USA
| | - Shamik Shah
- Department of Neurology, Stormont Vail Health, Topeka, USA
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Sircu V, Colesnic SI, Covantsev S, Corlateanu O, Sukhotko A, Popovici C, Corlateanu A. The Burden of Comorbidities in Obstructive Sleep Apnea and the Pathophysiologic Mechanisms and Effects of CPAP. Clocks Sleep 2023; 5:333-349. [PMID: 37366660 DOI: 10.3390/clockssleep5020025] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/22/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
Micro-arousals and the repeated desaturation of oxyhemoglobin, which are typical in obstructive sleep apnea syndrome (OSAS), have adverse effects on the health of patients, leading to a wide range of complications such as cardiovascular (arterial hypertension, pulmonary hypertension, chronic heart failure, arrhythmias, myocardial infarction), cerebrovascular (strokes), metabolic (insulin resistance, obesity, diabetes mellitus, metabolic syndrome), gastrointestinal (non-alcoholic liver disease), urinary (chronic renal failure), and neuropsychiatric complications as well as a wide range of malignancies. These, in turn, have multilateral effects on familial, occupational, and social life, as well as increasing the risks of road traffic accidents and accidents at the workplace. Awareness, timely screening, and the prevention of complications play important roles in diagnosing and treating comorbid conditions. This review focuses on comorbidities in OSAS and the effect of Continuous Positive Airway Pressure (CPAP) therapy on their prognoses.
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Affiliation(s)
- Victoria Sircu
- Division of Pneumology and Allergology, Department of Internal Medicine, State University of Medicine and Pharmacy Nicolae Testemitanu, MD-2004 Chisinau, Moldova
| | - Silvia-Iaroslava Colesnic
- Division of Pneumology and Allergology, Department of Internal Medicine, State University of Medicine and Pharmacy Nicolae Testemitanu, MD-2004 Chisinau, Moldova
| | - Serghei Covantsev
- Department of Clinical Research and Development, Botkin Hospital, 125284 Moscow, Russia
- Department of Emergency Medicine № 76, Botkin Hospital, 125284 Moscow, Russia
| | - Olga Corlateanu
- Department of Internal Medicine, State University of Medicine and Pharmacy Nicolae Testemitanu, MD-2004 Chisinau, Moldova
| | - Anna Sukhotko
- Department of General Oncology № 71, Botkin Hospital, 125284 Moscow, Russia
| | - Cristian Popovici
- Division of Pneumology and Allergology, Department of Internal Medicine, State University of Medicine and Pharmacy Nicolae Testemitanu, MD-2004 Chisinau, Moldova
| | - Alexandru Corlateanu
- Division of Pneumology and Allergology, Department of Internal Medicine, State University of Medicine and Pharmacy Nicolae Testemitanu, MD-2004 Chisinau, Moldova
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Gao H, Kan Z, Fang Y, Wang N, Yan W, Yang M, Song Y. Efficacy and safety of acupuncture in the treatment of stroke complicated with sleep apnea syndrome: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2023; 102:e33241. [PMID: 37058070 PMCID: PMC10101308 DOI: 10.1097/md.0000000000033241] [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: 01/04/2023] [Accepted: 02/13/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND stroke patients often have a combination of sleep apnea syndrome, which is an important and modifiable risk factor for stroke prognosis. Acupuncture is one of the measures for sleep apnea syndrome, and it is also widely used in stroke. However, we are concerned that its efficacy and safety in the treatment of stroke with sleep apnea syndrome are not yet clear. METHODS This systematic review and meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses schema and was registered with INPLASY (registration number: INPLASY202250113). The following 8 databases were searched: PubMed, Cochrane Library (CENTRAL), Embase, Web of Science, China National Knowledge Infrastructure, Chongqing VIP Information, WanFang Data, and China Biomedical Literature Database limited from the establishment of each database to May 4, 2022. Subject headings, free words, and keywords were used for retrieval. Relevant literature was supplemented by consulting other resources. We assessed the risk of bias in the included studies using the Cochrane risk of bias tool. RevMan 5.4 software (The Cochrane Collaboration, 2020) was used to perform the meta-analysis. RESULTS Six records were included, including a total of 513 participants: 256 in the experimental group and 257 in the control group. The results showed that the total effective rate (relative risk = 1.23, 95% confidence interval (CI): 1.13, 1.34, P < .00001), apnea-hypopnea index (mean difference (MD) = -8.39, 95% CI: -9.19, -7.59, P < .00001), Epworth Sleepiness Scale score (MD = -1.59, 95% CI: -2.66, -0.52, P = .004), minimal oxygen saturation (MD = 4.99, 95% CI: 3.5, 6.47, P < .00001), longest duration of apnea (MD = -7.47, 95% CI: -8.97, -5.97, P < .00001), longest duration of apnea (MD = -6.48, 95% CI: -8.60, -4.35, P < .00001), and S100β levels (standard mean difference = -1.52, 95% CI: -1.87, -1.18, P < .00001) were better in the experimental group than in the control group. Simultaneously, the effect of reducing the neuron-specific enolase level in the experimental group was comparable to that in the control group (MD = -3.40, 95% CI: -9.08, 2.29, P = .24). CONCLUSIONS Acupuncture can improve the clinical symptoms and related laboratory indicators for sleep apnea syndrome in patients with stroke. More high-quality trials remain urgently needed.
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Affiliation(s)
- Huanyu Gao
- Institute of Literature and Culture of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Zunqi Kan
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Yuqing Fang
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Ning Wang
- College of the First Clinical Medical, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Wenli Yan
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Mengqi Yang
- College of the First Clinical Medical, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Yongmei Song
- Institute of Literature and Culture of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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Toh ZA, Cheng LJ, Wu XV, De Silva DA, Oh HX, Ng SX, He HG, Pikkarainen M. Positive airway pressure therapy for post-stroke sleep disordered breathing: a systematic review, meta-analysis and meta-regression. Eur Respir Rev 2023; 32:32/167/220169. [PMID: 36889784 PMCID: PMC10032615 DOI: 10.1183/16000617.0169-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/24/2022] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Sleep disordered breathing (SDB) is an under-recognised independent risk factor and a potential consequence of stroke. We systematically reviewed and meta-analysed the effectiveness of positive airway pressure (PAP) therapy in improving post-stroke outcomes. METHODS We searched CENTRAL, Embase, PubMed, CINAHL, PsycINFO, Scopus, ProQuest, Web of Science and CNKI (China National Knowledge Infrastructure) for randomised controlled trials comparing PAP therapy against a control or placebo group. We evaluated the pooled effects of PAP therapy on recurrent vascular events, neurological deficit, cognition, functional independence, daytime sleepiness and depression using random effects meta-analyses. RESULTS We identified 24 studies. Our meta-analyses showed that PAP therapy reduced recurrent vascular events (risk ratio 0.47, 95% CI 0.28-0.78), and showed significant beneficial effects on neurological deficit (Hedges' g= -0.79, 95% CI -1.19- -0.39), cognition (g=0.85, 95% CI 0.04-1.65), functional independence (g=0.45, 95% CI 0.01-0.88) and daytime sleepiness (g= -0.96, 95% CI -1.56- -0.37). However, there was insignificant reduction in depression (g= -0.56, 95% CI -2.15-1.02). No publication bias was detected. CONCLUSIONS Post-stroke patients with SDB benefited from PAP therapy. Prospective trials are needed to determine the ideal initiation period and the minimum effective therapeutic dose.
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Affiliation(s)
- Zheng An Toh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Nursing, National University Hospital, Singapore
- National University Health System, Singapore
| | - Ling Jie Cheng
- National University Health System, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Xi Vivien Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- National University Health System, Singapore
| | - Deidre Anne De Silva
- Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore
| | - Hui Xian Oh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Nursing, National University Hospital, Singapore
- National University Health System, Singapore
| | - Si Xian Ng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Nursing, National University Hospital, Singapore
- National University Health System, Singapore
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- National University Health System, Singapore
| | - Minna Pikkarainen
- Department of Occupational Therapy, Prosthetics and Orthoptics, Faculty of Health Sciences and Department of Product Design, Faculty of Technology, Art and Design, Oslo Metropolitan University, Oslo, Norway
- Martti Ahtisaari Institute, University of Oulu, Oulu, Finland
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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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Aini N, Chu H, Banda KJ, Chen R, Lee TY, Pien LC, Liu D, Lai YJ, Kang XL, Chou KR. Prevalence of sleep-related breathing disorders and associated risk factors among people with dementia: A meta-analysis. Sleep Med 2023; 103:51-61. [PMID: 36758347 DOI: 10.1016/j.sleep.2023.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/15/2022] [Accepted: 01/25/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Sleep-related breathing disorders (SRBD) have shown to cause worsened cognitive impairment among people with dementia. Therefore, we conducted the first meta-analysis to estimate the prevalence of SRBD among people with dementia. METHODS Comprehensive searches were conducted in Embase, Ovid-MEDLINE, PubMed, PsycINFO, Scopus, Web of Science, and CINAHL. The generalized linear mixed model (GLMM) was used for the pooled prevalence analysis and heterogeneity using I2 test and Cochran's Q-statistic in R-software. Study quality was assessed by Hoy's risk of bias assessment tool. Overall, 20 studies from 1282 studies were included with 1461 participants. RESULTS The pooled prevalence of SRBD among dementia was 59% (95%CI: 44%-73%) with 55% (95%CI: 34%-74%) for obstructive sleep apnea (OSA), 49% (95%CI: 25%-73%) for unspecified SRBD, and 11% (95%CI: 5%-21%) for central sleep apnea (CSA). Regarding dementia subtypes, the prevalence of SRBD was 89% (95%CI: 61%-97%) for Alzheimer's dementia, 56% (95%CI: 48%-63%) for Parkinson's and Idiopathic Parkinson's dementia, and 16% (95%CI: 8%-30%) for Huntington's dementia. Significant moderator variables were male, body mass index, larger waist and hip circumference, waist-hip ratio, and comorbidities including hypertension, dyslipidemia, renal disease, diabetes, heart disease, and stroke. CONCLUSIONS There is considerable high prevalence of SRBD among dementia people, with OSA and unspecified SRBD being fivefold higher than CSA. Regarding dementia subtypes, Parkinson's and Idiopathic Parkinson's, and Alzheimer's dementia had four to sixfold increased risk of presenting with SRBD than Huntington's dementia. Therefore, assessment and management of SRBD in Alzheimer's, and Parkinson's and Idiopathic Parkinson's dementia deserves more attention in future research.
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Affiliation(s)
- Nur Aini
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Nursing Department, Faculty of Health Science, University of Muhammadiyah Malang, Indonesia
| | - Hsin Chu
- Institute of Aerospace and Undersea Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan; Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kondwani Joseph Banda
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Endoscopy Unit, Surgery Department, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Ruey Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan; Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Tso-Ying Lee
- Nursing Research Center, Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Li-Chung Pien
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Doresses Liu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yueh-Jung Lai
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Xiao Linda Kang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; School of Nursing, University of Pennsylvania, Philadelphia, USA
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan; Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan.
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13
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Sleep-Disordered Breathing in Acute Stroke: A Single-Center, Prospective, Longitudinal Study. J Clin Med 2023; 12:jcm12030986. [PMID: 36769634 PMCID: PMC9917629 DOI: 10.3390/jcm12030986] [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: 12/30/2022] [Revised: 01/21/2023] [Accepted: 01/24/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Sleep-disordered breathing (SDB) is common among acute stroke patients. We sought to investigate the prevalence, severity and type of SDB in consecutive acute stroke patients. Moreover, we aimed to identify independent predictors of SDB in the acute stroke setting and investigate potential associations between SDB and functional outcomes at three months. METHODS We prospectively studied consecutive acute stroke patients, who underwent overnight polysomnography within 72 h from symptom onset. Demographics, clinical and imaging characteristics were documented. Daytime sleepiness preceding the stroke, stroke severity on admission and functional outcome at three months were evaluated using the Epworth-Sleepiness Scale (ESS), National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS), respectively. SDB was documented using standard polysomnography criteria. RESULTS A total of 130 consecutive acute stroke patients were prospectively evaluated [110 with ischemic stroke and 20 with intracerebral hemorrhage, mean age 60.5 ± 10.9 years, 77% men, median NIHSS score on admission: 3 (IQR: 2-17)]. The rate of SDB detection on polysomnography recordings was 79% (95% CI: 71-86). Three variables were independently associated with the likelihood of SDB detection in multivariable analyses adjusting for potential confounders: age (OR per 10-year-increase: 2.318, 95% CI: 1.327-4.391, p = 0.005), male sex (OR: 7.901, 95% CI: 2.349-30.855, p = 0.001) and abnormal ESS-score (OR: 6.064, 95% CI: 1.560-32.283, p = 0.017). Among patients with SDB, congestive heart failure was independently associated with the likelihood of central apnea detection (OR: 18.295, 95% CI: 4.464-19.105, p < 0.001). Among all patients, increasing NIHSS score on admission (OR: 0.817, 95% CI: 0.737-0.891, p < 0.001) and Apnea-Hypopnea Index (OR: 0.979, 95% CI: 0.962-0.996, p = 0.020) emerged as independent predictors of excellent functional outcome at 3 months (mRS-scores 0-1). CONCLUSION The high prevalence and severity of SDB in acute stroke patients and its negative impact on functional outcome indicate the importance of polysomnography implementation in everyday clinical practice of acute stroke work-up and management.
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Xu J, Wang J, Wu H, Han F, Wang Q, Jiang Y, Chen R. Effects of severe obstructive sleep apnea on functional prognosis in the acute phase of ischemic stroke and quantitative electroencephalographic markers. Sleep Med 2023; 101:452-460. [PMID: 36516602 DOI: 10.1016/j.sleep.2022.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/07/2022]
Abstract
OBJECTIVE To investigate the effect of severe obstructive sleep apnea (OSA) on functional prognosis in the acute phase and quantitative electroencephalography (EEG) markers during sleep in ischemic stroke patients. METHODS This study included 125 mild-to-moderate acute ischemic stroke patients with OSA who underwent polysomnography (PSG) within one week of stroke onset between January 2015 and June 2020. Patients were grouped according to their apnea-hypopnea index (</≥ 30/h). Poor functional prognosis was defined as modified Rankin Scale score ≥3. The EEG recorded by PSG was extracted during different sleep stages for power spectrum analysis. The delta/alpha power ratio (DAR), (delta + theta)/(alpha + beta) ratio (the slowing ratio, TSR), and the relative power (RP) of each frequency band were calculated. Differences in clinical, PSG, and quantitative EEG characteristics were compared between the groups. Additionally, we explored predictors of poor functional prognosis. RESULTS Patients with severe OSA had a higher proportion of hypertension, lower relative power of high-frequency bands, and higher delta RP, TSR, and DAR (p < 0.05). Severe OSA was associated with a 3.6-fold increase in risk of poor prognosis (p < 0.05). Increased delta RP and TSR, as well as decreased alpha, beta, and sigma RP, may be independent predictors of a poor functional prognosis. CONCLUSIONS Severe OSA is an independent risk factor for a poor functional prognosis in patients with acute ischemic stroke, and quantitative EEG during sleep showed a significant slow wave enhancement, suggesting more severe brain dysfunction. The treatment of severe OSA may improve functional prognosis.
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Affiliation(s)
- Juan Xu
- Department of Respiratory Medicine, Sleep Center, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China; Department of Respiratory Medicine, The Yancheng Clinical College of Xuzhou Medical University, The First People's Hospital of Yancheng City, Yancheng, China
| | - Jianhua Wang
- Department of Respiratory Medicine, Sleep Center, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China; Department of Respiratory Medicine, Zigong Third People's Hospital, Zigong, China
| | - Huaman Wu
- Department of Respiratory Medicine, Sleep Center, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Fei Han
- Department of Respiratory Medicine, Sleep Center, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Qiaojun Wang
- Department of Respiratory Medicine, Sleep Center, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Yongqian Jiang
- Department of Respiratory Medicine, The Yancheng Clinical College of Xuzhou Medical University, The First People's Hospital of Yancheng City, Yancheng, China.
| | - Rui Chen
- Department of Respiratory Medicine, Sleep Center, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China.
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Inter-sleep stage variations in corrected QT interval differ between obstructive sleep apnea patients with and without stroke history. PLoS One 2022; 17:e0278520. [PMID: 36454997 PMCID: PMC9714836 DOI: 10.1371/journal.pone.0278520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/17/2022] [Indexed: 12/05/2022] Open
Abstract
Obstructive sleep apnea (OSA) is related to the progression of cardiovascular diseases (CVD); it is an independent risk factor for stroke and is also prevalent post-stroke. Furthermore, heart rate corrected QT (QTc) is an important predictor of the risk of arrhythmia and CVD. Thus, we aimed to investigate QTc interval variations in different sleep stages in OSA patients and whether nocturnal QTc intervals differ between OSA patients with and without stroke history. 18 OSA patients (apnea-hypopnea index (AHI)≥15) with previously diagnosed stroke and 18 OSA patients (AHI≥15) without stroke history were studied. Subjects underwent full polysomnography including an electrocardiogram measured by modified lead II configuration. RR, QT, and QTc intervals were calculated in all sleep stages. Regression analysis was utilized to investigate possible confounding effects of sleep stages and stroke history on QTc intervals. Compared to patients without previous stroke history, QTc intervals were significantly higher (β = 34, p<0.01) in patients with stroke history independent of age, sex, body mass index, and OSA severity. N3 sleep (β = 5.8, p<0.01) and REM sleep (β = 2.8, p<0.01) increased QTc intervals in both patient groups. In addition, QTc intervals increased progressively (p<0.05) towards deeper sleep in both groups; however, the magnitude of changes compared to the wake stage was significantly higher (p<0.05) in patients with stroke history. The findings of this study indicate that especially in deeper sleep, OSA patients with a previous stroke have an elevated risk for QTc prolongation further increasing the risk for ventricular arrhythmogenicity and sudden cardiac death.
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Gleeson M, McNicholas WT. Bidirectional relationships of comorbidity with obstructive sleep apnoea. Eur Respir Rev 2022; 31:31/164/210256. [PMID: 35508332 PMCID: PMC9488957 DOI: 10.1183/16000617.0256-2021] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/07/2022] [Indexed: 11/26/2022] Open
Abstract
Obstructive sleep apnoea (OSA) is frequently associated with comorbidities that include metabolic, cardiovascular, renal, pulmonary and neuropsychiatric. There is considerable evidence that OSA is an independent risk factor for many of these comorbidities but, more recently, there is evidence that some of these comorbidities may predispose to the development of OSA. Thus, there is growing evidence of a bidirectional relationship between OSA and comorbidity, especially for heart failure, metabolic syndrome and stroke. Potential mechanisms of bidirectional relationships differ in individual comorbidities with fluid retention and redistribution being especially important in heart failure and end-stage renal disease, whereas neural mechanisms may be more important in diabetes mellitus and stroke. The evidence for other comorbidities, such as hypertension and atrial fibrillation, support these being more a consequence of OSA with limited evidence to support a bidirectional relationship. The present review explores the evidence for such bidirectional relationships with a particular perspective on comorbidities that may predispose to OSA. The impact of therapy in bidirectional relationships is also reviewed, which highlights the clinical importance of accurate diagnosis. This aspect is especially true of COPD, where the identification of co-existing OSA has important implications for optimum therapy. Obstructive sleep apnoea (OSA) is an independent risk factor for comorbidity, especially cardiometabolic. However, some comorbidities may be risk factors for OSA, supporting a bidirectional relationship that may have important implications for treatment.https://bit.ly/3BbJy6V
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Affiliation(s)
- Margaret Gleeson
- School of Medicine, University College Dublin, and Dept of Respiratory and Sleep Medicine, St. Vincent's Hospital Group, Dublin, Ireland
| | - Walter T McNicholas
- School of Medicine, University College Dublin, and Dept of Respiratory and Sleep Medicine, St. Vincent's Hospital Group, Dublin, Ireland
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McNicholas WT, Pevernagie D. Obstructive sleep apnea: transition from pathophysiology to an integrative disease model. J Sleep Res 2022; 31:e13616. [PMID: 35609941 PMCID: PMC9539471 DOI: 10.1111/jsr.13616] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 12/12/2022]
Abstract
Obstructive sleep apnea (OSA) is characterised by recurring episodes of upper airway obstruction during sleep and the fundamental abnormality reflects the inability of the upper airway dilating muscles to withstand the negative forces generated within the upper airway during inspiration. Factors that result in narrowing of the oropharynx such as abnormal craniofacial anatomy, soft tissue accumulation in the neck, and rostral fluid shift in the recumbent position increase the collapsing forces within the airway. The counteracting forces of upper airway dilating muscles, especially the genioglossus, are negatively influenced by sleep onset, inadequacy of the genioglossus responsiveness, ventilatory instability, especially post arousal, and loop gain. OSA is frequently associated with comorbidities that include metabolic, cardiovascular, renal, pulmonary, and neuropsychiatric, and there is growing evidence of bidirectional relationships between OSA and comorbidity, especially for heart failure, metabolic syndrome, and stroke. A detailed understanding of the complex pathophysiology of OSA encourages the development of therapies targeted at pathophysiological endotypes and facilitates a move towards precision medicine as a potential alternative to continuous positive airway pressure therapy in selected patients.
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Affiliation(s)
- Walter T McNicholas
- Department of Respiratory and Sleep Medicine, St Vincent's Hospital Group, School of Medicine, University College Dublin, Dublin, Ireland
| | - Dirk Pevernagie
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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A portrait of obstructive sleep apnea risk factors in 27,210 middle-aged and older adults in the Canadian Longitudinal Study on Aging. Sci Rep 2022; 12:5127. [PMID: 35332170 PMCID: PMC8948183 DOI: 10.1038/s41598-022-08164-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/22/2022] [Indexed: 01/03/2023] Open
Abstract
Determining the prevalence and characteristics of individuals susceptible to present with obstructive sleep apnea (OSA) is essential for developing targeted and efficient prevention and screening strategies. We included 27,210 participants aged ≥45 years old (50.3% women) from the Canadian Longitudinal Study on Aging. Using the STOP questionnaire combined to the percentage of body fat (%BF), we estimated the prevalence of individuals at high-risk for OSA in a sex and age-specific manner, and tested the relation with comorbidities, menopause and systemic inflammation. The prevalence was 17.5%, and was lower in women (13.1%) than in men (21.9%). A high level of high-sensitivity C-reactive protein was the strongest factor associated with OSA risk and this association was 1.3-2.3 times higher in women than in men. OSA risk increased with age, cardiovascular diseases, diabetes mellitus, anxio-depressive symptoms, asthma and arthritis. In women, post-menopausal status was associated with a high OSA risk. Nearly 1 adult out of 5 older than 45 is at risk for OSA in Canada. Comorbidities, menopause and systemic inflammation, more than age, explain increased OSA prevalence. Considering this high prevalence and associations with medical and mental comorbidities, health care practitioners should incorporate systematic OSA screening in their clinical procedures.
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Sleep and Stroke: Opening Our Eyes to Current Knowledge of a Key Relationship. Curr Neurol Neurosci Rep 2022; 22:767-779. [PMID: 36190654 PMCID: PMC9633474 DOI: 10.1007/s11910-022-01234-2] [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] [Accepted: 09/06/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW To elucidate the interconnection between sleep and stroke. RECENT FINDINGS Growing data support a bidirectional relationship between stroke and sleep. In particular, there is strong evidence that sleep-disordered breathing plays a pivotal role as risk factor and concur to worsening functional outcome. Conversely, for others sleep disorders (e.g., insomnia, restless legs syndrome, periodic limb movements of sleep, REM sleep behavior disorder), the evidence is weak. Moreover, sleep disturbances are highly prevalent also in chronic stroke and concur to worsening quality of life of patients. Promising novel technologies will probably allow, in a near future, to guarantee a screening of commonest sleep disturbances in a larger proportion of patients with stroke. Sleep assessment and management should enter in the routinary evaluation of stroke patients, of both acute and chronic phase. Future research should focus on the efficacy of specific sleep intervention as a therapeutic option for stroke patients.
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Baillieul S, Dekkers M, Brill AK, Schmidt MH, Detante O, Pépin JL, Tamisier R, Bassetti CLA. Sleep apnoea and ischaemic stroke: current knowledge and future directions. Lancet Neurol 2021; 21:78-88. [PMID: 34942140 DOI: 10.1016/s1474-4422(21)00321-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/31/2021] [Accepted: 09/07/2021] [Indexed: 12/11/2022]
Abstract
Sleep apnoea, one of the most common chronic diseases, is a risk factor for ischaemic stroke, stroke recurrence, and poor functional recovery after stroke. More than half of stroke survivors present with sleep apnoea during the acute phase after stroke, with obstructive sleep apnoea being the most common subtype. Following a stroke, sleep apnoea frequency and severity might decrease over time, but moderate to severe sleep apnoea is nevertheless present in up to a third of patients in the chronic phase after an ischaemic stroke. Over the past few decades evidence suggests that treatment for sleep apnoea is feasible during the acute phase of stroke and might favourably affect recovery and long-term outcomes. Nevertheless, sleep apnoea still remains underdiagnosed and untreated in many cases, due to challenges in the detection and prediction of post-stroke sleep apnoea, uncertainty as to the optimal timing for its diagnosis, and a scarcity of clear treatment guidelines (ie, uncertainty on when to treat and the optimal treatment strategy). Moreover, the pathophysiology of sleep apnoea associated with stroke, the proportion of stroke survivors with obstructive and central sleep apnoea, and the temporal evolution of sleep apnoea subtypes following stroke remain to be clarified. To address these shortcomings, the management of sleep apnoea associated with stroke should be integrated into a multidisciplinary diagnostic, treatment, and follow-up strategy.
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Affiliation(s)
- Sébastien Baillieul
- Department of Neurology, Inselspital, University Hospital, Bern, Switzerland; Service Universitaire de Pneumologie Physiologie, Grenoble Alpes University Hospital, Grenoble, France; Inserm U1300, Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Martijn Dekkers
- Department of Neurology, Inselspital, University Hospital, Bern, Switzerland
| | - Anne-Kathrin Brill
- Department of Pulmonary Medicine, Inselspital, University Hospital, Bern, Switzerland
| | - Markus H Schmidt
- Department of Neurology, Inselspital, University Hospital, Bern, Switzerland; Ohio Sleep Medicine Institute, Dublin, OH, USA
| | - Olivier Detante
- Stroke Unit, Neurology Department, Grenoble Alpes University Hospital, Grenoble, France; Inserm U1216, Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Jean-Louis Pépin
- Service Universitaire de Pneumologie Physiologie, Grenoble Alpes University Hospital, Grenoble, France; Inserm U1300, Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Renaud Tamisier
- Service Universitaire de Pneumologie Physiologie, Grenoble Alpes University Hospital, Grenoble, France; Inserm U1300, Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France
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21
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Tanayapong P, Kuna ST. Sleep disordered breathing as a cause and consequence of stroke: A review of pathophysiological and clinical relationships. Sleep Med Rev 2021; 59:101499. [PMID: 34020180 DOI: 10.1016/j.smrv.2021.101499] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/12/2021] [Accepted: 04/25/2021] [Indexed: 12/22/2022]
Abstract
Stroke is the leading cause of death and disability globally. Sleep disordered breathing (SDB), a potentially modifiable risk factor of stroke, is highly prevalent in stroke survivors. Evidence supports a causal, bidirectional relationship between SDB and stroke. SDB may increase the risk of stroke occurrence and recurrence, and worsen stroke outcome. While SDB is associated with an increased incidence of hypertension and cardiac arrhythmias, both of which are traditional stroke risk factors, SDB is also an independent risk factor for stroke. A number of characteristics of SDB may increase stroke risk, including intermittent hypoxemia, sympathetic activation, changes in cerebral autoregulation, oxidative stress, systemic inflammation, hypercoagulability, and endothelial dysfunction. On the other hand, stroke may also cause new SDB or aggravate preexisting SDB. Continuous positive airway pressure treatment of SDB may have a beneficial role in reducing stroke risk and improving neurological outcome after stroke. The treatment should be considered as early as possible, particularly when SDB is present post-stroke. The goal of this review is to highlight the strong link between SDB and stroke and to raise awareness for practitioners to consider the possibility of SDB being present in all stroke survivors.
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Affiliation(s)
- Pongsakorn Tanayapong
- Division of Neurology, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand; Neurology Center, Vibhavadi Hospital, Bangkok, Thailand.
| | - Samuel T Kuna
- Department of Medicine, Corporal Michael J. Crescenz VA, Medical Center, Philadelphia, PA, United States; Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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22
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Abstract
PURPOSE OF REVIEW Stroke and sleep apnea are highly prevalent conditions with a physiologically plausible bidirectional relationship. This review addresses prestroke sleep apnea, wake-up stroke and sleep apnea, and poststroke sleep apnea, with an attempt to highlight research published in the last 18 months. RECENT FINDINGS Sleep apnea is highly prevalent poststroke. Poststroke sleep apnea is associated with worse poststroke functional and cognitive outcomes and a higher risk of recurrent stroke. Physiologic tests are needed to diagnose sleep apnea in poststroke patients as sleep apnea questionnaires do not perform well in this population. The role of CPAP in poststroke management is not yet well established. SUMMARY Sleep apnea is a well established independent risk factor for stroke that confers an approximately two-fold increased risk of incident stroke. Sleep apnea is highly prevalent poststroke and is associated with worse outcomes after stroke. Sleep apnea is an attractive target for research addressing secondary stroke prevention and recovery.
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23
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Hasan F, Gordon C, Wu D, Huang HC, Yuliana LT, Susatia B, Marta OFD, Chiu HY. Dynamic Prevalence of Sleep Disorders Following Stroke or Transient Ischemic Attack: Systematic Review and Meta-Analysis. Stroke 2021; 52:655-663. [PMID: 33406871 DOI: 10.1161/strokeaha.120.029847] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The exact prevalence of sleep disorders following stroke or transient ischemic attack (TIA) remains unclear. We aimed to determine the prevalence of sleep-disordered breathing, insomnia, periodic leg movement during sleep, and restless leg syndrome following stroke or TIA in acute, subacute, and chronic phases and examine the moderating effects of patient characteristics (eg, age) and methodological features (eg, study quality) on the prevalence. METHODS We performed a systematic review and meta-analysis. Embase and PubMed were searched from inception to December 18, 2019. We included 64 047 adults in 169 studies (prospective, retrospective, case-control, and cross-sectional study designs) reporting the prevalence of sleep disorders following stroke or TIA. RESULTS In the acute phase, the overall prevalence of mild, moderate, and severe sleep-disordered breathing was 66.8%, 50.3%, and 31.6% (95% CIs, 63.8-69.7, 41.9-58.7, and 24.9-39.1). In the subacute phase, the prevalence of mild, moderate, and severe sleep-disordered breathing was 65.5%, 44.3%, and 36.1% (95% CIs, 58.9-71.5, 36.1-52.8, and 22.2-52.8). In the chronic phase, the summary prevalence of mild, moderate, and severe sleep-disordered breathing was 66.2%, 33.1%, and 25.1% (95% CIs, 58.6-73.1, 24.8-42.6, and 10.9-47.6). The prevalence rates of insomnia in the acute, subacute, and chronic phases were 40.7%, 42.6%, and 35.9% (95% CIs, 31.8-50.3, 31.7-54.1, and 28.6-44.0). The pooled prevalence of periodic leg movement during sleep in the acute, subacute, and chronic phases was 32.0%, 27.3%, and 48.2% (95% CIs, 7.4-73.5, 11.6-51.7, and 33.1-63.5). The summary prevalence of restless leg syndrome in the acute and chronic phases was 10.4% and 13.7% (95 CIs, 6.4-16.4 and 2.3-51.8). Age, sex, comorbidities, smoking history, and study region had significant moderating effects on the prevalence of sleep disorders. CONCLUSIONS Sleep disorders following stroke or TIA are highly prevalent over time. Our findings indicate the importance of early screening and treating sleep disorders following stroke or TIA.
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Affiliation(s)
- Faizul Hasan
- School of Nursing, College of Nursing (F.H., H.-C.H., O.F.D.M., H.-Y.C.), Taipei Medical University, Taiwan.,School of Nursing (F.H., B.S.), Politeknik Kesehatan Kemenkes Malang, Indonesia
| | - Christopher Gordon
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Australia (C.G.)
| | - Dean Wu
- Department of Neurology, School of Medicine, College of Medicine (D.W.), Taipei Medical University, Taiwan.,Department of Neurology, Shuang-Ho Hospital (D.W.), Taipei Medical University, Taiwan.,Research Center of Sleep Medicine, College of Medicine (D.W., H.-Y.C.), Taipei Medical University, Taiwan
| | - Hui-Chuan Huang
- School of Nursing, College of Nursing (F.H., H.-C.H., O.F.D.M., H.-Y.C.), Taipei Medical University, Taiwan
| | | | - Budi Susatia
- School of Nursing (F.H., B.S.), Politeknik Kesehatan Kemenkes Malang, Indonesia
| | - Ollyvia Freeska Dwi Marta
- School of Nursing, College of Nursing (F.H., H.-C.H., O.F.D.M., H.-Y.C.), Taipei Medical University, Taiwan.,Nursing Department, Faculty of Health Science, University of Muhammadiyah Malang, Indonesia (O.F.D.M.)
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing (F.H., H.-C.H., O.F.D.M., H.-Y.C.), Taipei Medical University, Taiwan.,Research Center of Sleep Medicine, College of Medicine (D.W., H.-Y.C.), Taipei Medical University, Taiwan
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24
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Park J, Yeo M, Kim J, Kim S, Lee SH, Kwon S, Shin DI, Lee S, Lee SY. Sleep-disordered breathing and wake-up stroke: a differential association depending on etiologic subtypes. Sleep Med 2020; 76:43-47. [DOI: 10.1016/j.sleep.2020.09.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/07/2020] [Accepted: 09/29/2020] [Indexed: 12/17/2022]
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25
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Identifying neurological comorbidities in obstructive sleep apnea patients through polysomnography. Sleep Breath 2020; 25:1555-1557. [PMID: 33089399 PMCID: PMC8376689 DOI: 10.1007/s11325-020-02231-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/12/2020] [Accepted: 10/15/2020] [Indexed: 10/27/2022]
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26
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Bernasconi C, Ott SR, Fanfulla F, Miano S, Horvath T, Seiler A, Cereda CW, Brill AK, Young P, Nobili L, Manconi M, Bassetti CLA. SAS CARE 2 - a randomized study of CPAP in patients with obstructive sleep disordered breathing following ischemic stroke or transient ischemic attack. Sleep Med X 2020; 2:100027. [PMID: 33870178 PMCID: PMC8041126 DOI: 10.1016/j.sleepx.2020.100027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/03/2020] [Accepted: 09/29/2020] [Indexed: 12/23/2022] Open
Abstract
Objective/background The benefit of Continuous Positive Airway Pressure (CPAP) treatment following ischemic stroke in patients with obstructive sleep-disordered breathing (SDB) is unclear. We set out to investigate this open question in a randomized controlled trial as part of the SAS-CARE study. Patients/methods. Non-sleepy patients (ESS < 10) with ischemic stroke or transient ischemic attack (TIA) and obstructive SDB (AHI ≥ 20) 3 months post-stroke were randomized 1:1 to CPAP treatment (CPAP+) or standard care. Primary outcome was the occurrence of vascular events (TIA/stroke, myocardial infarction/revascularization, hospitalization for heart failure or unstable angina) or death within 24 months post-stroke. Secondary outcomes included Modified Rankin Scale (mRS) and Barthel Index. Results Among 238 SAS-CARE patients 41 (17%) non-sleepy obstructive SDB patients were randomized to CPAP (n = 19) or standard care (n = 22). Most patients (80%) had stroke and were males (78%), mean age was 64 ± 7 years and mean NIHSS score 0.6 ± 1.0 (range: 0–5). The primary endpoint was met by one patient in the standard care arm (a new stroke). In an intent-to treat analysis disregarding adherence, this corresponds to an absolute risk difference of 4.5% or an NNT = 22. mRS and Barthel Index were stable and similar between arms. CPAP adherence was sufficient in 60% of evaluable patients at month 24. Conclusion No benefit of CPAP started three months post-stroke was found in terms of new cardio- and cerebrovascular events over 2 years. This may be related to the small size of this study, the mild stoke severity, the exclusion of sleepy patients, the delayed start of treatment, and the overall low event rate. No benefit of CPAP started 3 months post-stroke was found. A sufficient CPAP compliance was observed over 2 years in 60% of patients. Studies of CPAP in mild stroke need to be large and include long-term outcomes.
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Affiliation(s)
- C Bernasconi
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - S R Ott
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Pulmonary and Sleep Medicine, St. Claraspital, Basel, Switzerland
| | - F Fanfulla
- Sleep Medicine, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,Sleep Medicine Unit, Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - S Miano
- Sleep Medicine, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - T Horvath
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - A Seiler
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - C W Cereda
- Stroke Center EOC, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland
| | - A-K Brill
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - P Young
- University Hospital Münster, Department of Neurology, Münster, Germany
| | - L Nobili
- Department of Neurology, Ospedale Niguarda, Milano, Italy.,DINOGMI, University of Genoa, Genoa, Italy
| | - M Manconi
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Sleep Medicine, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - C L A Bassetti
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Neurology Department, Sechenov First Moscow State Medical University, Moscow, Russia
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27
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Maiolino G, Bisogni V, Silvani A, Pengo MF, Lombardi C, Parati G. Treating sleep disorders to improve blood pressure control and cardiovascular prevention: a dream come true?-a narrative review. J Thorac Dis 2020; 12:S225-S234. [PMID: 33214926 PMCID: PMC7642627 DOI: 10.21037/jtd-cus-2020-014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Hypertension is one of the primary risk factors for heart disease and stroke, the leading causes of death worldwide. Current evidence supports the treatment of high blood pressure (BP) values in order to obtain a substantial reduction of cardiovascular burden. Sleep plays an important role in maintaining nocturnal BP control and nocturnal hypertension which, in turn, can be affected by the presence of sleep disorders. Whilst respiratory disturbances have been extensively studied and their causal role in the development of nocturnal hypertension has been demonstrated in both cross sectional and prospective studies, less is known about the impact of other sleep disorders such as insomnia. In this review, we aim to describe the role of sleep disorders in the development of nocturnal and diurnal hypertension. Furthermore, we aim to discuss the potential impact of the treatment of such sleep disorders on BP values as an adjunct treatment for patients with hypertension.
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Affiliation(s)
- Giuseppe Maiolino
- Clinica Medica 3, Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Valeria Bisogni
- Unit of Internal Medicine, Terni University Hospital, Terni, Italy
| | - Alessandro Silvani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Martino Francesco Pengo
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy
| | - Carolina Lombardi
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy.,Faculty of Medicine, University of Milan-Bicocca, Milan, Italy
| | - Gianfranco Parati
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy.,Faculty of Medicine, University of Milan-Bicocca, Milan, Italy
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28
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Zhao C, Viana A, Ma Y, Capasso R. Insights into Friedman stage II and III OSA patients through drug-induced sleep endoscopy. J Thorac Dis 2020; 12:3663-3672. [PMID: 32802445 PMCID: PMC7399404 DOI: 10.21037/jtd-20-1471] [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] [Indexed: 11/06/2022]
Abstract
Background The Friedman staging is a classic system to predict outcomes of obstructive sleep apnea (OSA) surgery. Increasing stage indicates more severe upper airway (UA) obstruction and worse surgical successful rate. In previous studies, the UA obstruction between stages were usually assessed based on awake examination. Drug-induced sleep endoscopy (DISE) is a new method that can evaluate airway collapse characteristics during sleep. Therefore, we planned to compare Friedman staging and DISE findings and fulfill the knowledge gap on the correlation between awake and sedated UA examination. Methods Retrospective case series study that assessed patients with OSA who underwent DISE. Subjects were classified to stage II and stage III groups based on Friedman staging system. UA collapse characteristics based on velum, oropharynx, tongue base, epiglottis (VOTE) classification, including single/multiple obstruction sites, single/combined upper and lower obstruction levels, collapse degree and patterns in different sites, and surgical results among the groups were analyzed. Results A total of 175 cases were analyzed. No significant differences were found in baseline measurements between groups. Stage III patients (n=102) had a higher proportion (74.5%) with 3 or 4 obstruction sites than stage II (57.5%, n=73). Velum (V) + oropharynx (O) + tongue base (T) was the most common multi-sites combined obstruction pattern with 33% in stage II and 37% in stage III, isolated lower level obstruction was the least with 6% and 4%, respectively. No significant differences were found in obstruction sites and levels. 106 patients underwent surgeries and 33 had post-surgical sleep study, 73.7% and 63.6% response rate were found in stage II and III with no significant difference. Conclusions Upper and lower combined obstruction was the main pattern of collapse in both, Friedman stage II and III patients. Patients with OSA and Friedman stage III had more than 2 sites of obstruction than stage II patients.
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Affiliation(s)
- Chen Zhao
- Department of Otorhinolaryngology, the First Affiliated Hospital of China Medical University, Shenyang, China.,Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University Medical Center, Stanford, California, USA
| | - Alonço Viana
- Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University Medical Center, Stanford, California, USA.,Graduate Program of Neurology, Rio de Janeiro State Federal University (UNIRIO), Brazil.,Department of Otorhinolaryngology, Marcílio Dias Naval Hospital, Brazil
| | - Yifei Ma
- Department of Otolaryngology-Head & Neck Surgery, Stanford University Medical Center, Stanford, California, USA
| | - Robson Capasso
- Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University Medical Center, Stanford, California, USA
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29
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Ott SR, Fanfulla F, Miano S, Horvath T, Seiler A, Bernasconi C, Cereda CW, Brill AK, Young P, Nobili L, Manconi M, Bassetti CLA. SAS Care 1: sleep-disordered breathing in acute stroke an transient ischaemic attack - prevalence, evolution and association with functional outcome at 3 months, a prospective observational polysomnography study. ERJ Open Res 2020; 6:00334-2019. [PMID: 32577418 PMCID: PMC7293990 DOI: 10.1183/23120541.00334-2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/24/2020] [Indexed: 12/27/2022] Open
Abstract
Sleep-disordered breathing (SDB) is frequent in patients with acute stroke. Little is known, however about the evolution of SDB after stroke. Most of our knowledge stems from smaller cohort studies applying limited cardiopulmonary sleep recordings or from cross-sectional data collected in different populations. This study aims to determine prevalence, type and intra-individual evolution of SDB based on full-night polysomnography (PSG) in acute stroke and 3 months thereafter. Furthermore, we aimed to identify predictors of SDB in the acute and chronic phase and to evaluate associations between SDB and functional outcome at 3 months (M3). A total of 166 patients with acute cerebrovascular events were evaluated by full PSG at baseline and 105 again at M3. The baseline prevalence of SDB (apnoea–hypopnoea index (AHI)>5·h−1) was 80.5% and 25.4% of the patients had severe SDB (AHI>30·h−1). Obstructive sleep apnoea was more prevalent than central sleep apnoea (83.8% versus 13%). Mean±SD AHI was 21.4±17.6·h−1and decreased significantly at M3 (18±16.4·h−1; p=0.018). At M3, 91% of all patients with baseline SDB still had an AHI>5·h−1 and in 68.1% the predominant type of SDB remained unchanged (78.9% in obstructive sleep apnoea and 44.4% in central sleep apnoea). The only predictors of SDB at baseline were higher age and body mass index and in the chronic phase additionally baseline AHI. Baseline AHI was associated with functional outcome (modified Rankin score >3) at M3. The high prevalence of SDB in acute stroke, its persistence after 3 months, and the association with functional outcome supports the recommendation for a rapid SDB screening in stroke patients. The high prevalence of SDB in acute stroke, its persistence after 3 months and its association with functional outcome support the recommendation for rapid SDB screening in stroke patientshttps://bit.ly/3bFWqV7
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Affiliation(s)
- Sebastian R Ott
- Dept of Pulmonary Medicine, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Sleep-Wake-Epilepsy Center, Dept of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Pulmonary and Sleep Medicine, St Claraspital, Basel, Switzerland.,These authors contributed equally
| | - Francesco Fanfulla
- Neurocentre of Southern Switzerland, Lugano, Switzerland.,Sleep Medicine Unit, Istituti Clinici Scientifici Maugeri, Pavia, Italy.,These authors contributed equally
| | - Silvia Miano
- Neurocentre of Southern Switzerland, Lugano, Switzerland
| | - Thomas Horvath
- Dept of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Andrea Seiler
- Dept of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Corrado Bernasconi
- Dept of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Carlo W Cereda
- Neurocentre of Southern Switzerland, Lugano, Switzerland
| | - Anne-Kathrin Brill
- Dept of Pulmonary Medicine, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Sleep-Wake-Epilepsy Center, Dept of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Peter Young
- Dept of Neurology, University Hospital Münster, Münster, Germany
| | - Lino Nobili
- Dept of Neurology, Ospedale Niguarda, Milan, Italy.,Dept of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health (DINOGMI), University of Genova, Genoa, Italy
| | - Mauro Manconi
- Neurocentre of Southern Switzerland, Lugano, Switzerland.,Dept of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Claudio L A Bassetti
- Sleep-Wake-Epilepsy Center, Dept of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Dept of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Dept of Neurology, Sechenow University, Moscow, Russia
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30
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Bassetti CLA, Randerath W, Vignatelli L, Ferini-Strambi L, Brill AK, Bonsignore MR, Grote L, Jennum P, Leys D, Minnerup J, Nobili L, Tonia T, Morgan R, Kerry J, Riha R, McNicholas WT, Papavasileiou V. EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke. Eur Respir J 2020; 55:13993003.01104-2019. [PMID: 32317355 DOI: 10.1183/13993003.01104-2019] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 09/12/2019] [Indexed: 12/26/2022]
Abstract
Sleep disorders are highly prevalent in the general population and may be linked in a bidirectional fashion to stroke, which is one of the leading causes of morbidity and mortality.Four major scientific societies established a task force of experts in neurology, stroke, respiratory medicine, sleep medicine and methodology, to critically evaluate the evidence regarding potential links and the impact of therapy. 13 research questions were evaluated in a systematic literature search using a stepwise hierarchical approach: first, systematic reviews and meta-analyses; second, primary studies post-dating the systematic reviews/meta-analyses. A total of 445 studies were evaluated and 88 included. Statements were generated regarding current evidence and clinical practice.Severe obstructive sleep apnoea (OSA) doubles the risk for incident stroke, especially in young to middle-aged patients. Continuous positive airway pressure (CPAP) may reduce stroke risk, especially in treatment-compliant patients. The prevalence of OSA is high in stroke patients and can be assessed by polygraphy. Severe OSA is a risk factor for recurrence of stroke and may be associated with stroke mortality, while CPAP may improve stroke outcome. It is not clear if insomnia increases stroke risk, while pharmacotherapy of insomnia may increase it. Periodic limb movements in sleep (PLMS), but not restless limb syndrome (RLS), may be associated with an increased risk of stroke. Preliminary data suggest a high frequency of post-stroke insomnia and RLS and their association with a less favourable stroke outcome, while treatment data are scarce.Overall, the evidence base is best for OSA relationship with stroke and supports active diagnosis and therapy. Research gaps remain especially regarding insomnia and RLS/PLMS relationships with stroke.
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Affiliation(s)
- Claudio L A Bassetti
- Neurology Dept, Medical Faculty, University Hospital, Bern, Switzerland.,Dept of Neurology, Sechenov First Moscow State Medical University, Moscow, Russia.,Co-shared first authorship
| | - Winfried Randerath
- Bethanien Hospital, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany.,Co-shared first authorship
| | - Luca Vignatelli
- Servizio di Epidemiologia e Biostatistica IRCCS, Istituto delle Scienze Neurologiche di Bologna Ospedale Bellaria, Bologna, Italy
| | - Luigi Ferini-Strambi
- Dept of Neurology OSR-Turro, Sleep Disorder Center, Vita-Salute San Raffaele University, Milan, Italy
| | - Anne-Kathrin Brill
- Dept of Pulmonary Medicine, University and University Hospital Bern, Bern, Switzerland
| | - Maria R Bonsignore
- PROMISE Dept, Division of Respiratory Medicine, DiBiMIS, University of Palermo and IBIM-CNR, Palermo, Italy
| | - Ludger Grote
- Sleep Disorders Center, Dept of Pulmonary Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Poul Jennum
- Danish Center for Sleep Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Didier Leys
- Dept of Neurology, University of Lille, Lille, France
| | - Jens Minnerup
- Dept of Neurology and Institute for Translational Neurology, University of Muenster, Muenster, Germany
| | - Lino Nobili
- Child Neuropsychiatry Unit, Gaslini Institute DINOGMI, University of Genova, Genoa, Italy
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, Universtity of Bern, Bern, Switzerland
| | - Rebecca Morgan
- Dept of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Joel Kerry
- Library and Information Service, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Renata Riha
- Sleep Research Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Dept of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Walter T McNicholas
- Dept of Respiratory and Sleep Medicine, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland.,First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Co-shared senior authorship
| | - Vasileios Papavasileiou
- Leeds Teaching Hospital NHS Trust, Leeds, UK.,Medical School, University of Leeds, Leeds, UK.,Co-shared senior authorship
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Bassetti CLA, Randerath W, Vignatelli L, Ferini‐Strambi L, Brill A, Bonsignore MR, Grote L, Jennum P, Leys D, Minnerup J, Nobili L, Tonia T, Morgan R, Kerry J, Riha R, McNicholas WT, Papavasileiou V. EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke. Eur J Neurol 2020; 27:1117-1136. [DOI: 10.1111/ene.14201] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/04/2020] [Indexed: 02/06/2023]
Affiliation(s)
- C. L. A. Bassetti
- Neurology Department Medical Faculty University Hospital Bern Switzerland
- Department of Neurology Sechenov First Moscow State Medical University Moscow Russia
| | - W. Randerath
- Clinic of Pneumology and Allergology Center for Sleep Medicine and Respiratory Care Bethanien Hospital Institute of Pneumology at the University of Cologne Solingen Germany
| | - L. Vignatelli
- Servizio di Epidemiologia e Biostatistica IRCCS Istituto delle Scienze Neurologiche di Bologna Ospedale Bellaria BolognaItaly
| | - L. Ferini‐Strambi
- Department of Neurology OSR‐Turro Sleep Disorder Center Vita‐Salute San Raffaele University Milan Italy
| | - A.‐K. Brill
- Department of Pulmonary Medicine University and University Hospital Bern Bern Switzerland
| | - M. R. Bonsignore
- PROMISE Department Division of Respiratory Medicine DiBiMIS University of Palermo and IBIM‐CNR Palermo Italy
| | - L. Grote
- Sleep Disorders Center Department of Pulmonary Medicine Sahlgrenska University Hospital Göteborg Sweden
| | - P. Jennum
- Danish Center for Sleep Medicine Rigshospitalet Copenhagen Denmark
| | - D. Leys
- Department of Neurology University of Lille Lille France
| | - J. Minnerup
- Department of Neurology and Institute for Translational Neurology University of Muenster Muenster Germany
| | - L. Nobili
- Child Neuropsychiatry Unit Gaslini Institute DINOGMI University of Genova Genoa Italy
| | - T. Tonia
- Institute of Social and Preventive Medicine Universtity of Bern Bern Switzerland
| | - R. Morgan
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton ON Canada
| | - J. Kerry
- Library and Information Service Leeds Teaching Hospitals NHS Trust LeedsUK
| | - R. Riha
- Sleep Research Unit Centre for Clinical Brain Sciences University of Edinburgh EdinburghUK
- Department of Sleep Medicine Royal Infirmary of Edinburgh Edinburgh UK
| | - W. T. McNicholas
- Department of Respiratory and Sleep Medicine St Vincent’s University Hospital DublinIreland
- School of Medicine University College Dublin Dublin Ireland
- First Affiliated Hospital of Guangzhou Medical University Guangzhou China
| | - V. Papavasileiou
- Leeds Teaching Hospital NHS Trust LeedsUK
- Medical School University of Leeds Leeds UK
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Crespo A, Baillieul S, Marhuenda E, Bradicich M, Andrianopoulos V, Louvaris Z, Marillier M, Almendros I. ERS International Congress, Madrid, 2019: highlights from the Sleep and Clinical Physiology Assembly. ERJ Open Res 2020; 6:00373-2019. [PMID: 32714963 PMCID: PMC7369446 DOI: 10.1183/23120541.00373-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 05/13/2020] [Indexed: 12/12/2022] Open
Abstract
The 2019 European Respiratory Society (ERS) International Congress took place in Madrid, Spain, and served as a platform to find out the latest advances in respiratory diseases research. The research aims are to understand the physiology and consequences of those diseases, as well as the improvement in their diagnoses, treatments and patient care. In particular, the scientific sessions arranged by ERS Assembly 4 provided novel insights into sleep-disordered breathing and new knowledge in respiratory physiology. This article, divided by session, will summarise the most relevant studies presented at the ERS International Congress. Each section has been written by Early Career Members specialising in the different fields of this interdisciplinary assembly.
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Affiliation(s)
- Andrea Crespo
- Multidisciplinary Sleep Unit, Dept of Pulmonology, Rio Hortega University Hospital, Valladolid, Spain
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
- All authors contributed equally to this work
| | - Sébastien Baillieul
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University, Grenoble, France
- FCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France
- All authors contributed equally to this work
| | - Esther Marhuenda
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias CIBERES, Madrid, Spain
- All authors contributed equally to this work
| | - Matteo Bradicich
- Dept of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland
- All authors contributed equally to this work
| | - Vasileios Andrianopoulos
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
- All authors contributed equally to this work
| | - Zafeiris Louvaris
- Faculty of Kinesiology and Rehabilitation Sciences, Division of Respiratory Rehabilitation, Department Rehabilitation Sciences KU Leuven, University Hospitals Leuven, Leuven, Belgium
- All authors contributed equally to this work
| | - Mathieu Marillier
- Laboratory of Clinical Exercise Physiology, Queen's University, Kingston, ON, Canada
- All authors contributed equally to this work
| | - Isaac Almendros
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias CIBERES, Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- All authors contributed equally to this work
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Slim M, Westmacott R, Toutounji S, Singh J, Narang I, Weiss S, Krishnan P, Grbac E, Surmava AM, Andres K, MacGregor D, deVeber G, Moharir M, Dlamini N. Obstructive sleep apnea syndrome and neuropsychological function in pediatric stroke. Eur J Paediatr Neurol 2020; 25:82-89. [PMID: 31787553 DOI: 10.1016/j.ejpn.2019.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 06/04/2019] [Accepted: 11/17/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To assess the prevalence of obstructive sleep apnea syndrome (OSAS) in children with arterial ischemic stroke (AIS) and to evaluate its association with neuropsychological outcomes. METHODS We conducted a cross-sectional study of sleep health and neuropsychological outcome in children with AIS. A consecutive cohort of children attending a stroke clinic were assessed using a standardized pediatric sleep questionnaire (PSQ) and standardized measures of pediatric stroke outcome and intellectual, executive and adaptive function. High risk for OSAS was defined as PSQ score ≥0.33. RESULTS Overall, 102 children were included (55% males, median age: 9 years [interquartile-range [IQR]: 6-14]). The prevalence of OSAS in children with AIS was significantly higher compared to published normative prevalence rate (25.5% vs 5%, p < 0.001). Children with OSAS were more likely to have infarcts affecting both the anterior and posterior circulation (37.5% vs 9.5%, p = 0.021). In addition, children with OSAS had significantly higher median Pediatric Stroke Outcome Measure (PSOM) scores (2 [IQR: 0-2] vs 1 [IQR: 1-3.5], p = 0.01) and were more likely to be prescribed concomitant medications affecting sleep architecture (50% vs 22.4%, p = 0.007). OSAS was associated with significantly lower scores on intellectual, memory, cognitive, behavioral, attention, executive and adaptive function scales. The association between PSQ and intellectual ability and working memory remained statistically significant upon controlling for potential confounding factors including stroke related characteristics (neurologic impairment and arterial territory). CONCLUSIONS The prevalence of OSAS in children with AIS compared to healthy controls is significantly elevated and is associated with poor neuropsychological outcomes. We highlight the importance of regular screening for OSAS - a modifiable risk factor - in children with AIS. The specific risk factors for OSAS and the potential benefits of therapeutic interventions in this patient population warrant further investigation.
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Affiliation(s)
- Mahmoud Slim
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Robyn Westmacott
- Department of Psychology, The Hospital for Sick Children, Toronto, Canada
| | - Sandra Toutounji
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Jaspal Singh
- Department of Neurology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Indra Narang
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Shelly Weiss
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Pradeep Krishnan
- Division of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada
| | - Elena Grbac
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Ann-Marie Surmava
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Kathleen Andres
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Daune MacGregor
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | - Gabrielle deVeber
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada
| | | | - Nomazulu Dlamini
- Division of Neurology, The Hospital for Sick Children, Toronto, Canada.
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Prospective study of sleep-disordered breathing in 28 patients with acute unilateral lateral medullary infarction. Sleep Breath 2020; 24:1557-1563. [DOI: 10.1007/s11325-020-02031-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/22/2019] [Accepted: 02/05/2020] [Indexed: 12/14/2022]
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