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Yang X, Lippert J, Dekkers M, Baillieul S, Duss SB, Reichlin T, Brill AK, Bernasconi C, Schmidt MH, Bassetti CL. Impact of Comorbid Sleep-Disordered Breathing and Atrial Fibrillation on the Long-Term Outcome After Ischemic Stroke. Stroke 2024; 55:586-594. [PMID: 38275115 PMCID: PMC10896199 DOI: 10.1161/strokeaha.123.042856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 11/13/2023] [Accepted: 12/01/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) and atrial fibrillation (AF) are highly prevalent in patients with stroke and are recognized as independent risk factors for stroke. Little is known about the impact of comorbid SDB and AF on long-term outcomes after stroke. METHODS In this prospective cohort study, 353 patients with acute ischemic stroke or transient ischemic attacks were analyzed. Patients were screened for SDB by respiratory polygraphy during acute hospitalization. Screening for AF was performed using a 7-day ECG up to 3× in the first 6 months. Follow-up visits were scheduled at 1, 3, 12, 24, and 36 months poststroke. Cox regression models adjusted for various factors (age, sex, body mass index, hypertension, diabetes, dyslipidemia, and heart failure) were used to assess the impact of comorbid SDB and AF on subsequent death or cerebro-cardiovascular events. RESULTS Among 353 patients (299 ischemic stroke and 54 transient ischemic attacks), median age, 67 (interquartile range, 57-74) years with 63% males. Moderate-to-severe SDB (apnea-hypopnea index score, ≥15/h) was present in 118 (33.4%) patients. Among the 56 (15.9%) patients with AF, 28 had comorbid moderate-to-severe SDB and AF. Over 36 months, there were 12 deaths and 67 recurrent cerebro-cardiovascular events. Patients with comorbid moderate-to-severe SDB and AF had a higher risk of subsequent death or cerebro-cardiovascular events compared with those with only moderate-to-severe SDB without AF (hazard ratio, 2.49 [95% CI, 1.18-5.24]) and to those without moderate-to-severe SDB or AF (hazard ratio, 2.25 [95% CI, 1.12-4.50]). However, no significant difference was found between the comorbid moderate-to-severe SDB and AF group and the group with only AF without moderate-to-severe SDB (hazard ratio, 1.64 [95% CI, 0.62-4.36]). CONCLUSIONS Comorbid moderate-to-severe SDB and AF significantly increase the risk of long-term mortality or recurrent cerebro-cardiovascular events after acute ischemic stroke. Considering both conditions as cumulative and modifiable cerebro-cardiovascular risk factors is of interest for the management of acute stroke. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02559739.
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Affiliation(s)
- Xiaoli Yang
- Department of Neurology (X.Y., J.L., M.D., S.B.D., C.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
- Interdisciplinary Sleep-Wake-Epilepsy-Center (X.Y., J.L., M.D., S.B.D., A.-K.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Julian Lippert
- Department of Neurology (X.Y., J.L., M.D., S.B.D., C.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
- Interdisciplinary Sleep-Wake-Epilepsy-Center (X.Y., J.L., M.D., S.B.D., A.-K.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Martijn Dekkers
- Department of Neurology (X.Y., J.L., M.D., S.B.D., C.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
- Interdisciplinary Sleep-Wake-Epilepsy-Center (X.Y., J.L., M.D., S.B.D., A.-K.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Sebastien Baillieul
- Grenoble Alpes University, HP2 Laboratory, INSERM U1300 and Grenoble Alpes University Hospital, France (S.B.)
| | - Simone B. Duss
- Department of Neurology (X.Y., J.L., M.D., S.B.D., C.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology (T.R.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Anne-Kathrin Brill
- Interdisciplinary Sleep-Wake-Epilepsy-Center (X.Y., J.L., M.D., S.B.D., A.-K.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
- Department of Pulmonary Medicine and Allergology (A.-K.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Corrado Bernasconi
- Department of Neurology (X.Y., J.L., M.D., S.B.D., C.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Markus H. Schmidt
- Department of Neurology (X.Y., J.L., M.D., S.B.D., C.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
- Interdisciplinary Sleep-Wake-Epilepsy-Center (X.Y., J.L., M.D., S.B.D., A.-K.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Claudio L.A. Bassetti
- Department of Neurology (X.Y., J.L., M.D., S.B.D., C.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
- Interdisciplinary Sleep-Wake-Epilepsy-Center (X.Y., J.L., M.D., S.B.D., A.-K.B., M.H.S., C.L.A.B.), Inselspital, Bern University Hospital, University of Bern, Switzerland
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Filchenko I, Mürner N, Dekkers MPJ, Baillieul S, Duss SB, Brill AK, Horvath T, Heldner MR, Rexhaj E, Bernasconi C, Bassetti CLA, Schmidt MH. Blood pressure variability, nocturnal heart rate variability and endothelial function predict recurrent cerebro-cardiovascular events following ischemic stroke. Front Cardiovasc Med 2023; 10:1288109. [PMID: 38034378 PMCID: PMC10687449 DOI: 10.3389/fcvm.2023.1288109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/13/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Cardiovascular parameters characterizing blood pressure (BP), heart rate (HR), endothelial function and arterial stiffness predict cerebro-cardiovascular events (CCVE) in the general population. Considering the paucity of data in stroke patients, we assessed these parameters as potential predictors of recurrent CCVE at acute stroke stroke. Patients and methods This is a secondary outcome analysis of a prospective observational longitudinal Sleep Deficiency & Stroke Outcome Study (ClinicalTrials.gov Identifier: NCT02559739). The study consecutively recruited acute ischemic stroke patients. Cardiovascular parameters (blood pressure variability [BPV], heart rate variability [HRV], endothelial function, and arterial stiffness) were assessed within the first week post-stroke. Future CCVE were recorded over a 3-year follow-up. Multivariate Cox regression analysis was used to investigate the prognostic value of 48 cardiovascular parameters regarding CCVE risk. Results Out of 447 recruited patients, 359 were included in this analysis. 20% of patients developed a future CCVE. A high variability of systolic BP (n = 333) and nocturnal HR (non-linear parameters; n = 187) at acute stroke predicted CCVE risk after adjustment for demographic parameters, cardiovascular risk factors and mean BP or HR, respectively. Endothelial dysfunction (n = 105) at acute stroke predicted CCVE risk after adjustment for age and sex, but not after adjustment for cardiovascular risk factors. Diurnal HR and arterial stiffness at acute stroke were not associated with CCVE risk. Conclusion High blood pressure variability, high nocturnal HRV and endothelial function contribute to the risk for future CCVE after stroke.
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Affiliation(s)
- Irina Filchenko
- Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Nicolas Mürner
- Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martijn P. J. Dekkers
- Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sebastien Baillieul
- Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Univ. Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, Grenoble, France
| | - Simone B. Duss
- Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anne-Kathrin Brill
- Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Pulmonary Medicine and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Horvath
- Stroke Unit, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mirjam R. Heldner
- Stroke Unit, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Emrush Rexhaj
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Corrado Bernasconi
- Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Claudio L. A. Bassetti
- Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus H. Schmidt
- Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Ohio Sleep Medicine Institute, Dublin, OH, United States
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Burtscher J, Citherlet T, Camacho-Cardenosa A, Camacho-Cardenosa M, Raberin A, Krumm B, Hohenauer E, Egg M, Lichtblau M, Müller J, Rybnikova EA, Gatterer H, Debevec T, Baillieul S, Manferdelli G, Behrendt T, Schega L, Ehrenreich H, Millet GP, Gassmann M, Schwarzer C, Glazachev O, Girard O, Lalande S, Hamlin M, Samaja M, Hüfner K, Burtscher M, Panza G, Mallet RT. Mechanisms underlying the health benefits of intermittent hypoxia conditioning. J Physiol 2023. [PMID: 37860950 DOI: 10.1113/jp285230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/11/2023] [Indexed: 10/21/2023] Open
Abstract
Intermittent hypoxia (IH) is commonly associated with pathological conditions, particularly obstructive sleep apnoea. However, IH is also increasingly used to enhance health and performance and is emerging as a potent non-pharmacological intervention against numerous diseases. Whether IH is detrimental or beneficial for health is largely determined by the intensity, duration, number and frequency of the hypoxic exposures and by the specific responses they engender. Adaptive responses to hypoxia protect from future hypoxic or ischaemic insults, improve cellular resilience and functions, and boost mental and physical performance. The cellular and systemic mechanisms producing these benefits are highly complex, and the failure of different components can shift long-term adaptation to maladaptation and the development of pathologies. Rather than discussing in detail the well-characterized individual responses and adaptations to IH, we here aim to summarize and integrate hypoxia-activated mechanisms into a holistic picture of the body's adaptive responses to hypoxia and specifically IH, and demonstrate how these mechanisms might be mobilized for their health benefits while minimizing the risks of hypoxia exposure.
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Affiliation(s)
- Johannes Burtscher
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Tom Citherlet
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Alba Camacho-Cardenosa
- Department of Physical Education and Sports, Faculty of Sports Science, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Marta Camacho-Cardenosa
- Clinical Management Unit of Endocrinology and Nutrition - GC17, Maimónides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, Córdoba, Spain
| | - Antoine Raberin
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Bastien Krumm
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Erich Hohenauer
- Rehabilitation and Exercise Science Laboratory (RES lab), Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Landquart, Switzerland
- International University of Applied Sciences THIM, Landquart, Switzerland
- Department of Neurosciences and Movement Science, University of Fribourg, Fribourg, Switzerland
| | - Margit Egg
- Institute of Zoology, University of Innsbruck, Innsbruck, Austria
| | - Mona Lichtblau
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Julian Müller
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Elena A Rybnikova
- Pavlov Institute of Physiology, Russian Academy of Sciences, St Petersburg, Russia
| | - Hannes Gatterer
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Institute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG), UMIT TIROL-Private University for Health Sciences and Health Technology, Hall in Tirol, Austria
| | - Tadej Debevec
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
- Department of Automatics, Biocybernetics and Robotics, Jožef Stefan Institute, Ljubljana, Slovenia
| | - Sebastien Baillieul
- Service Universitaire de Pneumologie Physiologie, University of Grenoble Alpes, Inserm, Grenoble, France
| | | | - Tom Behrendt
- Chair Health and Physical Activity, Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Lutz Schega
- Chair Health and Physical Activity, Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Hannelore Ehrenreich
- Clinical Neuroscience, University Medical Center and Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
| | - Grégoire P Millet
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Max Gassmann
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zürich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
- Universidad Peruana Cayetano Heredia (UPCH), Lima, Peru
| | - Christoph Schwarzer
- Institute of Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Oleg Glazachev
- Department of Normal Physiology, N.V. Sklifosovsky Institute of Clinical Medicine, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Olivier Girard
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Crawley, Western Australia, Australia
| | - Sophie Lalande
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, USA
| | - Michael Hamlin
- Department of Tourism, Sport and Society, Lincoln University, Christchurch, New Zealand
| | - Michele Samaja
- Department of Health Science, University of Milan, Milan, Italy
| | - Katharina Hüfner
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital for Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Gino Panza
- The Department of Health Care Sciences, Program of Occupational Therapy, Wayne State University, Detroit, MI, USA
- John D. Dingell VA Medical Center Detroit, Detroit, MI, USA
| | - Robert T Mallet
- Department of Physiology & Anatomy, University of North Texas Health Science Center, Fort Worth, TX, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Furian M, Robach P, Thoolen S, Rommel S, Baillieul S, Doutreleau S, Arnal PJ, Verges S. Blood pressure and sleep during a 12-month stay at Concordia Station (3233 m), Antarctica. Pulmonology 2023; 29:428-431. [PMID: 37037683 DOI: 10.1016/j.pulmoe.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/10/2023] [Accepted: 02/21/2023] [Indexed: 04/12/2023] Open
Affiliation(s)
- M Furian
- HP2 Laboratory, Université Grenoble Alpes, Inserm (U1300), CHU Grenoble Alpes, Grenoble 38000, France
| | - P Robach
- Ecole Nationale des Sports de Montagne, 74400 Chamonix, France
| | - S Thoolen
- French Polar Institute Paul-Émile Victor, Brest, France
| | - S Rommel
- French Polar Institute Paul-Émile Victor, Brest, France
| | - S Baillieul
- HP2 Laboratory, Université Grenoble Alpes, Inserm (U1300), CHU Grenoble Alpes, Grenoble 38000, France
| | - S Doutreleau
- HP2 Laboratory, Université Grenoble Alpes, Inserm (U1300), CHU Grenoble Alpes, Grenoble 38000, France
| | | | - S Verges
- HP2 Laboratory, Université Grenoble Alpes, Inserm (U1300), CHU Grenoble Alpes, Grenoble 38000, France.
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Yang X, Filchenko I, Dekkers M, Baillieul S, Petroulia V, Schmidt M, Manconi M, Bassetti C. SAS-CARE I: Sleep disordered breathing is associated with white matter hyperintensities in stroke patients. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Midelet A, Bailly S, Borel JC, Hy RL, Schaeffer MC, Baillieul S, Tamisier R, Pepin JL. Bayesian structural time series with synthetic controls for evaluating the impact of mask changes in residual apnea-hypopnea index telemonitoring data. IEEE J Biomed Health Inform 2022; 26:5213-5222. [PMID: 35895638 DOI: 10.1109/jbhi.2022.3194207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE In obstructive sleep apnea patients on continuous positive airway pressure (CPAP) treatment there is growing evidence for a significant impact of the type of mask on the residual apnea-hypopnea index (rAHI). Here, we propose a method for automatically classifying the impact of mask changes on rAHI. METHODS From a CPAP telemonitoring database of 3,581 patients, an interrupted time series design was applied to rAHI time series at an individual patient level to compare the observed rAHI after a mask-change with what would have occurred without the mask-change. rAHI time series before mask changes were modelled using different approaches. Mask changes were classified as: no effect, harmful, beneficial. The best model was chosen based on goodness-of-fit metrics and comparison with blinded classification by an experienced respiratory physician. RESULTS Bayesian structural time series with synthetic controls was the best approach in terms of agreement with the physician's classification, with an accuracy of 0.79. Changes from nasal to facial mask were more often harmful than beneficial: 13.4% vs 7.6% (p-value 0.05), with a clinically relevant increase in average rAHI greater than 8 events/hour in 4.6% of cases. Changes from facial to nasal mask were less often harmful: 6.0% vs 11.4% (p-value 0.05). CONCLUSION We propose an end-to-end method to automatically classify the impact of mask changes over fourteen days after a switchover. SIGNIFICANCE The proposed automated analysis of the impact of changes in health device settings or accessories presents a novel tool to include in remote monitoring platforms for raising alerts after harmful interventions.
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Baillieul S, Tamisier R, Eckert DJ, Pépin JL. Current knowledge and perspectives for pharmacological treatment in OSA. Arch Bronconeumol 2022; 58:681-684. [DOI: 10.1016/j.arbres.2021.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022]
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Léotard A, Levy J, Pérennou D, Pépin JL, Lofaso F, Bensmail D, Lebret M, Baillieul S. Sleep might have a pivotal role in rehabilitation medicine: A road map for care improvement and clinical research. Ann Phys Rehabil Med 2020; 64:101392. [PMID: 32445976 DOI: 10.1016/j.rehab.2020.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/31/2020] [Accepted: 04/13/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Antoine Léotard
- Département de physiologie, explorations fonctionnelles, unité des pathologies du sommeil, AP-HP, Hôpital Raymond-Poincaré, 104, boulevard Raymond-Poincaré, 92380 Garches, France; Université Versailles-Saint-Quentin-en-Yvelines, "End:icap" U1179 Inserm, UFR Des sciences de la sante-Simone-Veil, Versailles, France; Sleep Lab Initiative In PMR group (SLIIP), Garches, France.
| | - Jonathan Levy
- Service de médecine physique et de réadaptation, Hôpital Raymond Poincaré, AP-HP, 104, boulevard Raymond-Poincaré, 92380 Garches, France; Université Versailles-Saint-Quentin-en-Yvelines, "End:icap" U1179 Inserm, UFR Des sciences de la sante-Simone-Veil, Versailles, France; Sleep Lab Initiative In PMR group (SLIIP), Garches, France
| | - Dominic Pérennou
- Département de Rééducation Neurologique, CHU Grenoble Alpes, Grenoble, France; Laboratoire Psychologie et Neurocognition (LPNC), Univ Grenoble Alpes, Grenoble, 38000, Grenoble, France
| | - Jean-Louis Pépin
- HP2, Inserm U1042, Univ Grenoble Alpes, Grenoble, 38000 France; Laboratoire Sommeil et exercice, pole thorax-vaisseaux, CHU Grenoble Alpes, Grenoble, France
| | - Frédéric Lofaso
- Département de physiologie, explorations fonctionnelles, unité des pathologies du sommeil, AP-HP, Hôpital Raymond-Poincaré, 104, boulevard Raymond-Poincaré, 92380 Garches, France; Université Versailles-Saint-Quentin-en-Yvelines, "End:icap" U1179 Inserm, UFR Des sciences de la sante-Simone-Veil, Versailles, France
| | - Djamel Bensmail
- Service de médecine physique et de réadaptation, Hôpital Raymond Poincaré, AP-HP, 104, boulevard Raymond-Poincaré, 92380 Garches, France
| | - Marius Lebret
- Groupe de recherche en hypertension pulmonaire, Institut universitaire de cardiologie et de pneumologie de Québec, 2725, Chemin Sainte-Foy, G1V 4G5 Québec, Canada; Sleep Lab Initiative In PMR group (SLIIP), Garches, France
| | - Sebastien Baillieul
- HP2, Inserm U1042, Univ Grenoble Alpes, Grenoble, 38000 France; Laboratoire Sommeil et exercice, pole thorax-vaisseaux, CHU Grenoble Alpes, Grenoble, France; Sleep Lab Initiative In PMR group (SLIIP), Garches, France
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Alexandre S, Baillieul S, Detante O, Yonnet F, Bailly S, Destors M, Guzun R, Pépin J, Tamisier R. Ischemic stroke location, sleep disordered breathing and sleep: Intermediate analysis of an observational prospective cohort. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2020.03.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Soulard J, Huber C, Baillieul S, Thuriot A, Renard F, Aubert Broche B, Krainik A, Vuillerme N, Jaillard A. Motor tract integrity predicts walking recovery: A diffusion MRI study in subacute stroke. Neurology 2020; 94:e583-e593. [PMID: 31896618 DOI: 10.1212/wnl.0000000000008755] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 08/12/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To identify candidate biomarkers of walking recovery with motor tract integrity measurements using fractional anisotropy (FA) from the corticospinal tract (CST) and alternative motor pathways in patients with moderate to severe subacute stroke. METHODS Walking recovery was first assessed with generalized linear mixed model (GLMM) with repeated measures of walking scores (WS) over 2 years of follow-up in a longitudinal study of 29 patients with subacute ischemic stroke. Baseline FA measures from the ipsilesional and contralesional CST (i-CST and c-CST), cortico-reticulospinal pathway (i-CRP and c-CRP), and cerebellar peduncles were derived from a 60-direction diffusion MRI sequence on a 3T scanner. We performed correlation tests between WS and FA measures. Third, we investigated using GLMM whether motor tract integrity contributes to predict walking recovery. RESULTS We observed significant improvements of WS over time with a plateau reached at ≈6 months after stroke. WS significantly correlated with FA measures from i-CST, c-CST, i-CRP, and bilateral cerebellar peduncles. Walking recovery was predicted by FA measures from 3 tracts: i-CST, i-CRP, and contralesional superior cerebellar peduncle (c-SCP). Diffusion tensor imaging (DTI) predictors captured 80.5% of the unexplained variance of the model without DTI. CONCLUSIONS We identified i-CST and alternative motor-related tracts (namely i-CRP and c-SCP) as candidate biomarkers of walking recovery. The role of the SCP in walk recovery may rely on cerebellar nuclei projections to the thalamus, red nucleus, and reticular formation. Our findings suggest that a set of white matter tracts, part of subcortical motor networks, contribute to walking recovery in patients with moderate to severe stroke.
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Affiliation(s)
- Julie Soulard
- From the Université Grenoble Alpes (J.S., A.T., F.R., A.B.B., N.V., A.J.), AGEIS, Faculté de Médecine; Stroke Unit (J.S., A.T.), Neurologie, Centre Hospitalier Universitaire Grenoble Alpes (CHUGA); Unité IRM 3T-Recherche-UMS IRMaGe-CHUGA (C.H., A.K., A.J.); IRMaGe-Inserm US-017 (C.H., A.K.), CNRS UMS-3552, UGA, Grenoble; Neuroradiologie-IRM-Pôle Imagerie-CHUGA (A.K.); Centre Hospitalier Métropole Savoie (C.H.), Chambéry; Laboratoire HP2 (S.B.), UGA; Pôle thorax et vaisseaux, CHUGA; Pôle Recherche (A.J.), CHUGA, Grenoble; and Institut Universitaire de France (N.V.), Paris, France
| | - Coline Huber
- From the Université Grenoble Alpes (J.S., A.T., F.R., A.B.B., N.V., A.J.), AGEIS, Faculté de Médecine; Stroke Unit (J.S., A.T.), Neurologie, Centre Hospitalier Universitaire Grenoble Alpes (CHUGA); Unité IRM 3T-Recherche-UMS IRMaGe-CHUGA (C.H., A.K., A.J.); IRMaGe-Inserm US-017 (C.H., A.K.), CNRS UMS-3552, UGA, Grenoble; Neuroradiologie-IRM-Pôle Imagerie-CHUGA (A.K.); Centre Hospitalier Métropole Savoie (C.H.), Chambéry; Laboratoire HP2 (S.B.), UGA; Pôle thorax et vaisseaux, CHUGA; Pôle Recherche (A.J.), CHUGA, Grenoble; and Institut Universitaire de France (N.V.), Paris, France
| | - Sebastien Baillieul
- From the Université Grenoble Alpes (J.S., A.T., F.R., A.B.B., N.V., A.J.), AGEIS, Faculté de Médecine; Stroke Unit (J.S., A.T.), Neurologie, Centre Hospitalier Universitaire Grenoble Alpes (CHUGA); Unité IRM 3T-Recherche-UMS IRMaGe-CHUGA (C.H., A.K., A.J.); IRMaGe-Inserm US-017 (C.H., A.K.), CNRS UMS-3552, UGA, Grenoble; Neuroradiologie-IRM-Pôle Imagerie-CHUGA (A.K.); Centre Hospitalier Métropole Savoie (C.H.), Chambéry; Laboratoire HP2 (S.B.), UGA; Pôle thorax et vaisseaux, CHUGA; Pôle Recherche (A.J.), CHUGA, Grenoble; and Institut Universitaire de France (N.V.), Paris, France
| | - Antoine Thuriot
- From the Université Grenoble Alpes (J.S., A.T., F.R., A.B.B., N.V., A.J.), AGEIS, Faculté de Médecine; Stroke Unit (J.S., A.T.), Neurologie, Centre Hospitalier Universitaire Grenoble Alpes (CHUGA); Unité IRM 3T-Recherche-UMS IRMaGe-CHUGA (C.H., A.K., A.J.); IRMaGe-Inserm US-017 (C.H., A.K.), CNRS UMS-3552, UGA, Grenoble; Neuroradiologie-IRM-Pôle Imagerie-CHUGA (A.K.); Centre Hospitalier Métropole Savoie (C.H.), Chambéry; Laboratoire HP2 (S.B.), UGA; Pôle thorax et vaisseaux, CHUGA; Pôle Recherche (A.J.), CHUGA, Grenoble; and Institut Universitaire de France (N.V.), Paris, France
| | - Felix Renard
- From the Université Grenoble Alpes (J.S., A.T., F.R., A.B.B., N.V., A.J.), AGEIS, Faculté de Médecine; Stroke Unit (J.S., A.T.), Neurologie, Centre Hospitalier Universitaire Grenoble Alpes (CHUGA); Unité IRM 3T-Recherche-UMS IRMaGe-CHUGA (C.H., A.K., A.J.); IRMaGe-Inserm US-017 (C.H., A.K.), CNRS UMS-3552, UGA, Grenoble; Neuroradiologie-IRM-Pôle Imagerie-CHUGA (A.K.); Centre Hospitalier Métropole Savoie (C.H.), Chambéry; Laboratoire HP2 (S.B.), UGA; Pôle thorax et vaisseaux, CHUGA; Pôle Recherche (A.J.), CHUGA, Grenoble; and Institut Universitaire de France (N.V.), Paris, France
| | - Bérengère Aubert Broche
- From the Université Grenoble Alpes (J.S., A.T., F.R., A.B.B., N.V., A.J.), AGEIS, Faculté de Médecine; Stroke Unit (J.S., A.T.), Neurologie, Centre Hospitalier Universitaire Grenoble Alpes (CHUGA); Unité IRM 3T-Recherche-UMS IRMaGe-CHUGA (C.H., A.K., A.J.); IRMaGe-Inserm US-017 (C.H., A.K.), CNRS UMS-3552, UGA, Grenoble; Neuroradiologie-IRM-Pôle Imagerie-CHUGA (A.K.); Centre Hospitalier Métropole Savoie (C.H.), Chambéry; Laboratoire HP2 (S.B.), UGA; Pôle thorax et vaisseaux, CHUGA; Pôle Recherche (A.J.), CHUGA, Grenoble; and Institut Universitaire de France (N.V.), Paris, France
| | - Alexandre Krainik
- From the Université Grenoble Alpes (J.S., A.T., F.R., A.B.B., N.V., A.J.), AGEIS, Faculté de Médecine; Stroke Unit (J.S., A.T.), Neurologie, Centre Hospitalier Universitaire Grenoble Alpes (CHUGA); Unité IRM 3T-Recherche-UMS IRMaGe-CHUGA (C.H., A.K., A.J.); IRMaGe-Inserm US-017 (C.H., A.K.), CNRS UMS-3552, UGA, Grenoble; Neuroradiologie-IRM-Pôle Imagerie-CHUGA (A.K.); Centre Hospitalier Métropole Savoie (C.H.), Chambéry; Laboratoire HP2 (S.B.), UGA; Pôle thorax et vaisseaux, CHUGA; Pôle Recherche (A.J.), CHUGA, Grenoble; and Institut Universitaire de France (N.V.), Paris, France
| | - Nicolas Vuillerme
- From the Université Grenoble Alpes (J.S., A.T., F.R., A.B.B., N.V., A.J.), AGEIS, Faculté de Médecine; Stroke Unit (J.S., A.T.), Neurologie, Centre Hospitalier Universitaire Grenoble Alpes (CHUGA); Unité IRM 3T-Recherche-UMS IRMaGe-CHUGA (C.H., A.K., A.J.); IRMaGe-Inserm US-017 (C.H., A.K.), CNRS UMS-3552, UGA, Grenoble; Neuroradiologie-IRM-Pôle Imagerie-CHUGA (A.K.); Centre Hospitalier Métropole Savoie (C.H.), Chambéry; Laboratoire HP2 (S.B.), UGA; Pôle thorax et vaisseaux, CHUGA; Pôle Recherche (A.J.), CHUGA, Grenoble; and Institut Universitaire de France (N.V.), Paris, France
| | - Assia Jaillard
- From the Université Grenoble Alpes (J.S., A.T., F.R., A.B.B., N.V., A.J.), AGEIS, Faculté de Médecine; Stroke Unit (J.S., A.T.), Neurologie, Centre Hospitalier Universitaire Grenoble Alpes (CHUGA); Unité IRM 3T-Recherche-UMS IRMaGe-CHUGA (C.H., A.K., A.J.); IRMaGe-Inserm US-017 (C.H., A.K.), CNRS UMS-3552, UGA, Grenoble; Neuroradiologie-IRM-Pôle Imagerie-CHUGA (A.K.); Centre Hospitalier Métropole Savoie (C.H.), Chambéry; Laboratoire HP2 (S.B.), UGA; Pôle thorax et vaisseaux, CHUGA; Pôle Recherche (A.J.), CHUGA, Grenoble; and Institut Universitaire de France (N.V.), Paris, France.
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Tisserand R, Armand S, Allali G, Schnider A, Baillieul S. Cognitive-motor dual-task interference modulates mediolateral dynamic stability during gait in post-stroke individuals. Hum Mov Sci 2018; 58:175-184. [DOI: 10.1016/j.humov.2018.01.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/23/2018] [Accepted: 01/26/2018] [Indexed: 01/05/2023]
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Baillieul S, Chacaroun S, Doutreleau S, Detante O, Pépin JL, Verges S. Hypoxic conditioning and the central nervous system: A new therapeutic opportunity for brain and spinal cord injuries? Exp Biol Med (Maywood) 2017; 242:1198-1206. [PMID: 28585890 DOI: 10.1177/1535370217712691] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Central nervous system diseases are among the most disabling in the world. Neuroprotection and brain recovery from either acute or chronic neurodegeneration still represent a challenge in neurology and neurorehabilitation as pharmacology treatments are often insufficiently effective. Conditioning the central nervous system has been proposed as a potential non-pharmacological neuro-therapeutic. Conditioning refers to a procedure by which a potentially deleterious stimulus is applied near to but below the threshold of damage to the organism to increase resistance to the same or even different noxious stimuli given above the threshold of damage. Hypoxic conditioning has been investigated in several cellular and preclinical models and is now recognized as inducing endogenous mechanisms of neuroprotection. Ischemic, traumatic, or chronic neurodegenerative diseases can benefit from hypoxic conditioning strategies aiming at preventing the deleterious consequences or reducing the severity of the pathological condition (preconditioning) or aiming at inducing neuroplasticity and recovery (postconditioning) following central nervous system injury. Hypoxic conditioning can consist in single (sustained) or cyclical (intermittent, interspersed by short period of normoxia) hypoxia stimuli which duration range from few minutes to several hours and that can be repeated over several days or weeks. This mini-review addresses the existing evidence regarding the use of hypoxic conditioning as a potential innovating neuro-therapeutic modality to induce neuroprotection, neuroplasticity and brain recovery. This mini-review also emphasizes issues which remain to be clarified and future researches to be performed in the field. Impact statement Neuroprotection and brain recovery from either acute or chronic neurodegeneration still represent a challenge in neurology and neurorehabilitation. Hypoxic conditioning may represent a harmless and efficient non-pharmacological new therapeutic modality in the field of neuroprotection and neuroplasticity, as supported by many preclinical data. Animal studies provide clear evidence for neuroprotection and neuroplasticity induced by hypoxic conditioning in several models of neurological disorders. These studies show improved functional outcomes when hypoxic conditioning is applied and provides important information to translate this intervention to clinical practice. Some studies in humans provide encouraging data regarding the tolerance and therapeutic effects of hypoxic conditioning strategies. The main issues to address in future research include the definition of the appropriate hypoxic dose and pattern of exposure, the determination of relevant physiological biomarkers to assess the effects of the treatment and the evaluation of combined strategies involving hypoxic conditioning and other pharmacological or non-pharmacological treatments.
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Affiliation(s)
- S Baillieul
- 1 CHU Grenoble Alpes, Physiology, Sleep and Exercise Department, Grenoble F-38042, France.,2 INSERM, U1042, Grenoble F-38042, France.,3 HP2 Laboratory, Univ. Grenoble Alpes, Grenoble F-38042, France
| | - S Chacaroun
- 2 INSERM, U1042, Grenoble F-38042, France.,3 HP2 Laboratory, Univ. Grenoble Alpes, Grenoble F-38042, France
| | - S Doutreleau
- 1 CHU Grenoble Alpes, Physiology, Sleep and Exercise Department, Grenoble F-38042, France.,2 INSERM, U1042, Grenoble F-38042, France.,3 HP2 Laboratory, Univ. Grenoble Alpes, Grenoble F-38042, France
| | - O Detante
- 4 CHU Grenoble Alpes, Pôle Psychiatrie Neurologie, Stroke Unit, Grenoble F-38042, France.,5 Inserm U 836, Grenoble Institute of Neurosciences, Grenoble F-38042, France
| | - J L Pépin
- 1 CHU Grenoble Alpes, Physiology, Sleep and Exercise Department, Grenoble F-38042, France.,2 INSERM, U1042, Grenoble F-38042, France.,3 HP2 Laboratory, Univ. Grenoble Alpes, Grenoble F-38042, France
| | - S Verges
- 2 INSERM, U1042, Grenoble F-38042, France.,3 HP2 Laboratory, Univ. Grenoble Alpes, Grenoble F-38042, France
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Baillieul S, El Fatimi A, Nadeau S, Perennou D. Is the total vertical ground reaction force time-amplitude profile an invariant during sit-to-stand movements following stroke? Ann Phys Rehabil Med 2015. [DOI: 10.1016/j.rehab.2015.07.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gergelé L, Baillieul S, Mariat C, Cavalier E, Millet G. Agression rénale aiguë au décours de l’Ultra-Trail du Mont-Blanc. Nephrol Ther 2013. [DOI: 10.1016/j.nephro.2013.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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