Cerebral hemodynamic changes in sleep apnea syndrome and effect of continuous positive airway pressure treatment

Diomedi, Marina; Placidi, Fabio; Cupini, Letizia Maria; Bernardi, Giorgio; Silvestrini, Mauro

doi:10.1212/wnl.51.4.1051

Cited by 144 publications

(115 citation statements)

References 13 publications

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“…In contrast, over the same time period, morning hypercapnic cerebral vascular reactivity is markedly reduced, a finding that is in agreement with others. 1,16 The similarity in the magnitude of the hypoxic cerebral vascular response between the evening and morning is noteworthy, because we have previously reported that this response is absent during NREM sleep 7 ; indeed, hypoxia is associated with a reduction in CBF during NREM sleep. 7 Although the mechanism responsible for the abolition of this response is unknown, the present data would suggest that, in the majority of individuals, the return of the hypoxic response on waking occurs rapidly.…”

Section: Discussionmentioning

confidence: 74%

“…16,18 -20 The relative state of hypercapnia associated with sleep could, therefore, lead to a downregulation of CO 2 or pH receptors and an impaired morning cerebral vascular response to CO 2 . 16 This is the first study to simultaneously measure changes in NO and cerebral vascular reactivity. Total nitriteϩnitrate levels trended toward a decrease from evening to morning; a similar trend was reported by Elherick et al 10 However, the lack of correlation between total nitriteϩnitrate levels and hypercapnic cerebral vascular reactivity suggests that changes in total nitriteϩnitrate levels from evening to morning do not explain the fall in hypercapnic cerebral vascular reactivity.…”

Section: Discussionmentioning

confidence: 99%

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Overnight Changes in the Cerebral Vascular Response to Isocapnic Hypoxia and Hypercapnia in Healthy Humans

Meadows

Kotajima

Vazir

et al. 2005

Stroke

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Background and Purpose-The reduction in hypercapnic cerebral vascular reactivity that occurs in the morning after sleep is associated with an increased risk of cerebral ischemia and stroke. It is not known if the cerebral vascular response to hypoxia is similarly reduced in the morning, but such a reduction could be considered a further risk factor for cerebral vascular disease. Methods-To test if the cerebral vascular response to hypoxia is reduced in the morning, the overnight changes in the left middle cerebral artery velocity (MCAV) in response to isocapnic hypoxia (IH) and hypercapnia before and after a normal night sleep were determined in 18 individuals. Results-From evening to morning, hypercapnic cerebral vascular reactivity decreased significantly (evening 2.0Ϯ0.4, morning 1.3Ϯ0.2 cm/sec/mm Hg; PϽ0.05); in contrast, the increase in MCAV in response to IH (Ϫ10% SaO 2 ) was unchanged (evening 9.0Ϯ1.4, morning 8.7Ϯ2.2%; PϾ0.05). Conclusions-Our findings indicate that substantial differences exist in the regulation of the cerebral circulation in response to hypoxia and hypercapnia on waking from sleep. An intact cerebral vascular response to IH, during this time period, could be interpreted as a protective mechanism against cerebral ischemia and stroke; this is of particular relevance to patients with obstructive sleep apnea who arouse from sleep during hypoxia.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Overnight Changes in the Cerebral Vascular Response to Isocapnic Hypoxia and Hypercapnia in Healthy Humans

Meadows

Kotajima

Vazir

et al. 2005

Stroke

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“…In fact, nCPAP is the treatment of choice to improve several internal parameters in patients with OSA. [14][15][16][17][18] Vitamin D has pleiotropic effects and plays major roles in an extended range of organ functions and disorders. 7 Vitamin D is a fat-soluble secosteroid hormone which undergoes two hydroxylation reactions, first in the liver and second in the kidney.…”

Section: Discussionmentioning

confidence: 99%

Continuous Positive Airway Pressure Treatment Increases Serum Vitamin D Levels in Male Patients with Obstructive Sleep Apnea

Liguori

Romigi

Izzi

et al. 2015

Journal of Clinical Sleep Medicine

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BRIEF SUMMARYCurrent Knowledge/Study Rationale: Vitamin D not only participates in bone metabolism and regulates calcium homeostasis, but also has pleiotropic effects, modulating numerous metabolic processes. Considering that patients with obstructive sleep apnea (OSA) suffer from vitamin D defi ciency and show high serum parathyroid hormone (PTH) levels, we tested the effects of short-term continuous positive airway pressure (CPAP) on serum vitamin D and PTH levels. Study Impact: These fi ndings suggest that short-term CPAP therapy in male patients with OSA determines an increase of serum vitamin D levels. Therefore, the current study provides evidence that OSA seems to be an etiopathogenetic factor involved in vitamin D defi ciency, which may recover after CPAP therapy in male patients. Study Objective:Recent studies report a link between obstructive sleep apnea (OSA) syndrome, low vitamin D levels, and high parathyroid hormone (PTH) concentrations. The aim of the current study is to evaluate the effect of 7-night continuous positive airway pressure (CPAP) therapy on serum vitamin D, PTH, and calcium levels in patients with severe OSA syndrome. Methods: Patients with severe OSA were enrolled into the study and compared to control subjects. Patients with OSA underwent CPAP therapy for 7 nights and were consequently divided into responders (OSA-R, mean residual AHI < 5/h) and nonresponders (OSA-nR, mean residual AHI > 5/h). Serum vitamin D, PTH, and calcium levels were measured at baseline in patients with severe OSA (apnea-hypopnea index > 30/h) and control subjects. Patients with OSA underwent a fi nal morning blood sample after 7-night CPAP therapy. Results: We enrolled 90 patients with OSA into the study (65 OSA-R and 25 OSA-nR) compared to 32 control subjects. At baseline, lower vitamin D and higher PTH levels were detected in the OSA group compared to controls. After 7-night CPAP therapy, male OSA-R patients showed a signifi cant increase in vitamin D levels. Conversely, female OSA-R patients did not show the same increase in vitamin D levels. It was also observed that OSA-nR subjects did not show modifi cations of serum markers after nCPAP-therapy. Conclusions:The study demonstrates that short-term nCPAP treatment is able to promote the recovery of vitamin D homeostasis in male patients with OSA. The mediation of sexual hormones in regulating vitamin D is a possible explanation of the lack of recovery of vitamin D homeostasis in female patients with OSA as it often affects postmenopausal women. Keywords: calcium, CPAP, OSA, PTH, vitamin D Citation: Liguori C, Romigi A, Izzi F, Mercuri NB, Cordella A, Tarquini E, Giambrone MP, Marciani MG, Placidi F. Continuous positive airway pressure treatment increases serum vitamin D levels in male patients with obstructive sleep apnea.

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“…Age predisposes to SDB (Fleury 1992). SDB is recognized as an important risk factor for neurovascular disease (Diomedi et al 1998;Mayer et al 1999;Kotterba et al 1998).…”

Section: P Rimarymentioning

confidence: 99%

High prevalence of sleep‐disordered breathing in patients with primary open‐angle glaucoma

Onen

Mouriaux

Berramdane

et al. 2000

Acta Ophthalmologica Scandinavica

106

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ABSTRACT.Purpose: Elevated intraocular pressure and systemic hemodynamic changes are main risk factors in primary open-angle glaucoma (POAG). Sleep-disordered breathing (SDB) characterized by snoring, excessive daytime sleepiness and insomnia is accompanied by large swings in blood pressure and repetitive hypoxic periods during sleep. The aim of this study was to evaluate whether there is any relationship between SDB and POAG. Methods: Consecutively, 212 outpatients with POAG and 218 outpatients without POAG were recruited. Both eyes were examined. An interviewer-administered semi-structured questionnaire was used to collect SDB-related symptoms. Results: After controlling for age, relative to control group, POAG patients showed a high prevalence of snoring (47.6%, pΩ0.04), snoring plus, excessive daytime sleepiness (27.3%, pΩ0.01) and snoring plus, excessive daytime sleepiness, plus insomnia (14.6%, pΩ0.01). Conclusion: We found a high prevalence of SDB in patients with POAG. Chronic hemodynamic changes and recurrent severe hypoxia resulting from SDB may contribute to anoxic optic nerve damage, implicated in glaucoma.

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Cerebral hemodynamic changes in sleep apnea syndrome and effect of continuous positive airway pressure treatment

Abstract: These findings suggest an association between OSAS and diminished cerebral vasodilator reserve. This condition may be related to the increased susceptibility to cerebral ischemia in patients with OSAS, particularly evident in the early morning.

Cited by 144 publications

References 13 publications

Overnight Changes in the Cerebral Vascular Response to Isocapnic Hypoxia and Hypercapnia in Healthy Humans

Overnight Changes in the Cerebral Vascular Response to Isocapnic Hypoxia and Hypercapnia in Healthy Humans

Continuous Positive Airway Pressure Treatment Increases Serum Vitamin D Levels in Male Patients with Obstructive Sleep Apnea

High prevalence of sleep‐disordered breathing in patients with primary open‐angle glaucoma

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