Investigating the Relationship Between Stroke and Obstructive Sleep Apnea

Dyken, Mark Eric; Somers, Virend K.; Yamada, Thoru; Ren, Zong Ying; Zimmerman, M. Bridget

doi:10.1161/01.str.27.3.401

Cited by 482 publications

(271 citation statements)

References 21 publications

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“…[5] It is likely that the same mechanisms are valid in humans too, since obstructive sleep apnea leads to increased SNS activity and increased daytime blood pressure. [6][7][8] Obstructive breathing disorders are associated with cardiovascular diseases such as hypertension, [9][10][11] myocardial infarction, [12] stroke, [13] and heart failure. [14] When treated with continuous positive airway pressure (CPAP) during sleep, daytime blood pressure and sympathetic activity decrease.…”

Section: Introductionmentioning

confidence: 99%

Spontanous periodic breathing is associated with sympathetic hyperreactivity and baroreceptor dysfunction in hypertension

Binggeli

Sudano²,

Corti³

et al. 2010

Journal of Hypertension

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OBJECTIVES: Intermittent periods of hypoxemia such as during periodic breathing are associated with hypertension and increased sympathetic activity. In patients with sleep apnea syndrome, hypertension is common. Treating apnea improves hypertension and reduces sympathetic outflow. The aim of the present study was to investigate the phenomenon and mechanisms of spontaneous periodic breathing in patients with hypertension. METHOD: We examined 43 hypertensive patients with untreated hypertension without left-ventricular dysfunction, heart failure or sleep apnea syndrome. Muscle sympathetic nerve activity (MSA), heart rate (HR), blood pressure (BP) and respiration were continuously recorded at rest and during cold-pressor testing. Oxygen and a CO2-enriched gas were used to test central and peripheral chemoreceptors, respectively. Baroreceptor gain was measured using the alpha method. RESULTS: Seven out of 43 patients showed spontaneous periodic breathing while awake. No difference in MSA, HR and BP was seen between patients with and without periodic breathing at rest except the breathing pattern. However, the cold-pressor test caused a larger increase of MSA in patients with periodic breathing (203 +/-62 vs. 62 +/-8%, P < 0.0001 by ANOVA), as well as systolic (46 +/-6 vs. 25 +/-3 mmHg, P = 0.002) and diastolic BP (26 +/-5 vs. 12 +/-1 mmHg, P = 0.004, ANOVA). Baroreceptor gain was markedly higher in patients with periodic breathing. Chemoreceptor sensitivity was comparable. CONCLUSION: Spontaneous periodic breathing is relatively common in patients with hypertension and is associated with greatly enhanced responses to cold-pressor testing. We suggest increased baroreceptor gain and sympathetic outflow as a cause for the oscillatory respiration pattern via barorespiratory coupling.

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Section: Introductionmentioning

confidence: 99%

Spontanous periodic breathing is associated with sympathetic hyperreactivity and baroreceptor dysfunction in hypertension

Binggeli

Sudano²,

Corti³

et al. 2010

Journal of Hypertension

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“…It also revealed that it is unclear to what extent the sleep problems reported in the early phase after a stroke are transient. Some authors suggest that post-stroke sleep disturbances actually persist and become a chronic condition [10][11][12][13], but the evidence-base for this claim is poor and the prognosis beyond one-year post injury is not well understood. This is partly due to the use of heterogeneous study groups comprised of patients in various stages of recovery and with various levels of functional ability.…”

Section: Introductionmentioning

confidence: 99%

Time to wake-up: Sleep problems and daytime sleepiness in long-term stroke survivors

et al. 2008

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Background and purpose: In work with chronic stroke patients the authors observed that patients frequently appear sleepy and often comment on their poor sleep. Sleep difficulties are frequently reported and indeed clinically recognized in the acute phase post-stroke, but little is known about the sleep and daytime sleepiness of chronic stroke patients with sustained disabilities. The latter, however, deserves clarification because sleep is a critical modulator of health, daytime performance and wellbeing. The present study therefore explored the sleep and sleepiness in a chronic stroke population with sustained physical deficits. Methods: An opportunity sample of 20 patients with chronic low-functioning hemiplegia (12 months) completed the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Medical Outcome Study Short Form 36 and Hospital Anxiety and Depression Scale. Results: Compared to a normative healthy population, long-term stroke survivors reported poorer sleep and greater daytime sleepiness. Increased levels of sleepiness were associated with longer chronicity, whereas nocturnal sleep parameters were not. Conclusions: In line with clinical observations, stroke survivors with sustained physical disabilities report poorer sleep and experience greater levels of sleepiness. Further research in a larger cohort and including objective sleep measures is necessary to investigate the nature and scale of sleep difficulties and daytime sleepiness in more detail so that care and treatment strategies can be developed in due course

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“…OSA is characterized by repetitive collapse of the pharyngeal airway during sleep, yielding hypoxia, hypercapnia, and arousal from sleep to reestablish airway patency [2]. The associated consequences include daytime sleepiness [3], decreased cognitive performance, decreased quality of life [4], increased risk of automobile and industrial accidents [5,6], and adverse cardiovascular sequelae [7][8][9][10]. Treatment of OSA leads to improvements in many of these adverse outcomes and may reduce healthcare costs [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Automated detection of sleep disordered breathing using a nasal pressure monitoring device

Grover

Pittman

2008

Sleep Breath

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To assess the accuracy of a single channel portable monitoring device (RUSleeping™ RTS, Respironics, Murrysville, PA) that measures nasal pressure (a surrogate for airflow) to detect sleep disordered breathing (SDB). Twenty-five adult patients referred to a community sleep laboratory with suspected obstructive sleep apnea (OSA) participated in this investigation. The portable monitoring device was used in the sleep laboratory to acquire data concurrently with a standard multi-channel polysomnogram (PSG) to assess SDB. Respiratory events were scored manually on the PSG using standard criteria for clinical research to quantify an apnea-hypopnea index (AHI) based on events during sleep. The portable monitoring device automatically calculated an unedited respiratory event index (REI) based on recording time. These data were then compared using the Pearson product-moment correlation coefficient, Bland-Altman analysis, receiver operating characteristic (ROC) curves, and likelihood ratios. All 25 subjects completed the study. Mean age of subjects was 42.4±12.9 years and mean body mass index was 31.0± 7.4 kg m −2 . There was good agreement between the REI and the AHI (R=0.77, p<0.001, mean difference 2.6 events per hour [2 SD: 39.8] using a Bland-Altman plot). The area under the ROC curve for detecting SDB (PSG AHI greater than or equal to five events per hour) with the REI was 0.94 (95% CI 0.84-1.0). For an REI >11.9 events per hour, the sensitivity was 0.89 (95% CI 0.65-0.99) and the specificity was 0.86 (95% CI 0.42-1.0) with a likelihood ratio of 6.2 for a positive test (LR+) and 0.13 for a negative test (LR−). Similar results were observed for detecting moderatesevere SDB (PSG AHI≥15 events h −1 ) using REI >15.2 events h −1 . In a population of subjects with suspected OSA, this portable monitoring device can automatically quantify an REI that compares well to the AHI scored manually on a concurrent PSG. Such a device may prove useful to assess SDB in high risk populations with self-administered testing in ambulatory settings such as the home.

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Investigating the Relationship Between Stroke and Obstructive Sleep Apnea

Abstract: Patients with stroke have an increased incidence of obstructive sleep apnea compared with normal sex- and age-matched control subjects. Hypoxia and hemodynamic responses to obstructive sleep apnea may have predisposed these patients to stroke.

Cited by 482 publications

References 21 publications

Spontanous periodic breathing is associated with sympathetic hyperreactivity and baroreceptor dysfunction in hypertension

Spontanous periodic breathing is associated with sympathetic hyperreactivity and baroreceptor dysfunction in hypertension

Time to wake-up: Sleep problems and daytime sleepiness in long-term stroke survivors

Automated detection of sleep disordered breathing using a nasal pressure monitoring device

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