Moderate-to-severe obstructive sleep apnea is associated with cerebral small vessel disease

Song, Tae‐Jin; Park, Jung Hyun; Choi, Kyu-Yong; Chang, Yoonkyung; Moon, Jangsup; Kim, Ju-Hee; Choi, Yunseo; Kim, Yong-Jae; Lee, Hyang Woon

doi:10.1016/j.sleep.2016.03.006

Cited by 87 publications

(72 citation statements)

References 35 publications

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“…Several sleep disturbance conditions, including sleep apnea, periodic limb movement disorder and insomnia, are associated with increased risk of vascular disorders. 20 OSAHS 21,22 and RLS 23 have been identified as common sleep pathologies related to CSVD. However, evidence of a relationship between insomnia and CSVD is lacking.…”

Section: Discussionmentioning

confidence: 99%

<p>Chronic Insomnia Is Associated with Higher Circulating Interleukin-8 in Patients with Atherosclerotic Cerebral Small Vessel Disease</p>

Wang

Chen

Men

et al. 2020

NSS

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Objective: Chronic inflammatory responses and leukocyte infiltration are classical pathological features of cerebral small vessel disease (CSVD). To date, limited evidence of a relationship between chronic insomnia and inflammatory responses in patients with CSVD has been uncovered. The purpose of the present study was to investigate the potential relationship between chronic insomnia and pro-inflammatory cytokine levels in patients with atherosclerotic CSVD (A-CSVD). Methods: In total, 76 A-CSVD patients with or without chronic insomnia (CI) confirmed using magnetic resonance (MR) were prospectively recruited. Overnight polysomnography (PSG) was performed and serum levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), IL-6, IL-17A, IL-8, and IL-12 assessed. Cytokine levels were compared between CSVD+CI (study group) and CSVD without CI (control group) patients, and the correlations between PSG parameters and cytokine levels were explored in all patients via multiple linear regression analyses. Results: The serum IL-8 level of the study group (12.3±4.4 pg/mL) was significantly higher than that of the control group (7.5±2.2 pg/mL; P<0.05). PSG measurements showed that patients in the study group had significantly higher sleep onset latency (SOL), arousal index (ArI) and wake after sleep onset (WASO) as well as lower total sleep time (TST), sleep efficiency (SE) and stage 3 NREM sleep (N-3) ratio, compared with the control group (P<0.05). Multiple linear regression analyses led to the identification of ArI (β=0.026, P<0.05) and TST (β=−0.054, P<0.05) as significant positive and negative predictors of the IL-8 level, respectively. Conclusion: Chronic insomnia, in particular, sleep fragmentation and short sleep duration, may be involved in promotion of serum IL-8 expression in patients with atherosclerotic CSVD.

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Section: Discussionmentioning

confidence: 99%

<p>Chronic Insomnia Is Associated with Higher Circulating Interleukin-8 in Patients with Atherosclerotic Cerebral Small Vessel Disease</p>

Wang

Chen

Men

et al. 2020

NSS

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“…However, it may be argued that high‐platelet reactivity alone cannot be used as a good indicator for using more potent platelet inhibition, because if OSA also exists, then reducing the potential benefits of ischemic events may be offset by the bleeding rate. In fact, OSA is well‐established to be associated with increased bleeding risk 30, 31, 32. Indeed, evaluating outcome data in OSA patients will provide more insights on the risk‐benefit ratio of antithrombotic strategies, particularly with the introduction of novel and more potent agents.…”

Section: Discussionmentioning

confidence: 99%

Impact of Obstructive Sleep Apnea on Platelet Function Profiles in Patients With Acute Coronary Syndrome Taking Dual Antiplatelet Therapy

Gong

Xiao

Fan

et al. 2018

JAHA

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BackgroundObstructive sleep apnea (OSA) is a novel risk factor for acute coronary syndrome (ACS). Several studies have shown OSA to be associated with induced platelet reactivity. However, whether OSA have effects on platelet function profiles in ACS patients taking dual antiplatelet therapy remains unexplored.Methods and ResultsThis was a cross‐sectional observational study, in which ACS patients taking maintenance aspirin and clopidogrel therapy were included. OSA was defined as an apnea‐hypopnea index ≥15 events/hour. The inhibitory rate of arachidonic acid or adenosine diphosphate pathway were assessed with thrombelastography and defined patients with high residual on‐treatment platelet reactivity. Platelet indices were obtained from routine analysis of blood samples using an automated blood cell counter. A total of 127 ACS patients taking dual antiplatelet therapy were analyzed. Platelet volume indices, including mean platelet volume and platelet large cell ratio, were significantly increased in patients with OSA. Patients with OSA (n=68) had significantly lower inhibitory rate of adenosine diphosphate receptor pathway (P=0.028) compared with those without (n=59). After adjustment for potential confounders, patients with OSA were more likely to have high residual on‐treatment platelet reactivity after clopidogrel therapy (adjusted odds ratio: 3.25, 95% confidence interval: 1.19–8.87, P=0.021).ConclusionsIn ACS patients taking dual antiplatelet therapy, OSA is associated with an increased level of platelet volume indices, reduced clopidogrel‐induced antiplatelet effects and a greater prevalence of high residual on‐treatment platelet reactivity.

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“…61 Data are inconsistent in terms of the location and size of stroke and the risk of sleep apnea, though cerebrovascular neuronal damage to the brainstem and cortical areas are evident. 62 In one study, the incidence of stroke appeared to increase with the severity of sleep apnea. 63 These fi ndings were more pronounced in men than in women; however, this study may not have captured the increased cardiovascular risk in postmenopausal women.…”

Section: Obstructive Sleep Apneamentioning

confidence: 97%

Sleep apnea and the heart

Mehra

2019

CCJM

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The normal sleep-wake cycle is characterized by diurnal variations in blood pressure, heart rate, and cardiac events. Sleep apnea disrupts the normal sleep-heart interaction, and the pathophysiology varies for obstructive sleep apnea (OSA) and central sleep apnea (CSA). Associations exist between sleep-disordered breathing (which encompasses both OSA and CSA) and heart failure, atrial fi brillation, stroke, coronary artery disease, and cardiovascular mortality. Treatment options include positive airway pressure as well as adaptive servo-ventilation and phrenic nerve stimulation for CSA. Treatment improves blood pressure, quality of life, and sleepiness, the last particularly in those at risk for cardiovascular disease. Results from clinical trials are not defi nitive in terms of hard cardio vascular outcomes. ■ KEY POINTS Diurnal variations in blood pressure, heart rate, and cardiac events occur during normal sleep. While normal sleep may be cardioprotective, sleep apnea disrupts the normal sleep-heart interaction. Untreated severe sleep apnea increases the risk for cardiovascular events. Treatment with continuous positive airway pressure (CPAP) may reduce the risk of cardiac events based on some data, though randomized studies suggest no improvement in cardiovascular mortality.

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Moderate-to-severe obstructive sleep apnea is associated with cerebral small vessel disease

Cited by 87 publications

References 35 publications

<p>Chronic Insomnia Is Associated with Higher Circulating Interleukin-8 in Patients with Atherosclerotic Cerebral Small Vessel Disease</p>

<p>Chronic Insomnia Is Associated with Higher Circulating Interleukin-8 in Patients with Atherosclerotic Cerebral Small Vessel Disease</p>

Impact of Obstructive Sleep Apnea on Platelet Function Profiles in Patients With Acute Coronary Syndrome Taking Dual Antiplatelet Therapy

Sleep apnea and the heart

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