Obstructive sleep apnea exaggerates cognitive dysfunction in stroke patients

Zhang, Yan; Wang, Wanhua; Cai, Sijie; Sheng, Qi; Pan, Shenggui; Shen, Fang; Tang, Qing; Liu, Yang

doi:10.1016/j.sleep.2016.11.028

Cited by 21 publications

(12 citation statements)

References 46 publications

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“…Based on these prior findings, one may speculate that aberrant interhemispheric communications between bilateral prefrontal cortex and bilateral premotor and supplementary motor cortex, resulting from abnormal fiber connections, may contribute to the dysfunctions of prospective memory and sustained attention in OSA patients. However, although OSA-related impairments in sustained attention (Karimi et al, 2015;Luz et al, 2016;Simoes, Padilla, Bezerra, & Schmidt, 2018) and prospective memory (Zhang et al, 2017) have be previously reported, no significant intergroup differences in these cognitive domains were observed in this study, which may result from the possibility of a type II error due to the small sample size. Of note, the finding of significant correlations between altered diffusion metrics and cognitive performances exhibiting no intergroup differences highlights the multifaceted and complex nature of these relationships, which need to be clarified in a larger sample.…”

Section: Tacontrasting

confidence: 88%

Selective microstructural integrity impairments of the anterior corpus callosum are associated with cognitive deficits in obstructive sleep apnea

et al. 2019

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BackgroundThere is some evidence that obstructive sleep apnea (OSA) patients have white matter integrity abnormality in the corpus callosum (CC). However, whether the CC subregions are differentially affected in OSA is largely unknown.MethodsTwenty patients with OSA and 24 well‐matched healthy controls were enrolled and underwent diffusion tensor imaging (DTI) and clinical and cognitive assessments. DTI tractography was used to reconstruct the CC which was divided into five subregions. Intergroup differences in multiple diffusion metrics of each CC subregion and their correlations with clinical and cognitive parameters were tested.ResultsIn comparison with healthy controls, OSA patients exhibited white matter integrity alterations in the anterior CC, characterized by increased radial diffusivity (RD) in the subregion 1 and decreased fractional anisotropy (FA) along with increased mean diffusivity (MD) and RD in the subregion 2. Moreover, we found that the lower microstructural integrity in the anterior CC was correlated with worse prospective memory and sustained attention in OSA patients.ConclusionsThese findings indicate that the selective impairments of the anterior CC may help clarify the neural correlates of cognitive impairments in OSA.

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Section: Tacontrasting

confidence: 88%

Selective microstructural integrity impairments of the anterior corpus callosum are associated with cognitive deficits in obstructive sleep apnea

et al. 2019

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“…For example, MAs may experience lower blood oxygen levels during sleep, greater reductions in sleep efficiency, greater reductions in slow wave or rapid eye movement sleep, or greater reduction in spindle activity, which may translate into poorer cognitive outcome. [41][42][43][44] Another possibility is synergistic effects of SDB and other risk factors for poor stroke outcome. For example, individuals with diabetes and low sleep efficiency have poorer cognitive function than those with higher sleep efficiency.…”

Section: Discussionmentioning

confidence: 99%

“…Alternatively, downstream consequences of SDB may vary by ethnicity. For example, MAs may experience lower blood oxygen levels during sleep, greater reductions in sleep efficiency, greater reductions in slow wave or rapid eye movement sleep, or greater reduction in spindle activity, which may translate into poorer cognitive outcome . Another possibility is synergistic effects of SDB and other risk factors for poor stroke outcome.…”

Section: Discussionmentioning

confidence: 99%

Sleep‐disordered breathing and poststroke outcomes

Lisabeth

Sánchez

Lim

et al. 2019

Annals of Neurology

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Objective: To examine the association between sleep-disordered breathing and stroke outcomes, and determine the contribution of sleep-disordered breathing to outcome disparities in Mexican Americans. Methods: Ischemic stroke patients (n = 995), identified from the population-based Brain Attack Surveillance in Corpus Christi Project (2010Project ( -2015, were offered participation in a sleep-disordered breathing study including a home sleep apnea test (ApneaLink Plus). Sleep-disordered breathing (respiratory event index ≥10) was determined soon after stroke. Neurologic, functional, cognitive, and quality of life outcomes were assessed at 90 days poststroke. Regression models were used to assess associations between sleep-disordered breathing and outcomes, adjusted for sociodemographics, prestroke function and cognition, health-risk behaviors, stroke severity, and vascular risk factors. Results: Median age was 67 years (interquartile range [IQR] = 59-78); 62.1% were Mexican American. Median respiratory event index was 14 (IQR = 6-25); 62.8% had sleep-disordered breathing. Sleep-disordered breathing was associated with worse functional outcome (mean difference in activities of daily living/instrumental activities of daily living score = 0.15, 95% confidence interval [CI] = 0.01-0.28) and cognitive outcome (mean difference in modified Mini-Mental State Examination = −2.66, 95% CI = −4.85 to −0.47) but not neurologic or quality of life outcomes. Sleep-disordered breathing accounted for 9 to 10% of ethnic differences in functional and cognitive outcome and was associated with cognitive outcome more strongly for Mexican Americans (β = −3.97, 95% CI = −6.63 to −1.31) than non-Hispanic whites (β = −0.40, 95% CI = −4.18 to 3.39, p-interaction = 0.15). Interpretation: Sleep-disordered breathing is associated with worse functional and cognitive function at 90 days poststroke. These outcomes are reasonable endpoints for future trials of sleep-disordered breathing treatment in stroke. If effective, sleep-disordered breathing treatment may somewhat lessen ethnic stroke outcome disparities.

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“…Respiratory disturbances in sleep in patients with stroke, cause the worst efficiency of the rehabilitation process. It is shown that the presence of OSAS is accompanied by greater functional insufficiency and a longer period of hospitalization of patients [94][95][96][97][98][99][100].…”

Section: Characteristics Of Sleep Disorders In Patients With Strokementioning

confidence: 99%

Features of Circadian Rhythms in Patients with Cerebrovascular Diseases

Костенко¹,

Петрова²

2018

Circadian Rhythm - Cellular and Molecular Mechanisms

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The chapter describes in detail the pathogenetic role of desynchronosis in the development of cerebrovascular diseases (CVD). The data of domestic and foreign literature on the study of desynchronosis are presented. The role of melatonin in the regulation of circadian rhythms (CR) is shown. Pathological changes in CR affect sleep disturbance, emotional and cognitive disorders. It is demonstrated the need of the further study of the prevalence and structure of desynchronosis in patients with CVD. The search of the most significant factors of desynchronosis development in patients with vascular diseases is of great scientific and practical significance. The importance of creating and introducing diagnostic and therapeutic algorithms for chronodiagnostics and chronotherapy of CVD into everyday practical activities. The effectiveness of melatonin for the normalization of sleep and CR in patients with insomnia, acute stroke, depressive disorders is shown. Complex therapy of the patients with CVD taking into account chronobiological disorders allows to eliminate the adverse effect of sleep disorders and CR on the regulation of the cardiovascular system and improve the efficiency of rehabilitation.

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Obstructive sleep apnea exaggerates cognitive dysfunction in stroke patients

Cited by 21 publications

References 46 publications

Selective microstructural integrity impairments of the anterior corpus callosum are associated with cognitive deficits in obstructive sleep apnea

Selective microstructural integrity impairments of the anterior corpus callosum are associated with cognitive deficits in obstructive sleep apnea

Sleep‐disordered breathing and poststroke outcomes

Features of Circadian Rhythms in Patients with Cerebrovascular Diseases

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