Sleep Apnea and Stroke

Culebras, Antonio

doi:10.1007/s11910-014-0503-3

Cited by 24 publications

(13 citation statements)

References 54 publications

(39 reference statements)

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“…NOD was observed in 16.8% in our study, which was lower than the reported prevalence of sleep apnea after stroke using polysomnography. 6,7,9,23 In addition, we excluded patients treated with oxygen to minimize bias. This could have affected the lower rate of sleep-disordered breathing in our patients, despite the absolute numbers being small.…”

Section: Strokementioning

confidence: 99%

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Nocturnal Desaturation in the Stroke Unit Is Associated With Wake-Up Ischemic Stroke

Kim

Jeong

et al. 2016

Stroke

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Background and Purpose-Wake-up stroke (WUS) represents a quarter of all ischemic strokes and may be a specific subgroup. Nocturnal desaturation secondary to sleep-disordered breathing is an independent risk factor for stroke, but the association between nocturnal desaturation and WUS remains unclear. We investigated the relationship between nocturnal desaturation using oxygen desaturation index and WUS in patients with acute stroke in the stroke unit. Methods-A total of 298 patients admitted for acute ischemic stroke to the stroke unit between July 2013 and May 2015 were enrolled. The oxygen desaturation index was calculated using pulse oximetry data sampled every 1 minute during 9 hours on the first night (10:00 PM-7:00 AM) of the stroke unit admission, and nocturnal desaturation was defined as an oxygen desaturation index of 5 at least per hour. We compared the clinical characteristics and nocturnal desaturations between patients with and without WUS. Results-Among all patients (age, 67.7±12.6 years; male, 54.4%), 26.5% patients had WUS. The proportion of nocturnal desaturation was significantly greater in patients admitted with WUS (29.1% versus 12.3%, P=0.001). The age, sex, risk factors except for hyperlipidemia, stroke severity, and stroke mechanisms were similar between the 2 groups. After adjustment for covariates, it was found that nocturnal desaturation was significantly more common in the WUS group (odds ratio, 3.25; 95% confidence interval, 1.63-6.46). Conclusions-Nocturnal desaturation was more frequently observed in patients admitted with WUS during the first night in the stroke unit. This suggests that nocturnal desaturation is a possible modifiable risk factor for the occurrence of WUS. Baseline and Clinical AssessmentBaseline characteristics, including demographic data (age and sex) and vascular risk factors (hypertension, diabetes mellitus, hyperlipidemia, smoking history [current or past regular smoking], body mass index [BMI], and a past history of stroke/transient ischemic attack) were evaluated. Hypertension was defined as a history of antihypertensive treatment, a systolic blood pressure ≥140 mm Hg, or a diastolic blood pressure ≥90 mm Hg. 14 Hyperlipidemia was defined as a history of lipid-lowering medication, a serum total cholesterol level of >240 mg/dL, or a serum level of low-density lipoprotein cholesterol >160 mg/dL.15 Diabetes mellitus was defined as a hemoglobin A1C level of ≥6.5%, fasting blood glucose level of ≥7.0 mmol/L, nonfasting blood glucose level of ≥11.1 mmol/L, or the use of insulin or oral hypoglycemic drugs. 16 All of the patients were initially evaluated for stroke severity based on the National Institutes of Health Stroke Scale (NIHSS) neurological examination at SU admission. Ischemic strokes were categorized as large-artery atherosclerosis (LAA), small-vessel occlusion, cardioembolism, other determined, and undetermined based on the Trial of Org 10172 in Acute Stroke Treatment criteria. 17The ischemic lesion locations were divided into anterior circulation (ante...

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Section: Strokementioning

confidence: 99%

“…5,6 Specifically, sleep-disordered breathing may be associated with the development of WUS. Nocturnal hypoxia may trigger ischemia [6][7][8][9] or may increase the risk of ischemic event probably mediated by hypertension. Previous reports have suggested the possible association between WUS and sleep-disordered breathing.…”

mentioning

confidence: 99%

Nocturnal Desaturation in the Stroke Unit Is Associated With Wake-Up Ischemic Stroke

Kim

Jeong

et al. 2016

Stroke

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“…39 Obstructive sleep apnea can lead to reductions in cerebral blood flow and impaired cerebral autoregulation, possibly damaging the small vessels in the brain.…”

Section: Vascular Mechanisms Between Osa and Strokementioning

confidence: 99%

“…In addition, the benefits and timing of CPAP therapy after an acute stroke are not established. However, OSA patients at increased stroke risk or those who had a stroke should be risk-stratified, evaluated, and encouraged to use CPAP regularly as part of standard stroke care, 39 and because blacks and Hispanics have a history of poor CPAP compliance, culturally-tailored interventions are needed to increase CPAP compliance to reduce stroke events. 64 …”

Section: Summary and Future Directionsmentioning

confidence: 99%

Obstructive sleep apnea and stroke: links to health disparities

2015

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Obstructive sleep apnea (OSA) is a novel cardiovascular and cerebrovascular risk factor that presents unique opportunities to understand and reduce seemingly intractable stroke disparity among non-Hispanic blacks and Hispanic/Latinos. Individuals from these 2 groups have up to a 2-fold risk of stroke and greater burden of OSA. Obstructive sleep apnea directly and indirectly increases risk of stroke through a variety of autonomic, chemical, and inflammatory mechanisms and vascular risk factors such as hypertension, obesity, and diabetes mellitus. Untreated OSA exacerbates poststroke prognosis, as it may also influence rehabilitation efforts and functional outcomes such as cognitive function after a stroke. Conversely, treatment of OSA may reduce the risk of stroke and may yield better poststroke prognosis. Unfortunately, in racial/ethnic minority groups, there are limited awareness, knowledge, and screening opportunities for OSA. Increasing awareness and improving screening strategies for OSA in minorities may alleviate stroke risk burden and improve stroke outcomes in these populations. This review article is intended to highlight the epidemiology, clinical characteristics, pathophysiology, diagnosis, and treatment of OSA in relation to stroke risk, with an emphasis on race-ethnic disparities.

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“…Accumulating evidence indicates that sleep abnormalities are associated with many adverse health outcomes, such as metabolic syndrome [9], hypothyroid [10], obesity [11], especially CVD and stroke [12][13][14][15]. In addition, in the hospital groups, some previous studies have showed that obstructive sleep apnea (OSA) was associated with Hhcy.…”

Section: Introductionmentioning

confidence: 99%