Sleep Apnea in Patients Hospitalized With Acute Ischemic Stroke: Underrecognition and Associated Clinical Outcomes

Festic, Nura; Alejos, David; Bansal, Vikas; Mooney, Lesia; Fredrickson, Paul A.; Castillo, Pablo R.; Festić, Emir

doi:10.5664/jcsm.6884

Cited by 26 publications

(28 citation statements)

References 29 publications

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“…Primary studies: Six additional primary studies of class II or III quality were identified [110][111][112][113][114][115].…”

Section: What Is the Frequency Of Sdb In Stroke Patients?mentioning

confidence: 99%

“…The frequencies for the different AHI cut-offs were found: AHI >5 in 70.4% (95% CI 62. [95,[110][111][112][113][114][115]. Most studies published did not find any relationship between topography of stroke and frequency/severity of SDB, although few reports suggested an association between central SDB and supratentorial, and obstructive SDB and infratentorial stroke [31].…”

Section: Overview Of the Evidencementioning

confidence: 99%

“…New studies, published after the most up-to-date systematic review, did not find an independent association between SDB and mortality [111,114,119]; however, three of them [113,114,118] found an association of SDB with a worse neurological outcome (e.g. modified Rankin Scale score, Bartel Index, early neurological deterioration) (table e14).…”

Section: Overview Of the Evidencementioning

confidence: 99%

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EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

et al. 2020

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@ERSpublicationsEvidence suggests a bidirectional relationship between sleep and stroke. However, the pathophysiological base of the associations and the possibilities of improving prevention and outcome through sleep-related interventions require further evaluation.ABSTRACT Sleep disorders are highly prevalent in the general population and may be linked in a bidirectional fashion to stroke, which is one of the leading causes of morbidity and mortality.Four major scientific societies established a task force of experts in neurology, stroke, respiratory medicine, sleep medicine and methodology, to critically evaluate the evidence regarding potential links and the impact of therapy. 13 research questions were evaluated in a systematic literature search using a stepwise hierarchical approach: first, systematic reviews and meta-analyses; second, primary studies postdating the systematic reviews/meta-analyses. A total of 445 studies were evaluated and 88 included. Statements were generated regarding current evidence and clinical practice.Severe obstructive sleep apnoea (OSA) doubles the risk for incident stroke, especially in young to middle-aged patients. Continuous positive airway pressure (CPAP) may reduce stroke risk, especially in treatment-compliant patients. The prevalence of OSA is high in stroke patients and can be assessed by polygraphy. Severe OSA is a risk factor for recurrence of stroke and may be associated with stroke mortality, while CPAP may improve stroke outcome. It is not clear if insomnia increases stroke risk, while pharmacotherapy of insomnia may increase it. Periodic limb movements in sleep (PLMS), but not restless limb syndrome (RLS), may be associated with an increased risk of stroke. Preliminary data suggest a high frequency of post-stroke insomnia and RLS and their association with a less favourable stroke outcome, while treatment data are scarce.Overall, the evidence base is best for OSA relationship with stroke and supports active diagnosis and therapy. Research gaps remain especially regarding insomnia and RLS/PLMS relationships with stroke. This article has an editorial commentary: https://doi.

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“…Primary studies: Six additional primary studies of class II or III quality were identified [110][111][112][113][114][115].…”

Section: What Is the Frequency Of Sdb In Stroke Patients?mentioning

confidence: 99%

Section: Overview Of the Evidencementioning

confidence: 99%

Section: Overview Of the Evidencementioning

confidence: 99%

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EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

et al. 2020

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“…This finding may also suggest a cardioprotective role of OSA, which may attenuate the development of ST-elevation myocardial infarction (STEMI), perhaps through IPC [17]. In patients with OSA hospitalized because of an acute ischemic stroke, less severe neurological injury and lower unadjusted mortality rates were found than in those without a history of OSA [18]. Also, cardiac arrest survivors with OSA had better unadjusted survival rates and favorable adjusted neurological outcomes at discharge than those without OSA [19].…”

Section: Potential Involvement Of Ipc In Osa Patients With Acute MI Amentioning

confidence: 90%

“…The severity of the IH and the hypoxemia in OSA are determined by the number of the hypoxic events per hour of sleep, termed Apnea-Hypopnea Index (AHI). It mostly ranges from a cutoff point of 10 events per hour of sleep for normal breathing to mild (11)(12)(13)(14)(15)(16)(17)(18)(19)(20), moderate (21)(22)(23)(24)(25)(26)(27)(28)(29)(30), and severe OSA (>30 events per hour of sleep). In severe patients, blood oxygenation levels can intermittently drop to as low as 60%.…”

Section: Introductionmentioning

confidence: 99%

Intermittent Hypoxia and Obstructive Sleep Apnea: Mechanisms, Interindividual Responses and Clinical Insights

Lavie¹

2020

Atherosclerosis, Arteriosclerosis and Arteriolosclerosis

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Obstructive sleep apnea (OSA), a nightly respiratory condition, is characterized by recurrent upper airway collapse causing intermittent hypoxia (IH) resembling ischemia and reperfusion (I/R). Consequently, blood oxygenation levels are cyclically reduced; sleep fragmentation and sympathetic activation develop, thus invoking oxidative stress and inflammation. OSA is a major risk factor for cardio-/ cerebrovascular morbidity and mortality. However, not all OSA patients develop cardio-/cerebrovascular disease, even if suffering from similar OSA severity. Possibly, this results from interindividual differences in responses to a given hypoxic stimulus involving gene polymorphism in oxygen-regulated transcription factors and downstream genes. The current review is aimed at highlighting potentially protective mechanisms induced by IH and OSA, rather than its well-established deleterious effects, while focusing on acute coronary syndromes. Therefore, protective mechanisms revealed in I/R biology and exhibited in vitro and in animal models utilizing IH followed by a severe ischemia are discussed and linked to acute myocardial infarction patients with concomitant OSA. The roles of endothelial progenitor cells, their proliferative and angiogenic properties, and collateral formation are emphasized in the clinical setting, as well as heterogenic interindividual responses to identical hypoxic stimuli. These findings might represent potential predictors to cardio-/cerebrovascular health, by identifying patients at higher or lower cardiovascular risk.

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Up-to-date advance in the relationship between OSA and stroke: a narrative review

Sun,

Ma,

Shen

et al. 2023

Sleep Breath

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Sleep Apnea in Patients Hospitalized With Acute Ischemic Stroke: Underrecognition and Associated Clinical Outcomes

Cited by 26 publications

References 29 publications

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

Intermittent Hypoxia and Obstructive Sleep Apnea: Mechanisms, Interindividual Responses and Clinical Insights

Up-to-date advance in the relationship between OSA and stroke: a narrative review

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