Sleep apnea, narcolepsy, and dreaming: Regional cerebral hemodynamics

Meyer, John Stirling; Sakai, Fumihiko; Karacan, Ismet; Derman, Sabri; Yamamoto, Masahiro

doi:10.1002/ana.410070515

Cited by 75 publications

(24 citation statements)

References 26 publications

(14 reference statements)

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“…These observations agree with those of Meyer et al (30), who also demonstrated that sleep onset and the sleep stages affect CBP and its distribution (31). In our experiments we produced a relatively gradual change in P AC0 2 and P A02 which may bear little relationship to the more rapid and potentiated oscillations in respiratory gases resulting from periodic breathing.…”

Section: Discussionsupporting

confidence: 80%

Abnormal Cerebrovascular Responses to CO2 in Sleep Apnea Patients

Loeppky

Miranda

Eldridge

1984

Sleep

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Summary: The responses of common carotid blood flow (CCF), pressure (BP), and resistance (R) to variations in respiratory gases were compared during waking periods in 10 sleep apnea patients (SA) and 10 healthy controls (N) of similar age, Respiratory gases were altered by 3-min CO 2 rebreathing (RB), 3-min hyperventilation (HV), and 4-min hypoxia (HYP) procedures, CCF was measured continuously by a 5-MHz pulsed Doppler duplex scanner and R was calculated using brachial BP. During RB, which increased end-tidal Pco 2 (P AC0 2 ) by 15 mm Hg, SA had a lower CCF and greater BP response and therefore a significantly different (positive) change in R compared with N, The ventilatory responses to CO 2 were not significantly different. With HV the P A C0 2 fell by l3 mm Hg in both groups and CCF fell more markedly in SA than N with the same change in BP; therefore, R was increased significantly more in SA. The HYP results did not demonstrate a difference between groups, These results suggest that abnormal cerebrovascular responses to P ACOZ, initiated either by unusual vasoactive properties of cerebral resistance vessels or peculiar venous outlow patterns, may initiate or potentiate periodic breathing in SA by prolonging lung-to-brain circulation time, Key Words: Sleep apnea-Cerebral blood flow-Rebreathing-Hyperventilation-Hypoxia-Circulatory time lags.The malfunctions of physiological, anatomical, or neurological mechanisms which result in the clinical manifestation of the sleep apnea syndrome are not well understood. Numerous factors such as obesity, unusual airway and oral anatomy and oropharyngeal muscle tone, central neurological lesions, and insensitive or unstable operation of chemoreceptor responses to respiratory stimuli have all been implicated (1-3). The separation of sleep apnea syndromes into "obstructive" and "central" types is also no longer categorical because of increased resolution provided by better measurement techniques in sleep laboratories. Recent reports have demonstrated the propensity of healthy individuals to develop CheyneStokes respiration ,or sleep apnea with transient ascents to higher altitudes (4), and some transient episodes of sleep apnea are often noted in healthy individuals when their sleep is monitored. Sleep studies of randomly selected elderly patients who were subjectively not afflicted with sleep disorders revealed that about one-third had clinically significant sleep apnea (5). These and other observations have lead to the general consensus that the abnormal

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Section: Discussionsupporting

confidence: 80%

Abnormal Cerebrovascular Responses to CO2 in Sleep Apnea Patients

Loeppky

Miranda

Eldridge

1984

Sleep

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“…36 - 38 In patients with SAS, there is a critically reduced brain stem blood flow during sleep, indicating a disturbance of brain stem function including that of the ascending reticular activating system. 15 Our data showing an increased CO 2 reactivity during sleep in the investigated patients with SAS may therefore be further explained by a disturbance of the central catecholaminergic and cholinergic systems that coregulate CO 2 reactivity.…”

mentioning

confidence: 59%

“…For methodological reasons, only a few studies have investigated the effect of SAS on nocturnal cerebral hemodynamics. 15 Fast functional changes of cerebral 1819 - 21 The continuous registration of cerebral perfusion changes even during the relatively short episodes of apnea was possible with long-term (whole night) TCD monitoring.…”

Section: Discussionmentioning

confidence: 99%

“…Due to technical limitations, the alterations of CBF and cerebral hemodynamics associated with apnea have been investigated in very few studies up to now. 15 Transcranial Doppler ultrasonography (TCD) is a well-proven method detecting changes of cerebral perfusion within seconds. 1617 Recently studies established TCD as a method for continuous long-term and on-line recordings of cerebral perfusion during human sleep concomitant with simultaneous polysomnography.…”

mentioning

confidence: 99%

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Assessment of intracranial hemodynamics in sleep apnea syndrome.

Klingelhöfer

Hajak

Sander

et al. 1992

Stroke

109

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Sleep apnea syndrome may lead to changes in cerebral hemodynamics due to altered alveolar ventilation. We investigated the dynamics of CO2- and blood pressure-regulated alterations of cerebral blood flow velocities during apneic episodes and evaluated CO2 reactivity during different sleep stages. A computer-assisted pulsed Doppler system (2 MHz) was used for continuous overnight recordings of middle cerebral artery flow patterns together with simultaneous polysomnography, continuous blood pressure recordings, and measurements of end-expiratory CO2 in six patients with sleep apnea syndrome. Increases in mean flow velocity of 19-219% and in blood pressure of 12.5-83.1% could be observed during the apneic episodes, with maximum increases during rapid eye movement (REM) sleep. CO2 reactivity was in the normal range (4.4 +/- 1.2%) in the waking state and was markedly increased during sleep stages 1 and 2 (p less than 0.005 compared with awake). The greatest increase was found during REM sleep, with a rise of up to three times the waking value (p less than 0.0001 compared with sleep stage 2). The changes of mean flow velocity could be interpreted as reactive adaptation processes because of CO2 and blood pressure increases corresponding to apnea. The increased CO2 reactivity during sleep may indicate a "hypersensitivity" of intracranial vascular CO2 or pH receptors and a disturbance of central catecholaminergic and cholinergic systems. The pronounced velocity changes during apneic episodes and the concomitant alterations of vessel wall tension might lead to microangiopathies and macroangiopathies due to chronic strain on the brain vessels.

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“…This is because dreams are an opportunity for processing everyday events and a means of memory retention [13]. Dreams provide a ground for, long-term goals, everyday interactions and discharge of anxious emotions.…”

Section: Introductionmentioning

confidence: 99%

Application of Cognitive-behavioral Therapy in Obstructive Sleep Apnea: Comparison of CPAP Therapy and CBT on the Executive Functions of the Brain

Talebi¹,

Tabatabaye²,

Vahedi³

2017

J Sleep Disord Ther

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Purpose: Sleep apnea disorder brings about negative effects to the quality of life of the people involved. Debilitation of cognitive functioning is one of the consequences of this condition. Scant researches have been carried out to explore the efficacy of cognitive therapy on mitigating clinical symptoms and cognitive functions of the brain. The novelty of the present study is in combining cognitive method and medical treatment. This research aims to compare the effectiveness of continuous positive air pressure (CPAP) therapy and cognitive-behavioral treatment (CBT) on improving mental cognitive functions in patients with sleep apnea. Methods:The study population included all patients referred to the Bahar Sleep Disorders Clinic in Tehran, Iran. The sample consisted of 45 people who were randomly placed into three groups of 15 people (CPAP therapy, cognitive behavioral therapy, and control groups). All three groups were psychologically assessed prior to the intervention. Next, individuals in the cognitive-behavioral group underwent 12 sessions of cognitive training, progressive muscle relaxation, mental visualization, and sleep hygiene. The other group went through CPAP therapy. After the intervention, both groups were assessed psychologically. Data collection instruments included Wisconsin cognitive software, simple Stroop, complex Stroop, continuous performance, polysomnography device, and CPAP devices. Results:The results indicated that both types of intervention can enhance cognitive functioning; however, a greater efficacy is obtained by combining the two methods compared with the exclusive application of medical treatment. Conclusion:The authors propose cognitive-behavioral therapy OSA as a complement to medical treatment.

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Sleep apnea, narcolepsy, and dreaming: Regional cerebral hemodynamics

Cited by 75 publications

References 26 publications

Abnormal Cerebrovascular Responses to CO2 in Sleep Apnea Patients

Abnormal Cerebrovascular Responses to CO2 in Sleep Apnea Patients

Assessment of intracranial hemodynamics in sleep apnea syndrome.

Application of Cognitive-behavioral Therapy in Obstructive Sleep Apnea: Comparison of CPAP Therapy and CBT on the Executive Functions of the Brain

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