Sleep apnoea and the neurologist

Cheng, Shuli; Stark, Catherine; Stark, Richard

doi:10.1136/practneurol-2016-001524

Cited by 8 publications

(4 citation statements)

References 49 publications

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“…Unsurprisingly, SDB increases sleep disturbances and worsens the quality of sleep that is experienced, leading to daytime sleepiness, which is associated with deficits in working memory and vigilance [ 119 ]. Interestingly, sleep disturbances including insomnia, circadian rhythm alterations, and nocturnal agitation are also among the earliest behavioral changes associated with AD development, and they typically worsen during the development of the disease [ 121 , 122 , 134 , 135 , 136 , 137 , 138 , 139 ]. People reporting short sleep durations (<6 h) have increased incidence of hypertension, obesity, type II diabetes, cardiovascular disease, and stroke [ 140 , 141 , 142 , 143 ].…”

Section: Common Mechanisms Of Sdb and Admentioning

confidence: 99%

Alzheimer’s Disease, Sleep Disordered Breathing, and Microglia: Puzzling out a Common Link

Ulland

Ewald

Knutson

et al. 2021

Cells

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Sleep Disordered Breathing (SDB) and Alzheimer’s Disease (AD) are strongly associated clinically, but it is unknown if they are mechanistically associated. Here, we review data covering both the cellular and molecular responses in SDB and AD with an emphasis on the overlapping neuroimmune responses in both diseases. We extensively discuss the use of animal models of both diseases and their relative utilities in modeling human disease. Data presented here from mice exposed to intermittent hypoxia indicate that microglia become more activated following exposure to hypoxia. This also supports the idea that intermittent hypoxia can activate the neuroimmune system in a manner like that seen in AD. Finally, we highlight similarities in the cellular and neuroimmune responses between SDB and AD and propose that these similarities may lead to a pathological synergy between SDB and AD.

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Section: Common Mechanisms Of Sdb and Admentioning

confidence: 99%

Alzheimer’s Disease, Sleep Disordered Breathing, and Microglia: Puzzling out a Common Link

Ulland

Ewald

Knutson

et al. 2021

Cells

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“…(4) An altered cerebrovascular response to hypoxia and carbon dioxide over time contributes to reductions in cerebral blood flow. [7][8][9][10][11] Furthermore, OSA can exacerbate early neurologic worsening of a preexisting stroke by a mechanism called reversed Robin Hood syndrome (RRHS). Intermittent exposure to hypercapnia increases carbon dioxide-related vasodilation in unaffected vessels, generating an intracranial steal phenomenon that decreases the blood flow velocity in the ischemic areas of the brain.…”

mentioning

confidence: 99%

“…RRHS may play a key role in clinical deterioration after an acute stroke. 11,12 In addition, central sleep apneas are known to appear after stroke, especially in the acute stroke phase, whereas obstructive apneas tend to persist in the chronic stages. As the stroke condition improves, sleep apneas may decrease in intensity.…”

mentioning

confidence: 99%

Oximetry as an Accurate Tool for Identifying Moderate to Severe Sleep Apnea in Patients With Acute Stroke

Lin

Branson

Leung

et al. 2018

Journal of Clinical Sleep Medicine

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Study Objectives: Sleep-disordered breathing (SDB) is highly prevalent in patients with acute stroke. SDB is often underdiagnosed and associated with neurological deterioration and stroke recurrence. Polysomnography or home sleep apnea testing (HSAT) is typically used as the diagnostic modality; however, it may not be feasible to use regularly in patients with acute stroke. We investigated the predictive performance of pulse oximetry, a simpler alternative, to identify SDB. Methods: The records of 254 patients, who were admitted to Boston Medical Center for acute stroke and underwent HSAT, were retrospectively reviewed. Oxygen desaturation index (ODI) from pulse oximetry channel were compared to respiratory event index (REI) obtained from HSAT devices. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ODI were calculated, and different ODI cutoff values to predict SDB were proposed. Results: ODI had a strong correlation (r = .902) and agreement with REI. ODI was accurate in predicting SDB at different REI thresholds (REI ≥ 5, REI ≥ 15, and REI ≥ 30 events/h) with the area under the curve (AUC) of .965, .974, and .951, respectively. An ODI ≥ 5 events/h rules in the presence of SDB (specificity 91.7%, PPV 96.3%). An ODI ≥ 15 events/h rules in moderate to severe SDB (specificity 96.4%, PPV 95%) and an ODI < 5 events/h rules out moderate to severe SDB (sensitivity 100%, NPV 100%). Conclusions: Nocturnal pulse oximetry has a high diagnostic accuracy in predicting moderate to severe SDB in patients with acute stroke. Oximetry can be a simple modality to rapidly recognize patients with more severe SDB and facilitate the referral to the confirmation sleep study.

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“…An increase in sleep disorders has been reported in association with both AD and PD [21–23, 28–36]. In our studies using the Texas Alzheimer’s Research Care and Consortium cohort (TARCC, a collaborative Alzheimer’s research effort funded by the State of Texas), we found participants with cognitive deficits are more likely to report a significant elevation in sleep disturbances than those who are cognitively intact or have mild cognitive impairment (figure 1, table 1).…”

mentioning

confidence: 99%

Sex differences in sleep apnea and comorbid neurodegenerative diseases

Snyder

Cunningham

2018

Steroids

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Sleep apnea is a disorder, which increasingly affects people worldwide. Whether the associated hypoxic events during sleep are central or obstructive in origin, the end result is excessive daytime sleepiness and an increased risk for several comorbidities, such as cardiovascular and neurodegenerative disorders. Sleep apnea is diagnosed more frequently in men than women, suggesting a role of sex hormones in the pathology of the disease. Furthermore, there are sex differences in the development and progression of comorbid diseases associated with sleep apnea. Therefore, treatment of sleep apnea may be clinically relevant for prevention of subsequent sex-specific comorbid disorders. While the impact sleep apnea has on cardiovascular events has been the subject of many research studies, the role of sleep apnea in neurodegeneration is less established. Here we review known risk factors for sleep apnea and the implications of the observed sex differences in this disease. We also summarize the evidence and mechanisms for how sleep apnea may contribute to the onset of neurodegenerative disorders, such as Alzheimer's disease and Parkinson's disease.

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Sleep apnoea and the neurologist

Cited by 8 publications

References 49 publications

Alzheimer’s Disease, Sleep Disordered Breathing, and Microglia: Puzzling out a Common Link

Alzheimer’s Disease, Sleep Disordered Breathing, and Microglia: Puzzling out a Common Link

Oximetry as an Accurate Tool for Identifying Moderate to Severe Sleep Apnea in Patients With Acute Stroke

Sex differences in sleep apnea and comorbid neurodegenerative diseases

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