Sleep-related breathing disorders and cardiovascular disease

Roux, Francoise; D’Ambrosio, Carolyn; Mohsenin, Vahid

doi:10.1016/s0002-9343(00)00302-8

Cited by 177 publications

(122 citation statements)

References 83 publications

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“…Lung-peripheral vascular coupling seems to be a general phenomenon and may play a role in other types of vascular disease in patients without SCD. Obstructive sleep apnea, for example, is associated with myocardial infarction and with stroke (31)(32)(33)(34), and with sympathetic overflow and decreased parasympathetic modulation (35). The mechanisms in these disorders may well be related to episodic hypoperfusion induced by the pulmonary stretch signals.…”

Section: Discussionmentioning

confidence: 99%

Peripheral Vasoconstriction and Abnormal Parasympathetic Response to Sighs and Transient Hypoxia in Sickle Cell Disease

Sangkatumvong¹,

Khoo²,

Kato

et al. 2011

Am J Respir Crit Care Med

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Rationale: Sickle cell disease is an inherited blood disorder characterized by vasoocclusive crises. Although hypoxia and pulmonary disease are known risk factors for these crises, the mechanisms that initiate vasoocclusive events are not well known. Objectives: To study the relationship between transient hypoxia, respiration, and microvascular blood flow in patients with sickle cell. Methods: We established a protocol that mimics nighttime hypoxic episodes and measured microvascular blood flow to determine if transient hypoxia causes a decrease in microvascular blood flow. Significant desaturations were induced safely by five breaths of 100% nitrogen. Measurements and Main Results: Desaturation did not induce change in microvascular perfusion; however, it induced substantial transient parasympathetic activity withdrawal in patients with sickle cell disease, but not controls subjects. Marked periodic drops in peripheral microvascular perfusion, unrelated to hypoxia, were triggered by sighs in 11 of 11 patients with sickle cell and 8 of 11 control subjects. Although the sigh frequency was the same in both groups, the probability of a sigh inducing a perfusion drop was 78% in patients with sickle cell and 17% in control subjects (P , 0.001). Evidence for sighinduced sympathetic nervous system dominance was seen in patients with sickle cell (P , 0.05), but was not significant in control subjects.Conclusions: These data demonstrate significant disruption of autonomic nervous system balance, with marked parasympathetic withdrawal in response to transient hypoxia. They draw attention to an enhanced autonomic nervous system-mediated sigh-vasoconstrictor response in patients with sickle cell that could increase red cell retention in the microvasculature, promoting vasoocclusion.Keywords: hypoxia; autonomic nervous system; respiration; vasoconstriction; sickle cell disease Sickle cell disease (SCD) is an inherited blood disorder that results from an amino acid substitution in the b globin chain of hemoglobin, producing sickle hemoglobin (HbS) (1, 2). HbS polymerizes when it releases oxygen to tissues, causing the normally flexible red blood cells to become rigid and to obstruct blood flow (3). The subsequent ischemia results in chronic organ damage and ultimately premature death (3-5). Although SCD is caused by a single amino acid substitution, significant variability in the frequency of overt sickling episodes has been reported among subjects with the same genotype, suggesting that other factors cause the transition from steady-state sickling to full vasoocclusive crisis (VOC).The specific factors that affect this transition are incompletely understood. Flexible, oxygenated, HbS-containing red blood cells (SRBC) traverse capillaries and release their oxygen. After HbS releases its oxygen, it polymerizes after a short delay and the SRBC become rigid (6). If the SRBC fail to escape the microvasculature within the delay time period, the SRBC become lodged. Thus, any factor that increases the SRBC transit time or shortens t...

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Section: Discussionmentioning

confidence: 99%

Peripheral Vasoconstriction and Abnormal Parasympathetic Response to Sighs and Transient Hypoxia in Sickle Cell Disease

Sangkatumvong¹,

Khoo²,

Kato

et al. 2011

Am J Respir Crit Care Med

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“…Acutely, each of these stimuli acts independently to trigger central sympathetic outflow to the heart and periphery. The gas exchange abnormalities, sleep fragmentation, and autonomic activation have all been implicated as causes of the substantial adverse health effects attributed to SAS (2).…”

mentioning

confidence: 99%

Sleep Apnea with Intermittent Hemodialysis

Chan¹

2006

Journal of the American Society of Nephrology

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“…OUAS hastalarında tekrarlayan apne ve hipopnelere bağlı oluşan intratorasik negatif basınç, hipoksi, hiperkapni ve uyanıklık reaksiyonlarına bağlı artmış sempatik aktivite, vazokonstrüksiyona neden olarak sistemik vasküler rezistansı, kardiyak outputu artırır ve sıvı retansiyonuna neden olarak hipertansiyonun ortaya çıkmasına neden olur. OUAS'da hipertansiyona neden olan diğer bir faktör de artmış aldosteron seviyesidir (38)(39)(40)(41). OUAS hastalarında hem uyanıkken hem de nokturnal hipertansiyon saptanır.…”

Section: Hipertansiyonunclassified

The Relationship of Stroke and Sleep-A Review

Ak¹,

Yılmaz²

2018

jtsm

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Derleme / Review 95 GirişUyku ile ilişkili solunum bozuklukları sık karşılaşılan ve önemli bir sağlık sorunu olmasına rağmen yetersiz önemsenmektedir. Bu nedenle tanıda gecikmeye ve hastada ileri komplikasyonların ortaya çıkmasına sebep olabilir. İnme hastalarının %20-63'ünde hipersomni, insomni, parasomni, sirkadiyen ritim bozuklukları, uykuda hareket bozuklukları ve uyku ile ilişkili solunum bozuklukları görülmektedir (1). İnme tüm hastalıklar içinde uzun süreli özürlülüğe yol açan durumlar arasında ilk sırada, mortaliteye neden olan hastalıklar içerisinde ise üçüncü sırada bulunmaktadır (2). Uyku bozuklukları, inme için en az tanınan modifiye edilebilir risk faktörü olmaya devam etmektedir (3). Uyku bozuklukları ile vasküler risk faktörleriarasındaki ilişki iyi tanımlanmıştır. Uyku bozuklukları, birden fazla doğrudan veya dolaylı mekanizma yoluyla inme patolojisine katkıda bulunabilir (3,4) (Şekil1). Bu gözden geçirme yazısı ile inme veuyku bozuklukları arasındaki ilişkinin, epidemiyolojik, patofizyolojik, klinik açıdan ele alınarak tedavi stratejileriyle sunulması planlandı. Uykuda Solunumsal Patolojiler ve İnme Obstrüktif Uyku Apne Sendromu ve İnmeObstrüktif Uyku Apne sendromu (OUAS) uyku ile ilişkili bir solunum bozukluğudur ve gündüz aşırı uykululuk, horlama ve tanıklı apne gibi şikayetlerle karşımıza çıkar. Uyku sırasında solunum çabası olmasına karşılık hava akımında düşme (hipopne) veya duraksama (apne) ile klinik oluşturur. OUAS tanısında altın standart polisomnografidir (PSG). PSG tetkikinde en az 10 saniye süreyle solunumun durması "apne" anlamına gelir. "Hipopne" hava akımının başlangıçtaki bazal değerinin en az %30-50 oranında düşmesi ve genellikle oksijen desaturasyonu veya uyanıklık reaksiyonunun eşlik etmesidir. Tüm gece uykusundaki apne ve hipopnelerin indeks değeri "apne-hipopne indeksi" (AHİ) olarak tanımlanır. AHİ'nin 5-15/ saat arasında olması hafif, 15-30/saat arasında olması orta ve 30/saatin üzerinde olması ağır OUAS şeklinde sınıflandırılır. OUAS semptomlarını değerlendirirken gündüz aşırı uykululuğu ölçmede en sık kullanılan testlerden biri Epworth Uykululuk Skalası'dır (EUS). EUS, oldukça kolay ve hastanın kendisinin cevaplandırdığı sorulardan oluşan bir ölçektir. Kişinin uykululuk Abstract ÖzIschemic stroke appears the third leading cause of mortality and the first cause of disability in developing countries. The relationship between sleep disorders and cerebrovascular risk factors is well defined and there are different mechanisms in pathophysiology. Ischemic stroke affects many pathways, such as hypoxia, increased wakefulness reactions, decreased sleep quality, increased free oxygen radicals, inflammatory mechanisms activation, endothelial dysfunction, atherosclerosis, hypertension, and insulin resistance. Sleep disturbances contribute to stroke pathology through multiple direct or indirect mechanisms. Due to the fact that sleep disorders are among the changeable cerebrovascular risk factors, it is very important to raise awareness about the diagnosis, management and prevention of...

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Sleep-related breathing disorders and cardiovascular disease

Cited by 177 publications

References 83 publications

Peripheral Vasoconstriction and Abnormal Parasympathetic Response to Sighs and Transient Hypoxia in Sickle Cell Disease

Peripheral Vasoconstriction and Abnormal Parasympathetic Response to Sighs and Transient Hypoxia in Sickle Cell Disease

Sleep Apnea with Intermittent Hemodialysis

The Relationship of Stroke and Sleep-A Review

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