Sleep, sleep deprivation, autonomic nervous system and cardiovascular diseases

Tobaldini, Eleonora; Costantino, Giorgio; Solbiati, Monica; Cogliati, Chiara; Kára, Tomáš; Nobili, Lino; Montano, Nicola

doi:10.1016/j.neubiorev.2016.07.004

Cited by 446 publications

(339 citation statements)

References 102 publications

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“…30 Sleep fragmentation may lead to increased sympathetic output, such as changes in heart rate variability and temperature regulation, and impairment in hormonal secretion and immune function. 31 Over time, this hyperactivity during sleep might be generalized into an ongoing, daytime sympathetic overactivity, thereby increasing cardiovascular stress. 8 Significant association between cardiovascular risk factors and pRBD was observed in 2 previous cross-sectional studies.…”

Section: Insomniamentioning

confidence: 99%

Probable REM sleep behavior disorder and risk of stroke

Pavlova

Liu

et al. 2017

Neurology

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Objective: To examine whether probable REM sleep behavior disorder (pRBD) was associated with increased risk of developing stroke in a community-based cohort. Methods:The study included 12,003 participants (mean age 54.0 years) of the Kailuan Study, free of stroke, cancer, Parkinson disease, dementia, and head injury at baseline (2012). We determined pRBD using a validated REM sleep behavior disorder (RBD) questionnaire in 2012. Incident stroke cases were confirmed by review of medical records. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of stroke according to pRBD status, adjusting for several sleep measures (i.e., insomnia, daytime sleepiness, sleep duration, snoring, and use of hypnotics) and other potential confounders.Results: During 3 years of follow-up, we documented 159 incident stroke cases. Relative to participants without pRBD at the baseline, those with pRBD had a 157% higher risk (95% CI 59%-313%) of developing stroke. Presence of pRBD was associated with increased risk of both stroke types-the adjusted HR was 1.93 (95% CI 1.07-3.46) for ischemic stroke and 6.61 (95% CI 2.27-19.27) for hemorrhagic stroke.Conclusions: Presence of pRBD was associated with a higher risk of developing stroke, including both ischemic and hemorrhagic types. Future studies with clinically confirmed RBD and a longer follow-up would be appropriate to further investigate this association. Neurology ® 2017;88:1849-1855 GLOSSARY AIS 5 Athens Insomnia Scale; BMI 5 body mass index; CI 5 confidence interval; ESS 5 Epworth Sleepiness Scale; HDL-C 5 high-density lipoprotein cholesterol; HR 5 hazard ratio; ICD-10 5 International Classification of Diseases-10; LDL-C 5 lowdensity lipoprotein cholesterol; OR 5 odds ratio; OSA 5 obstructive sleep apnea; PD 5 Parkinson disease; pRBD 5 probable REM sleep behavior disorder; RBD 5 REM sleep behavior disorder; RBDQ-HK 5 RBD questionnaire-Hong Kong; RMB 5 renminbi.REM sleep behavior disorder (RBD) is associated with synucleinopathies, and a large proportion of individuals with RBD may already have or later develop Parkinson disease (PD), dementia with Lewy bodies, or multiple system atrophy. [1][2][3] Synucleinopathies were often associated with symptoms of autonomic dysfunction, such as impaired blood pressure control and reduced heart rate variability. 4,5 Consistently, individuals with idiopathic RBD experienced worse autonomic function, including cardiovascular, gastrointestinal, and urinary domains, relative to control participants. 6,7 The autonomic nervous system may have a role in the prepathologic state or contribute to the precipitating factors of the acute phase of stroke, such as atherosclerosis and sympathetic hyperactivity. 8 Some case reports suggested that stroke may cause RBD. 9-11 In a previous cross-sectional study, we also found that individuals with probable RBD (pRBD) had higher odds of several concurrent stroke risk factors, such as diabetes and hyperlipidemia. 12 However, whether RBD predicts subsequ...

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Section: Insomniamentioning

confidence: 99%

Probable REM sleep behavior disorder and risk of stroke

Pavlova

Liu

et al. 2017

Neurology

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“…This investigative attention was, and still is, justified by the recognition that these autonomic reflex controls are critical in the detection and correction of spontaneous changes in arterial blood pressure, thoracic blood volumes and pressures, humoral factors produced during myocardial ischemia and changes in arterial concentration of oxygen, carbon dioxide and pH. These reflexes are indeed essential to maintain whole-body homeostasis at rest (Salman, 2016), or during ordinary physiological events, such as, (i) changes in posture (i.e., clinostatic vs. orthostatic; Montano et al, 1994), (ii) alterations in the sleep-wake cycle (Narkiewicz et al, 1998; Tobaldini et al, 2017), (iii) in response to exercise (Negrão et al, 2001), or (iv) during emotional stress (Durocher et al, 2011). …”

Section: Hyperadrenergic State In Heart Failurementioning

confidence: 99%

Contribution of Autonomic Reflexes to the Hyperadrenergic State in Heart Failure

et al. 2017

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Heart failure (HF) is a complex syndrome representing the clinical endpoint of many cardiovascular diseases of different etiology. Given its prevalence, incidence and social impact, a better understanding of HF pathophysiology is paramount to implement more effective anti-HF therapies. Based on left ventricle (LV) performance, HF is currently classified as follows: (1) with reduced ejection fraction (HFrEF); (2) with mid-range EF (HFmrEF); and (3) with preserved EF (HFpEF). A central tenet of HFrEF pathophysiology is adrenergic hyperactivity, featuring increased sympathetic nerve discharge and a progressive loss of rhythmical sympathetic oscillations. The role of reflex mechanisms in sustaining adrenergic abnormalities during HFrEF is increasingly well appreciated and delineated. However, the same cannot be said for patients affected by HFpEF or HFmrEF, whom also present with autonomic dysfunction. Neural mechanisms of cardiovascular regulation act as “controller units,” detecting and adjusting for changes in arterial blood pressure, blood volume, and arterial concentrations of oxygen, carbon dioxide and pH, as well as for humoral factors eventually released after myocardial (or other tissue) ischemia. They do so on a beat-to-beat basis. The central dynamic integration of all these afferent signals ensures homeostasis, at rest and during states of physiological or pathophysiological stress. Thus, the net result of information gathered by each controller unit is transmitted by the autonomic branch using two different codes: intensity and rhythm of sympathetic discharges. The main scope of the present article is to (i) review the key neural mechanisms involved in cardiovascular regulation; (ii) discuss how their dysfunction accounts for the hyperadrenergic state present in certain forms of HF; and (iii) summarize how sympathetic efferent traffic reveal central integration among autonomic mechanisms under physiological and pathological conditions, with a special emphasis on pathophysiological characteristics of HF.

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“…20 Sleep fragmentation is another possible mechanism responsible for cardiovascular, metabolic, and neurocognitive complications. 21,22 There are few studies reporting the effect of continuous positive airway pressure (CPAP) therapy on the recurrence of vascular events in stabilized patients with stroke. The aim of this study was to assess the effect of CPAP treatment in prevention of new vascular events among stroke patients with OSA at least 6 weeks after the ictus.…”

Section: Introductionmentioning

confidence: 99%

Role of Positive Airway Pressure Therapy for Obstructive Sleep Apnea in Patients With Stroke: A Randomized Controlled Trial

Gupta

Shukla

Mohammed

et al. 2018

Journal of Clinical Sleep Medicine

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Study Objectives: Obstructive sleep apnea (OSA) is an independent risk factor for stroke. The objective of this study was to assess the effect of continuous positive airway pressure (CPAP) treatment on prevention of new vascular events among patients with stroke and OSA. Methods: Consecutive conscious patients presenting with first imaging-confirmed arterial stroke were included, 6 weeks or more after ictus. All patients underwent clinical and polysomnography (PSG) testing. Patients with an apnea-hypopnea index (AHI) of > 15 events/h were randomized to posttitration nightly CPAP treatment and non-CPAP (received best medical treatment) groups. On follow-up at 3, 6, and 12 months from randomization, evaluation was carried out for any new vascular events as the primary outcome measure, and for clinical stroke outcomes (using the Barthel Index and modified Rankin scale) and neuropsychological parameters as the secondary outcome measures. Results: Among the 679 patients with stroke who were screened, 116 reported for PSG, 83 had AHI > 15 events/h, and 70 (34 in CPAP and 36 in non-CPAP) were randomized. Thirteen patients could not be randomized because of a lack of CPAP devices. Four patients crossed over from the CPAP to the non-CPAP group. Age (mean age 53.41 ± 9.85 in CPAP versus 52.69 ± 13.23 years in non-CPAP, P = .81) and sex distribution (24 males in CPAP versus 33 males in non-CPAP, P = .79) were similar in both groups. At 12-month follow-up, there was 1 vascular event (3.33%) in the CPAP group and 6 events (15%) in the non-CPAP group (P = .23). Modified Rankin scale score improvement by ≥ 1 at 12-month follow-up was found in significantly more patients in the CPAP group than in the non-CPAP group (53% versus 27%). I NTRO DUCTI O NStroke is common, the second leading cause of death and disability, and is the cause of high health care costs.1,2 Important risk factors for stroke are hypertension, atrial fibrillation, diabetes, and smoking. These are well-established intervention targets for stroke's primary and secondary prevention. that leads to oxygen desaturation and sleep fragmentation. This further leads to an increased risk of cardiovascular disease, stroke, and death. [4][5][6] It has been established that OSA is an independent risk factor for stroke 1,7 and also aggravates other risk factors (hypertension, coronary artery disease, diabetes, and atrial fibrillation).1 The prevalence of OSA among patients with stroke is around 50% to 80%. Even with neurological improvement in patients with stroke, their OSA does not remit or improve. [8][9][10] The high prevalence of OSA among patients with stroke is associated with an unfavorable clinical course in terms of early neurological worsening, delirium, BRIEF SUMMARY Current Knowledge/Study Rationale: Stroke is a common cause of death and disability and obstructive sleep apnea (OSA) is an independent risk factor for stroke. The objective of this study was to assess the effect of continuous positive airway pressure (CPAP) treatment in prevention of new vascular ...

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Sleep, sleep deprivation, autonomic nervous system and cardiovascular diseases

Cited by 446 publications

References 102 publications

Probable REM sleep behavior disorder and risk of stroke

Probable REM sleep behavior disorder and risk of stroke

Contribution of Autonomic Reflexes to the Hyperadrenergic State in Heart Failure

Role of Positive Airway Pressure Therapy for Obstructive Sleep Apnea in Patients With Stroke: A Randomized Controlled Trial

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