The autonomic nervous system and ischemic stroke: a reciprocal interdependence

Micieli, Giuseppe; Cavallini, Anna

doi:10.1007/s10286-008-0495-7

Cited by 36 publications

(23 citation statements)

References 82 publications

(69 reference statements)

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“…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. 12,32 However, in the current study, after we controlled for these cardiovascular factors, the significant association between pRBD and stroke persisted, suggesting that pRBD could be a risk factor for stroke beyond these conventional factors.…”

Section: Insomniamentioning

confidence: 86%

“…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][10][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.…”

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confidence: 99%

“…2,13 On the other hand, RBD-related autonomic dysfunction could lead to atherosclerosis, which is the leading cause of ischemic stroke. 8 We hypothesized that presence of RBD might be associated with high risk of both ischemic and intracerebral hemorrhagic stroke. To test this hypothesis, we expanded our previous analyses to prospectively examine whether individuals with pRBD at baseline (2012) had a higher risk of stroke during 3 years of follow-up among ;12,000 Chinese adults.…”

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confidence: 99%

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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: 86%

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confidence: 99%

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confidence: 99%

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Probable REM sleep behavior disorder and risk of stroke

Pavlova

Liu

et al. 2017

Neurology

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“…An increased sympathetic nervous activity has a negative prognostic impact in patients with cardiovascular disease such as heart failure, [33] myocardial infarction, [34] and stroke. [35] Baroreceptor gain for slow changes of blood pressure was considerably higher in patients with PB representing increased controller gain in the baroreceptor feedback loop. Our experiments support the hypothesis that cyclic inhibition of respiration by carotid and aortic baroreceptors contributes to oscillations in the breathing pattern of hypertensive patients.…”

Section: Discussionmentioning

confidence: 96%

Spontanous periodic breathing is associated with sympathetic hyperreactivity and baroreceptor dysfunction in hypertension

Binggeli

Sudano²,

Corti³

et al. 2010

Journal of Hypertension

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OBJECTIVES: Intermittent periods of hypoxemia such as during periodic breathing are associated with hypertension and increased sympathetic activity. In patients with sleep apnea syndrome, hypertension is common. Treating apnea improves hypertension and reduces sympathetic outflow. The aim of the present study was to investigate the phenomenon and mechanisms of spontaneous periodic breathing in patients with hypertension. METHOD: We examined 43 hypertensive patients with untreated hypertension without left-ventricular dysfunction, heart failure or sleep apnea syndrome. Muscle sympathetic nerve activity (MSA), heart rate (HR), blood pressure (BP) and respiration were continuously recorded at rest and during cold-pressor testing. Oxygen and a CO2-enriched gas were used to test central and peripheral chemoreceptors, respectively. Baroreceptor gain was measured using the alpha method. RESULTS: Seven out of 43 patients showed spontaneous periodic breathing while awake. No difference in MSA, HR and BP was seen between patients with and without periodic breathing at rest except the breathing pattern. However, the cold-pressor test caused a larger increase of MSA in patients with periodic breathing (203 +/-62 vs. 62 +/-8%, P < 0.0001 by ANOVA), as well as systolic (46 +/-6 vs. 25 +/-3 mmHg, P = 0.002) and diastolic BP (26 +/-5 vs. 12 +/-1 mmHg, P = 0.004, ANOVA). Baroreceptor gain was markedly higher in patients with periodic breathing. Chemoreceptor sensitivity was comparable. CONCLUSION: Spontaneous periodic breathing is relatively common in patients with hypertension and is associated with greatly enhanced responses to cold-pressor testing. We suggest increased baroreceptor gain and sympathetic outflow as a cause for the oscillatory respiration pattern via barorespiratory coupling.

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“…[20] The ischemic brain can act through the autonomic nervous system to have suppressive effect that can induce intercurrent infections and contribute to the morbidity and mortality after stroke. [21][22][23] Therefore, immune system-mediated inflammation is critically involved in determining the fate of the brain following ischemic stroke. [24][25][26] Understanding the mechanisms underlying role of neuroinflammation in ischemic stroke would provide important targets for the development of therapy in ischemic stroke.…”

Section: Introductionmentioning

confidence: 99%

Role of neuroinflammation in ischemic stroke

Li¹,

Pan²,

Tang³

et al. 2017

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Ischemic stroke causes the depletion of energy and induce excitotoxicity and neuroinflammation in the brain that results from thrombotic blockage. Neuroinflammation occurs initially depending on activated resident microglia that has the same function as the macrophage. Activated microglia participates in the neuroinflammatory process by phagocytosing the injured brain cells and producing the pro-and anti-inflammatory mediators. In this review, the authors present an overview of the role of microglia in mediating neuroinflammation in ischemic stroke. Key words:Microglia, ischemic stroke, neuroinflammation ABSTRACT Topic: StrokeThis is an open access article distributed under the terms of the Creative Commons AttributionNonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

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The autonomic nervous system and ischemic stroke: a reciprocal interdependence

Cited by 36 publications

References 82 publications

Probable REM sleep behavior disorder and risk of stroke

Probable REM sleep behavior disorder and risk of stroke

Spontanous periodic breathing is associated with sympathetic hyperreactivity and baroreceptor dysfunction in hypertension

Role of neuroinflammation in ischemic stroke

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