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Hidayat R, Ulwanda RS, Irfannadhira AC, Rachmawati EZK, Pangeran D, Yunus RE, Mesiano T, Kurniawan M, Rasyid A, Harris S. Obstructive sleep apnea exaggeration as predictor of poor outcome post thrombolytic stroke. Radiol Case Rep 2024; 19:3324-3328. [PMID: 38860268 PMCID: PMC11163142 DOI: 10.1016/j.radcr.2024.04.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 06/12/2024] Open
Abstract
Obstructive sleep apnea (OSA) is a common sleep disordered breathing in stroke patients. This case report aimed to show the presence of OSA in stroke can contribute to the increasing chance of mortality and morbidity. We presented a case of first-time stroke in a 64-year-old female with a history of pre-stroke OSA. She underwent intravenous thrombolysis as main therapy within the time limit under 4.5 hours since the stroke onset. She had prolonged hospital stay due to complications from OSA, even though she only had a small ischemic core (9 mL) in follow-up radiological imaging and was discharged with a greater National Institutes of Health Stroke Scale (NIHSS) score than admission (5 to 10). OSA can be one of warning signs for poor prognosis in stroke patients. Understanding the presence of OSA not only can be beneficial toward choosing the next steps of therapy, but also important for the rehabilitation and recovery period of stroke patients.
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Affiliation(s)
- Rakhmad Hidayat
- Faculty of Medicine Universitas Indonesia, Indonesia
- Dr. Cipto Mangunkusumo Hospital, Indonesia
| | | | | | | | | | - Reyhan Eddy Yunus
- Faculty of Medicine Universitas Indonesia, Indonesia
- Dr. Cipto Mangunkusumo Hospital, Indonesia
| | - Taufik Mesiano
- Faculty of Medicine Universitas Indonesia, Indonesia
- Dr. Cipto Mangunkusumo Hospital, Indonesia
| | - Mohammad Kurniawan
- Faculty of Medicine Universitas Indonesia, Indonesia
- Dr. Cipto Mangunkusumo Hospital, Indonesia
| | - Al Rasyid
- Faculty of Medicine Universitas Indonesia, Indonesia
- Dr. Cipto Mangunkusumo Hospital, Indonesia
| | - Salim Harris
- Faculty of Medicine Universitas Indonesia, Indonesia
- Dr. Cipto Mangunkusumo Hospital, Indonesia
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Mogavero MP, DelRosso LM, Lanza G, Bruni O, Ferini Strambi L, Ferri R. The dynamics of cyclic-periodic phenomena during non-rapid and rapid eye movement sleep. J Sleep Res 2024:e14265. [PMID: 38853262 DOI: 10.1111/jsr.14265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/21/2024] [Accepted: 05/27/2024] [Indexed: 06/11/2024]
Abstract
Sleep is a complex physiological state characterized by distinct stages, each exhibiting unique electroencephalographic patterns and physiological phenomena. Sleep research has unveiled the presence of intricate cyclic-periodic phenomena during both non-rapid eye movement and rapid eye movement sleep stages. These phenomena encompass a spectrum of rhythmic oscillations and periodic events, including cyclic alternating pattern, periodic leg movements during sleep, respiratory-related events such as apneas, and heart rate variability. This narrative review synthesizes empirical findings and theoretical frameworks to elucidate the dynamics, interplay and implications of cyclic-periodic phenomena within the context of sleep physiology. Furthermore, it invokes the clinical relevance of these phenomena in the diagnosis and management of sleep disorders.
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Affiliation(s)
- Maria P Mogavero
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Neuroscience, Sleep Disorders Center, San Raffaele Scientific Institute, Milan, Italy
| | | | - Giuseppe Lanza
- Oasi Research Institute-IRCCS, Troina, Italy
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Luigi Ferini Strambi
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Neuroscience, Sleep Disorders Center, San Raffaele Scientific Institute, Milan, Italy
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Akyol Gurses A, Akyildiz UO. Rapid eye movement dependency is associated with increased inflammatory activity in obstructive sleep apnea syndrome. Brain Behav 2024; 14:e3546. [PMID: 38844423 PMCID: PMC11156523 DOI: 10.1002/brb3.3546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 03/18/2024] [Accepted: 05/07/2024] [Indexed: 06/10/2024] Open
Abstract
OBJECTIVE Rapid eye movement (REM)-dependent obstructive sleep apnea syndrome (OSAS) is a specific subtype of OSAS having some phenotypic characteristics like a preference for a younger age, female gender, and milder severity. Such favorable features could make it possible to consider an overall benign course for this phenotype. However, accumulating data introduced its association with several cardiometabolic and vascular disorders recently. The primary objective of this study was to address the disease from the inflammation perspective and evaluate the potential inflammatory status in this variant via two accessible blood parameters: platelet distribution width (PDW) and systemic immune-inflammation index (SII). The secondary aim was to investigate whether this status, together with other disease characteristics, demonstrates consistency under different definitions of REM-dependent OSAS published previously. PATIENTS AND METHODS The medical records of 35 patients with mild-to-moderate REM-dependent OSAS, 35 age- and sex-matched patients with REM-independent OSAS, and 25 non-OSA controls were retrospectively analyzed. Baseline features, polysomnographic characteristics, PDW, and SII were compared between the groups. Secondly, the analyses were repeated using different definitions of REM-dependent OSAS. Bivariate analyses were performed, and a multiple stepwise regression model was applied to adjust for body mass index (BMI) and cardiovascular risk (CVR) factors. RESULTS: Mean PDW and SII were increased in patients with REM-dependent OSAS as compared to non-OSA controls (p = .022 and .029). The significance remained stable after adjustment for BMI and CVRs and was consistent according to different definitions. The Comparison of patients with REM-independent OSAS and non-OSA controls, as well as the two different subtypes of OSAS, did not yield significance. CONCLUSION Based on the current findings, patients with REM-dependent OSAS appear to be susceptible to inflammation and should be carefully monitored for the negative consequences of that issue. To our knowledge, this study is the first to evaluate SII and PDW in REM-dependent OSAS.
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Affiliation(s)
- Asli Akyol Gurses
- Division of Clinical Neurophysiology, Department of Neurology, Faculty of MedicineGazi UniversityAnkaraTurkey
| | - Utku Ogan Akyildiz
- Department of Neurology, Faculty of MedicineAydin Adnan Menderes UniversityAydinTurkey
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Wang Z, Li S, Zuo C, Qin J, Wu D. Correlation Between Rapid Eye Movement Sleep Duration and Laryngopharyngeal Reflux in Patients with Obstructive Sleep Apnea. EAR, NOSE & THROAT JOURNAL 2023:1455613231214653. [PMID: 37997618 DOI: 10.1177/01455613231214653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
Objectives: The aim of this study was to investigate the correlation between rapid eye movement (REM) sleep duration and laryngopharyngeal reflux (LPR) in patients with obstructive sleep apnea (OSA). Methods: In all, 99 patients with OSA were enrolled in this study, and the correlation between REM sleep duration and the severity of LPR was analyzed after the polysomnography (PSG) and reflux symptom index (RSI) scores were completed. Subsequently, a multiple linear regression analysis was performed to further clarify the factors affecting LPR. Results: Partial correlation analysis showed that the REM sleep duration was positively correlated with the RSI scores (r = 0.236, P = .022) after controlling for apnea-hypopnea index (AHI), body mass index (BMI), lowest oxygen saturation (LSO2), age, and sex. The multiple linear regression analysis indicated that only REM sleep duration was a factor influencing LPR (t = 2.330, P = .022). Conclusions: Our study found a correlation between REM sleep duration and LPR in OSA patients. The shorter the REM sleep duration, the less severe the LPR symptoms.
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Affiliation(s)
- Zhe Wang
- Postgraduate Training Base of Jinzhou Medical University in the General Hospital of Northern Theater Command, Jinzhou, China
- Department of Otolaryngology, General Hospital of Northern Theater Command, Shenyang, China
| | - Shuhua Li
- Department of Otolaryngology, General Hospital of Northern Theater Command, Shenyang, China
| | - Chengcheng Zuo
- Department of Otolaryngology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate Training Base of Dalian Medical University in the General Hospital of Northern Theater Command, Dalian, China
| | - Jie Qin
- Department of Otolaryngology, General Hospital of Northern Theater Command, Shenyang, China
| | - Dahai Wu
- Department of Otolaryngology, General Hospital of Northern Theater Command, Shenyang, China
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Yang S, Kong X, Li X, Ge YJ. Serum C-reactive protein level and sleep characteristics in obstructive sleep apnea syndrome comorbid with panic disorder: a preliminary study. BMC Psychiatry 2023; 23:859. [PMID: 37985980 PMCID: PMC10662421 DOI: 10.1186/s12888-023-05376-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/12/2023] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVE Investigate the sleep characteristics of patients with obstructive sleep apnea syndrome (OSAS) comorbidity with panic disorder (PD), exploring its potential association with serum C-reactive protein (CRP) levels. PATIENTS AND METHODS Fifty-four patients (25 OSAS patients with PD and 29 without PD) and 25 healthy controls (HCs) were included. The Self-rating anxiety scale (SAS), self-rating depression scale (SDS), and Pittsburgh sleep quality index (PSQI) were used to assess the mood and sleep quality of the subjects. All patients had circulating CRP levels and polysomnography was performed. RESULTS OSAS with PD had higher SAS, SDS, PSQI than the OSAS without PD. Compared to OSAS without PD, OSAS with PD had higher percentage of non- rapid eye movement sleep 1 and 2 (N1 and N2%), sleep latency, and a lower percentage of rapid eye movement sleep (REM%). Respiratory-related microarousal index, AHI, and time below 90% oxygen saturation (T90) were low, and the lowest oxygen saturation (LO2) was high. Serum CRP levels in OSAS patients with PD were lower than that in OSAS patients without PD, but higher than that in HCs. In OSAS patients with PD, serum CRP levels were negatively correlated with wake time after sleep onset and SAS scores but positively correlated with sleep efficiency and N2%. Serum CRP levels were positively correlated with T90 and negatively correlated with LO2. CONCLUSION OSAS patients with PD had worse sleep quality, less severe OSAS, and low serum CRP levels. Serum CRP levels in OSAS patients with PD were associated with poorer sleep quality and duration of hypoxia rather than AHI.
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Affiliation(s)
- Shuai Yang
- Department of Neurocritical Care Unit, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, P. R. China
- Department of Neurology (Sleep Disorders), Affiliated Chaohu Hospital of Anhui Medical University, Hefei (Chaohu), P. R. China
| | - Xiaoyi Kong
- Department of Neurology (Sleep Disorders), Affiliated Chaohu Hospital of Anhui Medical University, Hefei (Chaohu), P. R. China
| | - Xueyan Li
- Department of Neurology (Sleep Disorders), Affiliated Chaohu Hospital of Anhui Medical University, Hefei (Chaohu), P. R. China
| | - Yi-Jun Ge
- Department of Neurology (Sleep Disorders), Affiliated Chaohu Hospital of Anhui Medical University, Hefei (Chaohu), P. R. China.
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Alvente S, Matteoli G, Miglioranza E, Zoccoli G, Bastianini S. How to study sleep apneas in mouse models of human pathology. J Neurosci Methods 2023; 395:109923. [PMID: 37459897 DOI: 10.1016/j.jneumeth.2023.109923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/28/2023] [Accepted: 07/13/2023] [Indexed: 07/22/2023]
Abstract
Sleep apnea, the most widespread sleep-related breathing disorder (SBD), consists of recurrent episodes of breathing cessation during sleep. This condition can be classified as either central (CSA) or obstructive (OSA) sleep apnea, with the latest being the most common and toxic. Due to the complexity of living organisms, animal models and, particularly, mice still represent an essential tool for the study of SBD. In the present review we first discuss the methodological pros and cons in the use of whole-body plethysmography to coupling respiratory and sleep measurements and to characterize CSA and OSA in mice; then, we draw an updated and objective picture of the methods used so far in the study of sleep apnea in mice. Most of the studies present in the literature used intermittent hypoxia to mimic OSA in mice and to investigate consequent pathological correlates. On the contrary, few studies using genetic manipulation or high-fat diets investigated the pathogenesis or potential treatments of sleep apnea. To date, mice lacking orexins, hemeoxygenase-2, monoamine oxidase A, Phox2b or Cdkl5 can be considered validated mouse models of sleep apnea. Moreover, genetically- or diet-induced obese mice, and mice recapitulating Down syndrome were proposed as OSA models. In conclusion, our review shows that despite the growing interest in the field and the need of new therapeutical approaches, technical complexity and inter-study variability strongly limit the availability of validated mouse of sleep apnea, which are essential in biomedical research.
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Affiliation(s)
- Sara Alvente
- PRISM Lab, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Gabriele Matteoli
- PRISM Lab, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Elena Miglioranza
- PRISM Lab, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giovanna Zoccoli
- PRISM Lab, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Stefano Bastianini
- PRISM Lab, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
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Chiu HY, Liu YY, Shiao TH, Su KC, Chou KT, Chen YM. Clinical Characteristics of Rapid Eye Movement-Related Obstructive Sleep Apnea: An Experience in a Tertiary Medical Center of Taiwan. Nat Sci Sleep 2022; 14:1521-1532. [PMID: 36068886 PMCID: PMC9441168 DOI: 10.2147/nss.s368659] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/23/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Obstructive sleep apnea (OSA) is characterized by intermittent hypoxemia and sleep fragmentation. While apnea is pronounced with severe desaturation during rapid eye movement (REM) sleep, REM-related OSA is a distinct phenotype of OSA associated with respiratory disturbances predominantly during REM sleep. In this study, we investigated the clinical features of REM-related OSA in Taiwan. PATIENTS AND METHODS All patients diagnosed with OSA in the Taipei Veterans General Hospital from 2015 to 2017 were analyzed retrospectively and classified into REM-related OSA (REM-OSA) group, non-REM related OSA (NREM-OSA) group, and non-stage specific-OSA group. The clinical demographics, OSA-related symptoms, polysomnography results, and medical comorbidities of the three groups were analyzed. RESULTS Among 1331 patients with OSA, 414 (31.1%) were classified as REM-OSA, 808 (60.7%) as NREM-OSA, and 109 (8.2%) as non-stage specific-OSA. After being adjusted for OSA severity, the REM-OSA group was associated with less portion of males, longer desaturation duration, and lower nadir oxygen saturation (SpO2) compared with the NREM-OSA group in mild and moderate OSA. In moderate OSA, the non-stage specific-OSA group featured more OSA severity and more desaturation compared with the other groups. The Epworth Sleepiness Scale scores and the prevalence of comorbidities did not vary among the REM-OSA, NREM-OSA, and non-stage specific-OSA groups. High REM-AHI/NREM-AHI ratio was associated with young age, female gender, high BMI, and low AHI. CONCLUSION OSA patients with high REM-AHI/NREM-AHI ratio are related to young age, female gender, high BMI, and low AHI. Patients with REM-related OSA presented with longer desaturation duration and lower nadir SpO2 after being adjusted for OSA severity.
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Affiliation(s)
- Hwa-Yen Chiu
- Chest Department, Taipei Veterans General Hospital, Taipei, 11217, Taiwan, Republic of China.,Institute of Biophotonics, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan, Republic of China.,Division of Internal Medicine, Hsinchu Branch, Taipei Veterans General Hospital, Hsinchu, 31064, Taiwan, Republic of China.,School of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan, Republic of China
| | - Yung-Yang Liu
- Chest Department, Taipei Veterans General Hospital, Taipei, 11217, Taiwan, Republic of China.,School of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan, Republic of China
| | - Tsu-Hui Shiao
- Chest Department, Taipei Veterans General Hospital, Taipei, 11217, Taiwan, Republic of China.,School of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan, Republic of China
| | - Kang-Cheng Su
- Chest Department, Taipei Veterans General Hospital, Taipei, 11217, Taiwan, Republic of China.,School of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan, Republic of China
| | - Kun-Ta Chou
- Chest Department, Taipei Veterans General Hospital, Taipei, 11217, Taiwan, Republic of China.,School of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan, Republic of China
| | - Yuh-Min Chen
- Chest Department, Taipei Veterans General Hospital, Taipei, 11217, Taiwan, Republic of China.,School of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan, Republic of China
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Wang L, Wei D, Zhang J, Cao J, Zhang X. High Rapid Eye Movement Sleep Apnea Hypopnea Index is Associated with Hypertension in Patients with Obstructive Sleep Apnea. Nat Sci Sleep 2022; 14:1249-1258. [PMID: 35832389 PMCID: PMC9271684 DOI: 10.2147/nss.s369614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/29/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Obstructive sleep apnea (OSA) plays an important role in the pathogenesis of hypertension. The aim of this cross-sectional study was to explore the clinical and polysomnographic characteristics of OSA patients with hypertension and to explore the gender differences in the relationship between rapid eye movement (REM) OSA and hypertension. PATIENTS AND METHODS A total of 808 patients with OSA at a tertiary hospital were enrolled in this study, and OSA patients were divided into groups presenting with or without hypertension. The clinical and polysomnographic characteristics were compared between the groups. Multivariate binary logistic analysis was performed to assess the association between REM OSA and hypertension. RESULTS After adjustment for potential confounders, the risk of hypertension in patients with OSA increased with severity categories of apnea hypopnea index during rapid eye movement sleep stage (REM AHI) (OR = 1.61 for REM AHI ≥58.87 events/h relative to REM AHI <30.50 events/h, 95% CI 1.07-2.42, P = 0.022). Consistent with this, when taken as a continuous variable, this association still remains significant (OR = 1.007, 95% CI 1.001-1.014, P < 0.05). This effect was more pronounced in women patients, the OR for REM AHI ≥57.24 events/h relative to REM AHI <30.36 events/h was 2.79 (95% CI, 1.16-6.73; P = 0.022); however, there was no significant difference in male patients. CONCLUSION REM AHI was significantly and positively associated with hypertension in patients with OSA, and the effect was more pronounced in female patients.
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Affiliation(s)
- Le Wang
- Department of Respiratory and Critical Care, Tianjin Medical University General Hospital, Tianjin, The People's Republic of China
| | - Donghui Wei
- Department of Respiratory and Critical Care, Tianjin Medical University General Hospital, Tianjin, The People's Republic of China
| | - Jing Zhang
- Department of Respiratory and Critical Care, Tianjin Medical University General Hospital, Tianjin, The People's Republic of China
| | - Jie Cao
- Department of Respiratory and Critical Care, Tianjin Medical University General Hospital, Tianjin, The People's Republic of China
| | - Xinxin Zhang
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, The People's Republic of China
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