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Baillieul S, Tamisier R, Gévaudan B, Alexandre S, Detante O, Dauvilliers Y, Bassetti C, Pépin JL, Bailly S. Trajectories of self-reported daytime sleepiness post-ischemic stroke and transient ischemic attack: A propensity score matching study versus non-stroke patients. Eur Stroke J 2024; 9:451-459. [PMID: 38268186 DOI: 10.1177/23969873241227751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION Severe sleep apnea (SA) affects one-third of stroke patients. Sleepiness, one of the cardinal symptoms of SA, negatively impacts functional stroke outcomes. The impact of continuous positive airway pressure (CPAP) on post-stroke sleepiness is poorly described. We aimed to compare through a propensity score matching the trajectories of self-reported sleepiness post-stroke with matched individuals including SA patients adherent or not to CPAP. PATIENTS AND METHODS Sixty five (80.2%) ischemic stroke and 16 (19.8%) TIA patients (median [Q1;Q3] age = 67.0 [58.0;74.0] years, 70.4% male, body mass index [BMI] = 26.1 [24.5;29.8] kg·m-2, admission NIHSS = 3.0 [1.0;5.0]), with polysomnography and an Epworth Sleepiness Scale (ESS) performed within 1 year following stroke and with a follow-up ESS (delay = 236 [147;399] days) were included in the analysis. A 2:1 propensity score matching based on age, gender, BMI, and the apnea-hypopnea index was performed to identify 162 matched individuals referred for SA suspicion, free of stroke or TIA. Multivariable negative binomial regression models were performed to identify the determinants of sleepiness trajectories post-stroke. RESULTS Baseline ESS was comparable between stroke/TIA and matched individuals (median [Q1; Q3] ESS = 7 [4;10] versus 6 [4;10], p = 0.86). The range of improvement in ESS was higher in stroke patients compared to controls (∆ESS = -2 [-4;1] vs -1 [-3;2], p = 0.03). In multivariable analysis, comorbid SA and CPAP treatment did not influence trajectories of sleepiness post-stroke. DISCUSSION AND CONCLUSION Sleepiness improvement was unexpectedly higher in stroke patients compared to matched individuals, with no significant influence of comorbid SA and CPAP on its trajectory. Sleepiness may not be primarily indicative of SA in stroke or TIA patients.
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Affiliation(s)
- Sébastien Baillieul
- Univ. Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, Grenoble, France
| | - Renaud Tamisier
- Univ. Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, Grenoble, France
| | - Bastien Gévaudan
- Univ. Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, Grenoble, France
| | - Sarah Alexandre
- Univ. Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, Grenoble, France
| | - Olivier Detante
- Neurology Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Yves Dauvilliers
- National Reference Centre for Orphan Diseases Narcolepsy Rare Hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, University of Montpellier, Montpellier, France
- Institute for Neurosciences of Montpellier (INM), University of Montpellier, INSERM, Montpellier, France
| | - Claudio Bassetti
- Neurology Department, Inselspital, Bern University Hospital, Switzerland
| | - Jean-Louis Pépin
- Univ. Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, Grenoble, France
| | - Sébastien Bailly
- Univ. Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, Grenoble, France
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Mayer-Suess L, Ibrahim A, Moelgg K, Cesari M, Knoflach M, Högl B, Stefani A, Kiechl S, Heidbreder A. Sleep disorders as both risk factors for, and a consequence of, stroke: A narrative review. Int J Stroke 2024; 19:490-498. [PMID: 37885093 PMCID: PMC11134986 DOI: 10.1177/17474930231212349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND AND PURPOSE Sleep disorders are increasingly implicated as risk factors for stroke, as well as a determinant of stroke outcome. They can also occur secondary to the stroke itself. In this review, we describe the variety of different sleep disorders associated with stroke and analyze their effect on stroke risk and outcome. METHODS A search term-based literature review ("sleep," "insomnia," "narcolepsy," "restless legs syndrome," "periodic limb movements during sleep," "excessive daytime sleepiness" AND "stroke" OR "cerebrovascular" in PubMed; "stroke" and "sleep" in ClinicalTrials.gov) was performed. English articles from 1990 to March 2023 were considered. RESULTS Increasing evidence suggests that sleep disorders are risk factors for stroke. In addition, sleep disturbance has been reported in half of all stroke sufferers; specifically, an increase is not only sleep-related breathing disorders but also periodic limb movements during sleep, narcolepsy, rapid eye movement (REM) sleep behavior disorder, insomnia, sleep duration, and circadian rhythm sleep-wake disorders. Poststroke sleep disturbance has been associated with worse outcome. CONCLUSION Sleep disorders are risk factors for stroke and associated with worse stroke outcome. They are also a common consequence of stroke. Recent guidelines suggest screening for sleep disorders after stroke. It is possible that treatment of sleep disorders could both reduce stroke risk and improve stroke outcome, although further data from clinical trials are required.
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Affiliation(s)
- Lukas Mayer-Suess
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Abubaker Ibrahim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Kurt Moelgg
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage—Research Centre on Clinical Stroke Research, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Neurological Clinical Research Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage—Research Centre on Clinical Stroke Research, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neurology, Johannes Kepler University Linz, Linz, Austria
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Zhou Y, Jin X, Liu X, Tang J, Song L, Zhu Y, Zhai W, Wang X. Correlation between obstructive sleep apnea and hypoperfusion in patients with acute cerebral infarction. Front Neurol 2024; 15:1363053. [PMID: 38651100 PMCID: PMC11033380 DOI: 10.3389/fneur.2024.1363053] [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: 12/29/2023] [Accepted: 03/28/2024] [Indexed: 04/25/2024] Open
Abstract
Purpose To explore the relationship between obstructive sleep apnea (OSA) and hypoperfusion during ultra-early acute cerebral infarction. Patients and methods Data were retrospectively collected from patients admitted to our hospital with acute cerebral infarction between January 2020 and January 2022, who underwent comprehensive whole-brain computed tomography perfusion imaging and angiography examinations within 6 h of onset. The F-stroke software automatically assessed and obtained relevant data (Tmax). The patients underwent an initial screening for sleep apnea. Based on their Apnea-Hypopnea Index (AHI), patients were categorized into an AHI ≤15 (n = 22) or AHI >15 (n = 25) group. The pairwise difference of the time-to-maximum of the residue function (Tmax) > 6 s volume was compared, and the correlation between AHI, mean pulse oxygen saturation (SpO2), oxygen desaturation index (ODI), percentage of time with oxygen saturation < 90% (T90%), and the Tmax >6 s volume was analyzed. Results The Tmax >6 s volume in the AHI > 15 group was significantly larger than that in the AHI ≤ 15 group [109 (62-157) vs. 59 (21-106) mL, p = 0.013]. Spearman's correlation analysis revealed Tmax >6 s volume was significantly correlated with AHI, mean SpO2, ODI, and T90% in the AHI > 15 group, however, no significant correlations were observed in the AHI ≤ 15 group. Controlling for the site of occlusion and Multiphase CT angiography (mCTA) score, AHI (β = 0.919, p < 0.001), mean SpO2 (β = -0.460, p = 0.031), ODI (β = 0.467, p = 0.032), and T90% (β =0.478, p = 0.026) remained associated with early hypoperfusion in the AHI > 15 group. Conclusion In patients with acute cerebral infarction and AHI > 15, AHI, mean SpO2, ODI and T90% were associated with early hypoperfusion. However, no such relationship exists among patients with AHI ≤ 15.
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Affiliation(s)
| | | | | | | | | | | | | | - Xianhui Wang
- Department of Neurology, First People’s Hospital of Taicang, Taicang City, Jiangsu Province, China
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Xu X, Zhou W, Wang Y, Wang Z, Zhang X, Zhang X, Tian S, Wu G. Enhanced external counterpulsation improves sleep quality in chronic insomnia: A pilot randomized controlled study. J Affect Disord 2024; 350:608-617. [PMID: 38218261 DOI: 10.1016/j.jad.2024.01.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/05/2023] [Accepted: 01/07/2024] [Indexed: 01/15/2024]
Abstract
PURPOSE To investigate the short-term efficacy of enhanced external counterpulsation (EECP) on chronic insomnia. METHODS This is a pilot randomized, participant-blind, and sham-controlled study. Forty-six participants with chronic insomnia were randomly assigned in a 1:1 ratio to receive EECP or sham EECP intervention (total of 35 sessions with 45 min each). The primary outcome was Pittsburgh Sleep Quality Index (PSQI). The secondary outcomes included sleep diary, Hospital Anxiety and Depression Scale (HADS), Short-Form Health Survey (SF12), flow mediated dilation (FMD), serum biomarkers of melatonin, cortisol, interleukin-6, and high sensitivity C-reactive protein. Outcomes were assessed after treatment and at 3-month follow-up. RESULTS The PSQI was significantly decreased in both EECP and sham groups after 35-session intervention (13.74 to 6.96 in EECP and 13.04 to 9.48 in sham), and EECP decreased PSQI more than sham EECP (p = 0.009). PSQI in two groups kept improved at 3-month follow-up. After treatment, the total sleep time, sleep efficiency, FMD value and SF12 mental component of EECP group were significantly improved, and group differences were found for these outcomes. At follow-up, total sleep time, sleep efficiency and SF12 mental component of EECP group remained improved, and group difference for SF12 mental component was found. Post-treatment and follow-up HADS-A significantly decreased in both groups, with no differences between groups. Post-treatment serum biomarkers showed no differences within and between groups. LIMITATION Lack of objective sleep measurement. CONCLUSION EECP could improve sleep quality and mental quality of life in chronic insomnia and the therapeutic effect maintained for 3 months.
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Affiliation(s)
- Xiuli Xu
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong 518033, China; Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Sun Yat-sen University, Shenzhen, Guangdong 518033, China; National Health Commission Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, Guangdong 528478, China
| | - Wenjuan Zhou
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong 518033, China
| | - Yinfen Wang
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong 518033, China
| | - Zhenyu Wang
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong 518033, China; Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Sun Yat-sen University, Shenzhen, Guangdong 518033, China; National Health Commission Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, Guangdong 528478, China
| | - Xiaocong Zhang
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong 518033, China; Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Sun Yat-sen University, Shenzhen, Guangdong 518033, China; National Health Commission Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, Guangdong 528478, China
| | - Xinxia Zhang
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong 518033, China; Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Sun Yat-sen University, Shenzhen, Guangdong 518033, China
| | - Shuai Tian
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong 518033, China; Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Sun Yat-sen University, Shenzhen, Guangdong 518033, China; National Health Commission Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, Guangdong 528478, China.
| | - Guifu Wu
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong 518033, China; Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Sun Yat-sen University, Shenzhen, Guangdong 518033, China; National Health Commission Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, Guangdong 528478, China.
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Wardlaw JM, Chabriat H, de Leeuw FE, Debette S, Dichgans M, Doubal F, Jokinen H, Katsanos AH, Ornello R, Pantoni L, Pasi M, Pavlovic AM, Rudilosso S, Schmidt R, Staals J, Taylor-Rowan M, Hussain S, Lindgren AG. European stroke organisation (ESO) guideline on cerebral small vessel disease, part 2, lacunar ischaemic stroke. Eur Stroke J 2024; 9:5-68. [PMID: 38380638 PMCID: PMC10916806 DOI: 10.1177/23969873231219416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/22/2023] [Indexed: 02/22/2024] Open
Abstract
A quarter of ischaemic strokes are lacunar subtype, typically neurologically mild, usually resulting from intrinsic cerebral small vessel pathology, with risk factor profiles and outcome rates differing from other stroke subtypes. This European Stroke Organisation (ESO) guideline provides evidence-based recommendations to assist with clinical decisions about management of lacunar ischaemic stroke to prevent adverse clinical outcomes. The guideline was developed according to ESO standard operating procedures and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. We addressed acute treatment (including progressive lacunar stroke) and secondary prevention in lacunar ischaemic stroke, and prioritised the interventions of thrombolysis, antiplatelet drugs, blood pressure lowering, lipid lowering, lifestyle, and other interventions and their potential effects on the clinical outcomes recurrent stroke, dependency, major adverse cardiovascular events, death, cognitive decline, mobility, gait, or mood disorders. We systematically reviewed the literature, assessed the evidence and where feasible formulated evidence-based recommendations, and expert concensus statements. We found little direct evidence, mostly of low quality. We recommend that patients with suspected acute lacunar ischaemic stroke receive intravenous alteplase, antiplatelet drugs and avoid blood pressure lowering according to current acute ischaemic stroke guidelines. For secondary prevention, we recommend single antiplatelet treatment long-term, blood pressure control, and lipid lowering according to current guidelines. We recommend smoking cessation, regular exercise, other healthy lifestyle modifications, and avoid obesity for general health benefits. We cannot make any recommendation concerning progressive stroke or other drugs. Large randomised controlled trials with clinically important endpoints, including cognitive endpoints, are a priority for lacunar ischaemic stroke.
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Affiliation(s)
- Joanna M Wardlaw
- Centre for Clinical Brain Sciences, UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Hugues Chabriat
- CNVT and Department of Neurology, Hopital Lariboisière, Paris, France
| | - Frank-Erik de Leeuw
- Department of Neurology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Stéphanie Debette
- Bordeaux Population Health Research Center; University of Bordeaux – Inserm U1219; Bordeaux; Department of Neurology, Institute for Neurodegenerative Diseases, Bordeaux University Hospital, Bordeaux, France
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Medical Center, Munich; Munich Cluster for Systems Neurology (SyNergy), Munich; German Center for Neurodegenerative Diseases (DZNE, Munich), Munich; German Centre for Cardiovascular Research (DZHK, Munich), Munich, Germany
| | - Fergus Doubal
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor’s Building, Edinburgh, UK
| | - Hanna Jokinen
- Neurocenter, Helsinki University Hospital and University of Helsinki, HUS, Helsinki, Finland
| | - Aristeidis H Katsanos
- Neurology, McMaster University & Population Health Research Institute, Hamilton, ON, Canada
| | - Raffaele Ornello
- Neurology/Department of Biotechnological ad Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | | | - Marco Pasi
- Department of Neurology, University of Tours, Tours, France
| | - Aleksandra M Pavlovic
- University of Belgrade, Faculty of Special Education and Rehabilitation, Belgrade, Serbia
| | - Salvatore Rudilosso
- Comprehensive Stroke Center, Department of Neurology, Hospital Clínic of Barcelona, Barcelona, Spain
| | | | - Julie Staals
- Department of Neurology and CARIM School for cardiovascular diseases, MUMC+, Maastricht, The Netherlands
| | - Martin Taylor-Rowan
- School of Health and Wellbeing; General Practice and Primary Care, Clarice Pears Building, University of Glasgow, Glasgow, UK
| | | | - Arne G Lindgren
- Department of Clinical Sciences Lund, Neurology, Lund University; Department of Neurology, Skåne University Hospital, Lund, Skånes Universitetssjukhus, Lund, Sweden
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6
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Sun B, Ma Q, Shen J, Meng Z, Xu J. Up-to-date advance in the relationship between OSA and stroke: a narrative review. Sleep Breath 2024; 28:53-60. [PMID: 37632670 DOI: 10.1007/s11325-023-02904-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/26/2023] [Accepted: 08/11/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE Obstructive sleep apnea (OSA) and stroke affect each other. In this review, we summarized the effect of OSA on the onset and recurrence of stroke, the prognosis, and the treatment of poststroke patients with OSA. METHODS Pubmed/MEDLINE were searched through May 2023 to explore the relationship between OSA and stroke. The relevant papers included OSA and stroke, OSA and recurrent stroke, and the prognosis and treatment of poststroke patients with OSA. RESULTS The results showed that OSA can promote the onset and recurrence of stroke and that OSA may adversely affect the prognosis of poststroke patients. The application of continuous positive airway pressure (CPAP) and other treatments may benefit poststroke patients with OSA, though the long term effects of treatment are not well documented. CONCLUSION Both the onset and recurrence of stroke closely correlated with OSA, but the specific mechanisms remain unclear. Further studies should be carried out to explore effective treatments in patients with stroke and OSA.
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Affiliation(s)
- Bo Sun
- Department of Respiratory and Critical Care Medicine, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, 6 Beijing Road West, Huaian, 223300, Jiangsu, China
| | - Qiyun Ma
- Department of Respiratory and Critical Care Medicine, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, 6 Beijing Road West, Huaian, 223300, Jiangsu, China
| | - Jiani Shen
- Department of Respiratory and Critical Care Medicine, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, 6 Beijing Road West, Huaian, 223300, Jiangsu, China
| | - Zili Meng
- Department of Respiratory and Critical Care Medicine, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, 6 Beijing Road West, Huaian, 223300, Jiangsu, China
| | - Jing Xu
- Department of Respiratory and Critical Care Medicine, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, 6 Beijing Road West, Huaian, 223300, Jiangsu, China.
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7
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de Oliveira Vaz L, Galvão AP, Nunes DLM, de Almeida JC, de Fátima Garcia Diniz J, Oliveira-Filho J. Effects of inspiratory muscle training on the severity of obstructive sleep apnea in individuals after stroke: a protocol for a randomized controlled trial. Sleep Breath 2023; 27:2257-2263. [PMID: 37103682 DOI: 10.1007/s11325-023-02825-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 03/12/2023] [Accepted: 04/03/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing in cerebrovascular diseases, requiring a multidisciplinary approach. There are few studies evaluating the effects of inspiratory muscle training (IMT) in individuals with OSA and the findings regarding the possible effect on apnea hypopnea index (AHI) reduction are controversial. OBJECTIVE This protocol for a randomized clinical trial will assess the effects of IMT on the severity of obstructive sleep apnea, sleep quality, and daytime sleepiness in individuals after stroke participating in a rehabilitation program. METHODS This study will be a randomized controlled trial with blinded assessors. Forty individuals after stroke will randomized to two groups. For 5 weeks, both groups will participate in the rehabilitation program activities, including aerobic exercise, resistance training, and educational class when they will receive guidance on the behavioral management of OSA. The experimental group will also perform high-intensity IMT 5 times a week, for 5 weeks, consisting initially of five sets of five repetitions achieving 75% of the maximal inspiratory pressure, increasing one set each week, totaling nine sets at the end of training. The primary outcome will be the severity of OSA measured as AHI at 5 weeks. Secondary outcomes will include sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI) and daytime sleepiness measured by Epworth Sleepiness Scale (ESS). Outcomes will be collected by a researcher blinded to group allocation at baseline (week 0), after intervention (week 5), and 1 month beyond intervention (week 9). TRIAL REGISTRATION Clinical Trials Register: NCT05135494.
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Affiliation(s)
- Lorena de Oliveira Vaz
- The SARAH Network of Rehabilitation Hospitals, Av Tancredo Neves 2782, Salvador, Bahia, 41820900, Brazil.
- Post-Graduation Program in Health Sciences, Federal University of Bahia, Salvador, Bahia, Brazil.
| | - Ana Paula Galvão
- The SARAH Network of Rehabilitation Hospitals, Av Tancredo Neves 2782, Salvador, Bahia, 41820900, Brazil
| | - Daniela Lino Macedo Nunes
- The SARAH Network of Rehabilitation Hospitals, Av Tancredo Neves 2782, Salvador, Bahia, 41820900, Brazil
| | | | | | - Jamary Oliveira-Filho
- Post-Graduation Program in Health Sciences, Federal University of Bahia, Salvador, Bahia, Brazil
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Riemann D, Espie CA, Altena E, Arnardottir ES, Baglioni C, Bassetti CLA, Bastien C, Berzina N, Bjorvatn B, Dikeos D, Dolenc Groselj L, Ellis JG, Garcia-Borreguero D, Geoffroy PA, Gjerstad M, Gonçalves M, Hertenstein E, Hoedlmoser K, Hion T, Holzinger B, Janku K, Jansson-Fröjmark M, Järnefelt H, Jernelöv S, Jennum PJ, Khachatryan S, Krone L, Kyle SD, Lancee J, Leger D, Lupusor A, Marques DR, Nissen C, Palagini L, Paunio T, Perogamvros L, Pevernagie D, Schabus M, Shochat T, Szentkiralyi A, Van Someren E, van Straten A, Wichniak A, Verbraecken J, Spiegelhalder K. The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023. J Sleep Res 2023; 32:e14035. [PMID: 38016484 DOI: 10.1111/jsr.14035] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 11/30/2023]
Abstract
Progress in the field of insomnia since 2017 necessitated this update of the European Insomnia Guideline. Recommendations for the diagnostic procedure for insomnia and its comorbidities are: clinical interview (encompassing sleep and medical history); the use of sleep questionnaires and diaries (and physical examination and additional measures where indicated) (A). Actigraphy is not recommended for the routine evaluation of insomnia (C), but may be useful for differential-diagnostic purposes (A). Polysomnography should be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep-related breathing disorders, etc.), treatment-resistant insomnia (A) and for other indications (B). Cognitive-behavioural therapy for insomnia is recommended as the first-line treatment for chronic insomnia in adults of any age (including patients with comorbidities), either applied in-person or digitally (A). When cognitive-behavioural therapy for insomnia is not sufficiently effective, a pharmacological intervention can be offered (A). Benzodiazepines (A), benzodiazepine receptor agonists (A), daridorexant (A) and low-dose sedating antidepressants (B) can be used for the short-term treatment of insomnia (≤ 4 weeks). Longer-term treatment with these substances may be initiated in some cases, considering advantages and disadvantages (B). Orexin receptor antagonists can be used for periods of up to 3 months or longer in some cases (A). Prolonged-release melatonin can be used for up to 3 months in patients ≥ 55 years (B). Antihistaminergic drugs, antipsychotics, fast-release melatonin, ramelteon and phytotherapeutics are not recommended for insomnia treatment (A). Light therapy and exercise interventions may be useful as adjunct therapies to cognitive-behavioural therapy for insomnia (B).
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Affiliation(s)
- Dieter Riemann
- Department of Clinical Psychology and Psychophysiology, Centre for Mental Health (Department), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Colin A Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience at the University of Oxford, Oxford, UK
| | | | - Erna Sif Arnardottir
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Reykjavik, Iceland
- Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Chiara Baglioni
- Human Sciences Department, University of Rome Guglielmo Marconi Rome, Rome, Italy
| | | | - Celyne Bastien
- École de Psychologie, Université Laval, Québec, Québec, Canada
| | | | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Dimitris Dikeos
- First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Leja Dolenc Groselj
- Institute of Clinical Neurophysiology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Jason G Ellis
- Northumbria Sleep Research Laboratory, Northumbria University, Newcastle, UK
| | | | | | | | | | - Elisabeth Hertenstein
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Kerstin Hoedlmoser
- Centre for Cognitive Neurosciences, University of Salzburg, Salzburg, Austria
| | - Tuuliki Hion
- East-Viru Central Hospital, Kohtla-Järve, Estonia
| | | | - Karolina Janku
- Center for Sleep and Chronobiology Research, National Institute of Mental Health, Klecany, Czech Republic
| | - Markus Jansson-Fröjmark
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden and Stockholm Health Care Services, Stockholm, Sweden
| | - Heli Järnefelt
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Susanna Jernelöv
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden and Stockholm Health Care Services, Stockholm, Sweden
| | - Poul Jørgen Jennum
- Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
| | - Samson Khachatryan
- Department of Neurology and Neurosurgery, Armenian National Institute of Health, Yerevan, Armenia
| | - Lukas Krone
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience at the University of Oxford, Oxford, UK
- Department of Neurology, Inselspital, University of Bern, Berne, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience at the University of Oxford, Oxford, UK
| | - Jaap Lancee
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Damien Leger
- Université Paris Cité, APHP, Hôtel Dieu de Paris, Centre du Sommeil et de la Vigilance, Paris, France
| | - Adrian Lupusor
- Functional Neurology, Institute of Neurology and Neurosurgery, Chisinau, Moldova
| | - Daniel Ruivo Marques
- Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
- CINEICC - Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Christoph Nissen
- Department of Psychiatry, University Hospital Geneve, Geneve, Switzerland
| | - Laura Palagini
- Psychiatry Unit, Department of Clinical and Experimental Medicine, School of Medicine, University of Pisa, Pisa, Italy
| | - Tiina Paunio
- Department of Psychiatry and SleepWell Research Program, Faculty of Medicine, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Dirk Pevernagie
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Manuel Schabus
- Centre for Cognitive Neurosciences, University of Salzburg, Salzburg, Austria
| | - Tamar Shochat
- The Cheryl Spencer Institute of Nursing Research, University of Haifa, Haifa, Israel
| | - Andras Szentkiralyi
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Eus Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
- Departments of Integrative Neurophysiology and Psychiatry, Center for Neurogenomics and Cognitive Research, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, The Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro- and Developmental Psychology & Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Adam Wichniak
- Sleep Medicine Center and Third Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Kai Spiegelhalder
- Department of Clinical Psychology and Psychophysiology, Centre for Mental Health (Department), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Marzouqah R, Dharmakulaseelan L, Colelli DR, Lindo CJ, Costa YS, Jairam T, Xiong K, Murray BJ, Chen JL, Thorpe K, Yunusova Y, Boulos MI. Strengthening oropharyngeal muscles as an approach to treat post-stroke obstructive sleep apnea: A feasibility randomised controlled trial. J Sleep Res 2023:e14086. [PMID: 37909249 DOI: 10.1111/jsr.14086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/13/2023] [Accepted: 10/15/2023] [Indexed: 11/02/2023]
Abstract
This study aimed to determine the feasibility of a randomised controlled trial (RCT) evaluating oropharyngeal exercise (OPE) intervention as an alternative therapy for obstructive sleep apnea (OSA) in patients with stroke or transient ischaemic attack (TIA). Despite the high prevalence of OSA in this population, the standard therapy, continuous positive airway pressure (CPAP), is often poorly tolerated. Thirty stroke/TIA patients with OSA unable to tolerate CPAP were randomly assigned to an oropharyngeal exercise or sham exercise protocol. They performed exercises for 6 weeks, 5 days per week, 30 minutes twice per day. Feasibility was ascertained by the proportion of enrolled patients who completed more than 80% of the OPE regimen. Isometric tongue pressures, apnea-hypopnea index (AHI), oxygen desaturation index (ODI), daytime sleepiness, and quality of life (QOL) outcomes were collected at baseline, post-training (6-week follow-up), and retention (10-week follow-up) to document preliminary efficacy. Adherence to study exercises was excellent, with 83% of participants completing more than 80% of the exercises. The isometric tongue pressures were observed to improve in the oropharyngeal exercise group (compared with the sham group), along with a decrease in OSA severity (measured by the AHI and ODI), reduced daytime sleepiness, and enhanced quality of life outcomes following the exercise programme. Only the effects on posterior isometric tongue pressure and daytime sleepiness remained significantly different between groups at the retention session. In conclusion, an RCT evaluating the efficacy of oropharyngeal exercises on post-stroke/TIA OSA is feasible and our preliminary results suggest a clinically meaningful effect.
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Affiliation(s)
- Reeman Marzouqah
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- University Health Network - KITE, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Laavanya Dharmakulaseelan
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - David R Colelli
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - C J Lindo
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Yakdehikandage S Costa
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Trevor Jairam
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Kathy Xiong
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Brian J Murray
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Joyce L Chen
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Yana Yunusova
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- University Health Network - KITE, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mark I Boulos
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
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Lim DC, Najafi A, Afifi L, Bassetti CLA, Buysse DJ, Han F, Högl B, Melaku YA, Morin CM, Pack AI, Poyares D, Somers VK, Eastwood PR, Zee PC, Jackson CL. The need to promote sleep health in public health agendas across the globe. Lancet Public Health 2023; 8:e820-e826. [PMID: 37777291 PMCID: PMC10664020 DOI: 10.1016/s2468-2667(23)00182-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 10/02/2023]
Abstract
Healthy sleep is essential for physical and mental health, and social wellbeing; however, across the globe, and particularly in developing countries, national public health agendas rarely consider sleep health. Sleep should be promoted as an essential pillar of health, equivalent to nutrition and physical activity. To improve sleep health across the globe, a focus on education and awareness, research, and targeted public health policies are needed. We recommend developing sleep health educational programmes and awareness campaigns; increasing, standardising, and centralising data on sleep quantity and quality in every country across the globe; and developing and implementing sleep health policies across sectors of society. Efforts are needed to ensure equity and inclusivity for all people, particularly those who are most socially and economically vulnerable, and historically excluded.
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Affiliation(s)
- Diane C Lim
- Miami Veterans Affairs Healthcare System, Miami, FL, USA; Division of Pulmonary, Critical Care and Sleep Medicine, University of Miami, Miami, FL, USA
| | - Arezu Najafi
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran; Sleep Breathing Disorders Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Lamia Afifi
- Clinical Neurophysiology Unit, School of Medicine, Cairo University Hospitals, Cairo, Egypt
| | | | - Daniel J Buysse
- Center for Sleep and Circadian Science, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Fang Han
- Department of Sleep Medicine, Peking University People's Hospital, Beijing, China
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Yohannes Adama Melaku
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Charles M Morin
- Department of Psychology, and CERVO Brain Research Center, Université Laval, Quebec City, QC, Canada
| | - Allan I Pack
- Sleep Division, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dalva Poyares
- Psychobiology Department, Sleep Medicine Division, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Peter R Eastwood
- Health Futures Institute, Murdoch University, Perth, WA, Australia
| | - Phyllis C Zee
- Division of Sleep Medicine, Center for Circadian and Sleep Medicine, Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Chandra L Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, US Department of Health and Human Services, Research Triangle Park, NC, USA; Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA.
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Baillieul S, Denis C, Barateau L, Arquizan C, Detante O, Pépin JL, Dauvilliers Y, Tamisier R. The multifaceted aspects of sleep and sleep-wake disorders following stroke. Rev Neurol (Paris) 2023; 179:782-792. [PMID: 37612191 DOI: 10.1016/j.neurol.2023.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/25/2023]
Abstract
Sleep-wake disorders (SWD) are acknowledged risk factors for both ischemic stroke and poor cardiovascular and functional outcome after stroke. SWD are frequent following stroke, with sleep apnea (SA) being the most frequent SWD affecting more than half of stroke survivors. While sleep disturbances and SWD are frequently reported in the acute phase, they may persist in the chronic phase after an ischemic stroke. Despite the frequency and risk associated with SWD following stroke, screening for SWD remains rare in the clinical setting, due to challenges in the assessment of post-stroke SWD, uncertainty regarding the optimal timing for their diagnosis, and a lack of clear treatment guidelines (i.e., when to treat and the optimal treatment strategy). However, little evidence support the feasibility of SWD treatment even in the acute phase of stroke and its favorable effect on long-term cardiovascular and functional outcomes. Thus, sleep health recommendations and SWD treatment should be systematically embedded in secondary stroke prevention strategy. We therefore propose that the management of SWD associated with stroke should rely on a multidisciplinary approach, with an integrated diagnostic, treatment, and follow-up strategy. The challenges in the field are to improve post-stroke SWD diagnosis, prognosis and treatment, through a better appraisal of their pathophysiology and temporal evolution.
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Affiliation(s)
- S Baillieul
- Université Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, 38000 Grenoble, France.
| | - C Denis
- National Reference Centre for Orphan Diseases Narcolepsy Rare Hypersomnias, Sleep Disorders Unit, Department of Neurology, CHU de Montpellier, University of Montpellier, Montpellier, France
| | - L Barateau
- National Reference Centre for Orphan Diseases Narcolepsy Rare Hypersomnias, Sleep Disorders Unit, Department of Neurology, CHU de Montpellier, University of Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier (INM), University of Montpellier, Inserm, Montpellier, France
| | - C Arquizan
- Department of Neurology, Hôpital Gui-de-Chauliac, Montpellier, France; Inserm U1266, Paris, France
| | - O Detante
- Neurology Department, Grenoble Alpes University Hospital, Grenoble, France
| | - J-L Pépin
- Université Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, 38000 Grenoble, France
| | - Y Dauvilliers
- National Reference Centre for Orphan Diseases Narcolepsy Rare Hypersomnias, Sleep Disorders Unit, Department of Neurology, CHU de Montpellier, University of Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier (INM), University of Montpellier, Inserm, Montpellier, France
| | - R Tamisier
- Université Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, 38000 Grenoble, France
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Ottavi TP, Pepper E, Bateman G, Fiorentino M, Brodtmann A. Consensus statement for the management of incidentally found brain white matter hyperintensities in general medical practice. Med J Aust 2023; 219:278-284. [PMID: 37604652 DOI: 10.5694/mja2.52079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 06/09/2023] [Accepted: 06/30/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION There is a paradigm shift in our understanding of white matter hyperintensities (WMH) found on brain imaging. They were once thought to be a normal phenomenon of ageing and, therefore, warranted no further investigation. However, evidence now suggests these lesions are markers of poor brain and cardiovascular health, portending an increased risk of stroke, cognitive decline, depression and death. Nevertheless, no specific guidelines exist for the management of incidentally found WMH for general medical practitioners and other clinicians ordering brain magnetic resonance imaging scans for diverse clinical indications. Informed by a literature review and expert opinion gleaned from stroke neurologists, medical and imaging specialists, and general practitioners, we present our consensus statement to guide the management of incidentally found WMH in adults. MAIN RECOMMENDATIONS When incidental WMH are found on brain imaging: Perform a detailed history and examination to screen for neurological events. Investigate for potential undiagnosed or undertreated cardiovascular risk factors, especially hypertension and diabetes mellitus. Commence intensive and individualised cardiovascular risk management when risk factors are uncovered. Treat underlying risk factors via accepted guidelines but note that antiplatelet and anticoagulant medications should not be prescribed for incidental WMH in the absence of an alternative indication. CHANGES TO MANAGEMENT AS A RESULT OF THIS CONSENSUS STATEMENT A brain health opportunity. We consider the discovery of incidental WMH on brain imaging to represent an opportunity to investigate for common cardiovascular risk factors and to optimise brain health. This can be commenced and monitored by the general practitioner or physician without delay in waiting for an outpatient neurology review.
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Plomaritis P, Theodorou A, Michalaki V, Stefanou MI, Palaiodimou L, Papagiannopoulou G, Kotsali-Peteinelli V, Bregianni M, Andreadou E, Paraskevas GP, Giannopoulos S, Tsivgoulis G, Bonakis A. Periodic Limb Movements during Sleep in Acute Stroke: Prevalence, Severity and Impact on Post-Stroke Recovery. J Clin Med 2023; 12:5881. [PMID: 37762823 PMCID: PMC10531709 DOI: 10.3390/jcm12185881] [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: 08/03/2023] [Revised: 08/25/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Periodic Limb Movements during Sleep (PLMS) have been described to be frequently present in stroke patients. We aimed to evaluate the prevalence and severity of PLMS in acute stroke patients and clarify the association between PLMS and coexisting Sleep Disordered Breathing (SDB). Additionally, we focused on identifying variables that could independently predict the presence of PLMS in patients with acute stroke. The potential impact of PLMS on stroke outcome at three months was investigated as well. METHODS In this study, we performed overnight polysomnography on consecutive stroke patients within 72 h from symptom onset. Data regarding clinical and imaging characteristics were prospectively collected. National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) and Epworth-Sleepiness Scale (ESS) were used to evaluate stroke severity on admission, stroke outcome at three months and history of daytime sleepiness, respectively. We documented PLMS and SDB using standard polysomnography criteria. RESULTS We prospectively assessed 126 patients with acute stroke [109 with ischemic and 17 with hemorrhagic stroke, mean age 60 ± 11 years, 68% men, median NIHSS score on admission: 3 (IQR: 2-7)]. The overall rate of PLMS in our cohort was 76%, and the rate of SDB among patients with PLMS was 83%. PLMS detection rates differed significantly (p-value: <0.001) according to SDB, with PLMS prevalence increasing with greater SDB severity. SDB could independently (OR:4.869, 95% CI: 1.884-12.784, p-value: 0.001) predict the presence of PLMS in the acute stroke phase in multivariable analyses adjusting for potential confounders. Moreover, baseline stroke severity (NIHSS-score increase in per-1 point: OR: 0.819, 95% CI: 0.737-0.895, p-value < 0.001) and PLMS (OR:0.099, 95% CI: 0.009-0.482, p-value = 0.015) were significantly associated with the likelihood of excellent functional outcome (mRS-scores: 0-1) at 3 months. CONCLUSION The common presence of mostly severe PLMS in patients with acute stroke and their negative effect on stroke outcomes point out the necessity for early PLMS detection and treatment.
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Affiliation(s)
- Panagiotis Plomaritis
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Chaidari, Greece; (P.P.); (A.T.); (V.M.); (M.-I.S.); (L.P.); (G.P.); (V.K.-P.); (M.B.); (G.P.P.); (S.G.); (G.T.)
| | - Aikaterini Theodorou
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Chaidari, Greece; (P.P.); (A.T.); (V.M.); (M.-I.S.); (L.P.); (G.P.); (V.K.-P.); (M.B.); (G.P.P.); (S.G.); (G.T.)
| | - Vasiliki Michalaki
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Chaidari, Greece; (P.P.); (A.T.); (V.M.); (M.-I.S.); (L.P.); (G.P.); (V.K.-P.); (M.B.); (G.P.P.); (S.G.); (G.T.)
| | - Maria-Ioanna Stefanou
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Chaidari, Greece; (P.P.); (A.T.); (V.M.); (M.-I.S.); (L.P.); (G.P.); (V.K.-P.); (M.B.); (G.P.P.); (S.G.); (G.T.)
| | - Lina Palaiodimou
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Chaidari, Greece; (P.P.); (A.T.); (V.M.); (M.-I.S.); (L.P.); (G.P.); (V.K.-P.); (M.B.); (G.P.P.); (S.G.); (G.T.)
| | - Georgia Papagiannopoulou
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Chaidari, Greece; (P.P.); (A.T.); (V.M.); (M.-I.S.); (L.P.); (G.P.); (V.K.-P.); (M.B.); (G.P.P.); (S.G.); (G.T.)
| | - Vasiliki Kotsali-Peteinelli
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Chaidari, Greece; (P.P.); (A.T.); (V.M.); (M.-I.S.); (L.P.); (G.P.); (V.K.-P.); (M.B.); (G.P.P.); (S.G.); (G.T.)
| | - Marianna Bregianni
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Chaidari, Greece; (P.P.); (A.T.); (V.M.); (M.-I.S.); (L.P.); (G.P.); (V.K.-P.); (M.B.); (G.P.P.); (S.G.); (G.T.)
| | - Elissavet Andreadou
- First Department of Neurology, “Eginition” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Georgios P. Paraskevas
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Chaidari, Greece; (P.P.); (A.T.); (V.M.); (M.-I.S.); (L.P.); (G.P.); (V.K.-P.); (M.B.); (G.P.P.); (S.G.); (G.T.)
| | - Sotirios Giannopoulos
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Chaidari, Greece; (P.P.); (A.T.); (V.M.); (M.-I.S.); (L.P.); (G.P.); (V.K.-P.); (M.B.); (G.P.P.); (S.G.); (G.T.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Chaidari, Greece; (P.P.); (A.T.); (V.M.); (M.-I.S.); (L.P.); (G.P.); (V.K.-P.); (M.B.); (G.P.P.); (S.G.); (G.T.)
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Anastasios Bonakis
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Chaidari, Greece; (P.P.); (A.T.); (V.M.); (M.-I.S.); (L.P.); (G.P.); (V.K.-P.); (M.B.); (G.P.P.); (S.G.); (G.T.)
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14
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Frange C, Elias RM, Siengsukon C, Coelho FMS. Physical activity for obstructive sleep apnea after stroke? A pilot study assessing the contribution of body fluids. Sleep Breath 2023; 27:1343-1350. [PMID: 36327028 DOI: 10.1007/s11325-022-02735-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/10/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) and physical inactivity are common after stroke. Physical inactivity can lead to/or exacerbate edema following stroke, and the resultant overnight fluid shift may increase the risk of OSA. We aimed to investigate the effect of physical activity on nocturnal rostral fluid shift, sleep pattern, and edematous state of hemiparetic patients. METHODS Neck circumference (tape measured) and arms, legs, and trunk fluid volume (bioelectrical impedance spectrum analyzer) were measured before and after 2 polysomnography (PSG) examinations. In the lab, a whole night PSG was performed after the intervention. The intervention consisted of inactivity (lying down and sitting) or activity (standing, performing calf muscle contractions while standing, walking, and climbing stairs) between 13 and 21 h, after the randomization of the participants. With a 7-day interval, participants crossed over to the other group. RESULTS From 126 eligible participants, 8 with hemiparetic post-first-ever ischemic stroke at the subacute phase were recruited (age: 53.2 ± 16.2; 6 women). Physical activity reduced AHI from 19 to 13 n°/h and wake after sleep onset from 76.5 to 60.3 min and increased fluid volume of paretic and non-paretic arms and trunk before sleep compared to inactivity. CONCLUSION An acute bout of physical activity reduced OSA classification based on AHI (from moderate to mild) and sleep fragmentation. Our results provide preliminary evidence of a possible link between physical activity in patients after stroke as an intervention to counteract OSA severity and improve sleep.
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Affiliation(s)
- Cristina Frange
- Neurology and Neurosurgery Department, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
| | - Rosilene Motta Elias
- Nephrology Division, Department of Medicine of the Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Catherine Siengsukon
- Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kanasas, USA
| | - Fernando Morgadinho Santos Coelho
- Neurology and Neurosurgery Department, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
- Psychobiolgy Department, UNIFESP, São Paulo, Brazil
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Fisker FY, Udholm N, Fuglsang M, Lundbye-Christensen S, Marshall NS, Bille J, Nyboe C, Udholm S. Risk of permanent social security benefits and overview of work participation among patients with obstructive sleep apnea. Sleep Med 2023; 108:16-21. [PMID: 37307696 DOI: 10.1016/j.sleep.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/09/2023] [Accepted: 05/14/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND In this nationwide study, we used Danish population registries to estimate the excess risk of receiving permanent social security benefits for patients with obstructive sleep apnea (OSA) and to track their labour force participation. METHODS We identified all Danish citizens receiving a diagnosis of OSA between 1995 and 2015. As a reference cohort, we randomly selected 10 citizens for each patient, matched by sex and birth year. Using the Fine and Gray competing risk regression, we estimated the cumulative incidences of receiving permanent social security benefits. Cox proportional hazard models were used to compare the risk of receiving permanent social security benefits in patients with OSA compared to the reference cohort. The Danish Rational Economic Agents' Model (DREAM) database was used to identify the labour market status prior to diagnosis, at time of diagnosis, and after diagnosis. RESULTS We identified 48,168 patients with OSA. A total of 12,413 (25.8%) patients with OSA had received permanent social security benefits, compared with 75,812 (15.7%) individuals in the reference cohort. Patients with OSA had a significantly increased risk of receiving permanent social security benefits when compared with the reference cohort (hazard ratio, 1.95; 95% CI, 1.88-2.02; and subhazard ratio, 1.92; 95% CI, 1.85-1.98). Work participation was lower for OSA patients compared to references at all time-points. CONCLUSION Patients with OSA have a moderately increased risk of receiving permanent social security benefits in Denmark after controlling for available confounders.
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Affiliation(s)
- Filip Yang Fisker
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Nichlas Udholm
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Milos Fuglsang
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Nathaniel S Marshall
- The Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute for Medical Research, Sydney, Australia
| | - Jesper Bille
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Camilla Nyboe
- Department of Cardiothoracic and Vascular Surgery, Anaesthesia Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Sebastian Udholm
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark.
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16
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Huang X, Xiong Y, Jiang S, Tang L, Lin X, Fang X, Shi Y, Lan W, Xie Y, Peng T. Chaihu Longgu Muli Decoction for post-stroke insomnia: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e33376. [PMID: 37058036 PMCID: PMC10101286 DOI: 10.1097/md.0000000000033376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Poststroke insomnia (PSI) is a frequent complication of stroke usually as a comorbidity of poststroke depression and mainly occurs within the first 6 months after stroke.[1] Addressing PSI to improve stroke prognosis is of great value. Herbal medicine like Chaihu Longgu Muli Decoction (CLMD), which is commonly considered to be a good treatment for depression and epilepsy, has the therapeutic potential on PSI; however, insufficient systematic reviews were conducted to testify its efficacy. Therefore, the objective of this paper is to provide reliable evidence of the efficacy and safety of CLMD on PSI and a foundation for further investigation. METHODS The literature of clinical randomized controlled trials (RCTs) regarding CLMD for PSI published before June of 2021 will be retrieved in the databases, and 2 investigators will be asked to collect and crosscheck the data independently. For the including studies, the quality evaluation on methodology will be assessed in the light of the Cochrane Handbook for Systematic Review of Interventions V.5.1.0 as well as the quality of evidence will be evaluated by the Grading of Recommendations Assessment, Development, and Evaluation. Besides, the assessment of heterogeneity and reporting bias, the sensitivity analysis and the subgroup analysis will be conducted. Stata 15 will be applied to analyze the above data. RESULTS The review will conduct a high-quality synthesis on present evidence of CLMD for PSI. CONCLUSION The conclusion of the study will indicate whether CLMD is effective and safe for PSI.
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Affiliation(s)
- Xuedi Huang
- Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Jiangxi, China
| | - Yue Xiong
- Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Jiangxi, China
| | - Sichen Jiang
- Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Jiangxi, China
| | - Lihua Tang
- Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Jiangxi, China
| | - Xingzhen Lin
- Nanchang Hongdu Hospital of Traditional Chinese Medicine, Jiangxi, China
| | - Xinyue Fang
- Guangzhou University of Chinese Medicine, Jiangxi, China
| | - Yuzhen Shi
- Guangzhou University of Chinese Medicine, Jiangxi, China
| | - Wanning Lan
- Guangzhou University of Chinese Medicine, Jiangxi, China
| | - Yaying Xie
- Guangzhou University of Chinese Medicine, Jiangxi, China
| | - Tianzhong Peng
- Nanchang Hongdu Hospital of Traditional Chinese Medicine, Jiangxi, China
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17
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Sleep-Disordered Breathing in Acute Stroke: A Single-Center, Prospective, Longitudinal Study. J Clin Med 2023; 12:jcm12030986. [PMID: 36769634 PMCID: PMC9917629 DOI: 10.3390/jcm12030986] [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: 12/30/2022] [Revised: 01/21/2023] [Accepted: 01/24/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Sleep-disordered breathing (SDB) is common among acute stroke patients. We sought to investigate the prevalence, severity and type of SDB in consecutive acute stroke patients. Moreover, we aimed to identify independent predictors of SDB in the acute stroke setting and investigate potential associations between SDB and functional outcomes at three months. METHODS We prospectively studied consecutive acute stroke patients, who underwent overnight polysomnography within 72 h from symptom onset. Demographics, clinical and imaging characteristics were documented. Daytime sleepiness preceding the stroke, stroke severity on admission and functional outcome at three months were evaluated using the Epworth-Sleepiness Scale (ESS), National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS), respectively. SDB was documented using standard polysomnography criteria. RESULTS A total of 130 consecutive acute stroke patients were prospectively evaluated [110 with ischemic stroke and 20 with intracerebral hemorrhage, mean age 60.5 ± 10.9 years, 77% men, median NIHSS score on admission: 3 (IQR: 2-17)]. The rate of SDB detection on polysomnography recordings was 79% (95% CI: 71-86). Three variables were independently associated with the likelihood of SDB detection in multivariable analyses adjusting for potential confounders: age (OR per 10-year-increase: 2.318, 95% CI: 1.327-4.391, p = 0.005), male sex (OR: 7.901, 95% CI: 2.349-30.855, p = 0.001) and abnormal ESS-score (OR: 6.064, 95% CI: 1.560-32.283, p = 0.017). Among patients with SDB, congestive heart failure was independently associated with the likelihood of central apnea detection (OR: 18.295, 95% CI: 4.464-19.105, p < 0.001). Among all patients, increasing NIHSS score on admission (OR: 0.817, 95% CI: 0.737-0.891, p < 0.001) and Apnea-Hypopnea Index (OR: 0.979, 95% CI: 0.962-0.996, p = 0.020) emerged as independent predictors of excellent functional outcome at 3 months (mRS-scores 0-1). CONCLUSION The high prevalence and severity of SDB in acute stroke patients and its negative impact on functional outcome indicate the importance of polysomnography implementation in everyday clinical practice of acute stroke work-up and management.
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18
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Frequency and evolution of sleep-wake disturbances after ischemic stroke: A 2-year prospective study of 437 patients. Sleep Med 2023; 101:244-251. [PMID: 36446142 DOI: 10.1016/j.sleep.2022.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/30/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In the absence of systematic and longitudinal data, this study prospectively assessed both frequency and evolution of sleep-wake disturbances (SWD) after stroke. METHODS In 437 consecutively recruited patients with ischemic stroke or transient ischemic attack (TIA), stroke characteristics and outcome were assessed within the 1st week and 3.2 ± 0.3 years (M±SD) after the acute event. SWD were assessed by interview and questionnaires at 1 and 3 months as well as 1 and 2 years after the acute event. Sleep disordered breathing (SDB) was assessed by respirography in the acute phase and repeated in one fifth of the participants 3 months and 1 year later. RESULTS Patients (63.8% male, 87% ischemic stroke and mean age 65.1 ± 13.0 years) presented with mean NIHSS-score of 3.5 ± 4.5 at admission. In the acute phase, respiratory event index was >15/h in 34% and >30/h in 15% of patients. Over the entire observation period, the frequencies of excessive daytime sleepiness (EDS), fatigue and insomnia varied between 10-14%, 22-28% and 20-28%, respectively. Mean insomnia and EDS scores decreased from acute to chronic stroke, whereas restless legs syndrome (RLS) percentages (6-9%) and mean fatigue scores remained similar. Mean self-reported sleep duration was enhanced at acute stroke (month 1: 07:54 ± 01:27h) and decreased at chronic stage (year 2: 07:43 ± 01:20h). CONCLUSIONS This study documents a high frequency of SDB, insomnia, fatigue and a prolonged sleep duration after stroke/TIA, which can persist for years. Considering the negative effects of SWD on physical, brain and mental health these data suggest the need for a systematic assessment and management of post-stroke SWD.
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19
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Pajediene E, Paulekas E, Salteniene V, Skieceviciene J, Arstikyte J, Petrikonis K, Kupcinskas J, Bassetti CL, Daiva R. Diurnal variation of clock genes expression and other sleep-wake rhythm biomarkers among acute ischemic stroke patients. Sleep Med 2022; 99:1-10. [DOI: 10.1016/j.sleep.2022.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 10/31/2022]
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20
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Liu X, Lam DCL, Mak HKF, Ip MSM, Lau KK. Associations of sleep apnea risk and oxygen desaturation indices with cerebral small vessel disease burden in patients with stroke. Front Neurol 2022; 13:956208. [PMID: 36090876 PMCID: PMC9452809 DOI: 10.3389/fneur.2022.956208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/22/2022] [Indexed: 11/27/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) is associated with cerebral small vessel disease (CSVD). Nonetheless, whether OSA-risk determined by a simple screening questionnaire or indices quantifying nocturnal hypoxemia other than the conventional apnea–hypopnea index (AHI) by the home sleep apnea test (HSAT) associated with CSVD burden remains uncertain. Methods From 2018 to 2021, we recruited patients with transient ischemic attack (TIA)/minor stroke from the Queen Mary Hospital Acute Stroke Unit and TIA/Stroke Outpatient Clinics. Logistic regression models were applied to determine the association of baseline OSA-risk (on STOP-BANG questionnaire) or HSAT-derived indices quantifying nocturnal hypoxemia with global burden/individual markers of CSVD on MRI. Indices included oxygen desaturation (≥3%) index (ODI), minimum oxygen saturation (SpO2), percentage of total sleep time with an oxygen saturation <90% (CT90%), and desaturation duration (≥3%, DesDur). Results In 283 patients with TIA/minor stroke (mean age 65 years, 64% men), OSA-risk was significantly associated with total CSVD score (multivariate-adjusted odds ratio: 1.23, 95% confidence interval 1.01–1.51), presence of lacunes [1.39 (1.09–1.79)] and burden of basal ganglia PVSs [1.32 (1.06–1.67)]. In 85/283 patients who completed HSAT, neither AHI, minimum SpO2 nor CT90% was associated with CSVD burden. Nonetheless, ODI and DesDur remained significantly associated with total CSVD score after covariate adjustment: ODI [1.04 (1.01–1.07)] and DesDur [1.04 (1.01–1.08)]. Conclusion In patients with TIA/minor stroke, high OSA-risk was associated with a greater CSVD burden. Oxygen desaturation indices (ODI and DesDur) rather than AHI were independently associated with global CSVD burden, indicating that longer and more severe desaturations may contribute to the pathogenesis of CSVD.
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Affiliation(s)
- Xiaodi Liu
- Division of Neurology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - David Chi-Leung Lam
- Division of Respiratory Medicine, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Henry Ka-Fung Mak
- Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Mary Sau-Man Ip
- Division of Respiratory Medicine, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- *Correspondence: Mary Sau-Man Ip
| | - Kui Kai Lau
- Division of Neurology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Kui Kai Lau
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21
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Gleeson M, McNicholas WT. Bidirectional relationships of comorbidity with obstructive sleep apnoea. Eur Respir Rev 2022; 31:31/164/210256. [PMID: 35508332 PMCID: PMC9488957 DOI: 10.1183/16000617.0256-2021] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/07/2022] [Indexed: 11/26/2022] Open
Abstract
Obstructive sleep apnoea (OSA) is frequently associated with comorbidities that include metabolic, cardiovascular, renal, pulmonary and neuropsychiatric. There is considerable evidence that OSA is an independent risk factor for many of these comorbidities but, more recently, there is evidence that some of these comorbidities may predispose to the development of OSA. Thus, there is growing evidence of a bidirectional relationship between OSA and comorbidity, especially for heart failure, metabolic syndrome and stroke. Potential mechanisms of bidirectional relationships differ in individual comorbidities with fluid retention and redistribution being especially important in heart failure and end-stage renal disease, whereas neural mechanisms may be more important in diabetes mellitus and stroke. The evidence for other comorbidities, such as hypertension and atrial fibrillation, support these being more a consequence of OSA with limited evidence to support a bidirectional relationship. The present review explores the evidence for such bidirectional relationships with a particular perspective on comorbidities that may predispose to OSA. The impact of therapy in bidirectional relationships is also reviewed, which highlights the clinical importance of accurate diagnosis. This aspect is especially true of COPD, where the identification of co-existing OSA has important implications for optimum therapy. Obstructive sleep apnoea (OSA) is an independent risk factor for comorbidity, especially cardiometabolic. However, some comorbidities may be risk factors for OSA, supporting a bidirectional relationship that may have important implications for treatment.https://bit.ly/3BbJy6V
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Affiliation(s)
- Margaret Gleeson
- School of Medicine, University College Dublin, and Dept of Respiratory and Sleep Medicine, St. Vincent's Hospital Group, Dublin, Ireland
| | - Walter T McNicholas
- School of Medicine, University College Dublin, and Dept of Respiratory and Sleep Medicine, St. Vincent's Hospital Group, Dublin, Ireland
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22
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McNicholas WT, Pevernagie D. Obstructive sleep apnea: transition from pathophysiology to an integrative disease model. J Sleep Res 2022; 31:e13616. [PMID: 35609941 PMCID: PMC9539471 DOI: 10.1111/jsr.13616] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 12/12/2022]
Abstract
Obstructive sleep apnea (OSA) is characterised by recurring episodes of upper airway obstruction during sleep and the fundamental abnormality reflects the inability of the upper airway dilating muscles to withstand the negative forces generated within the upper airway during inspiration. Factors that result in narrowing of the oropharynx such as abnormal craniofacial anatomy, soft tissue accumulation in the neck, and rostral fluid shift in the recumbent position increase the collapsing forces within the airway. The counteracting forces of upper airway dilating muscles, especially the genioglossus, are negatively influenced by sleep onset, inadequacy of the genioglossus responsiveness, ventilatory instability, especially post arousal, and loop gain. OSA is frequently associated with comorbidities that include metabolic, cardiovascular, renal, pulmonary, and neuropsychiatric, and there is growing evidence of bidirectional relationships between OSA and comorbidity, especially for heart failure, metabolic syndrome, and stroke. A detailed understanding of the complex pathophysiology of OSA encourages the development of therapies targeted at pathophysiological endotypes and facilitates a move towards precision medicine as a potential alternative to continuous positive airway pressure therapy in selected patients.
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Affiliation(s)
- Walter T McNicholas
- Department of Respiratory and Sleep Medicine, St Vincent's Hospital Group, School of Medicine, University College Dublin, Dublin, Ireland
| | - Dirk Pevernagie
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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23
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Deboer T, Arnardóttir ES, Landolt H, Luppi PH, McNicholas WT, Pevernagie D, Plazzi G. The European Sleep Research Society – past, present and future. J Sleep Res 2022; 31:e13601. [PMID: 35430759 PMCID: PMC9539836 DOI: 10.1111/jsr.13601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 03/18/2022] [Indexed: 01/20/2023]
Abstract
It is 50 years ago, in 1972, that the founding conference of the European Sleep Research Society (ESRS) was organised in Basel. Since then the Society has had 13 presidents and a multitude of board members and has organised, among other things, another 24 congresses. At this 50th anniversary, as the 26th ESRS congress is approaching, we have summarised the history of the ESRS. In this review, we provide a background to show why the foundation of a European society was a logical step, and show how, in the course of the past 50 years, the Society changed and grew. We give special attention to some developments that occurred over the years and discuss where the ESRS stands now, and how we foresee its future.
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Affiliation(s)
- Tom Deboer
- Laboratory for Neurophysiology, Department of Cell and Chemical Biology Leiden University Medical Center Leiden the Netherlands
| | - Erna Sif Arnardóttir
- Reykjavik University Sleep Institute School of Technology Reykjavik University Reykjavik Iceland
| | - Hans‐Peter Landolt
- Institute of Pharmacology and Toxicology, University of Zürich Zürich Switzerland
- Sleep & Health Zürich University Center of Competence, University of Zürich Zürich Switzerland
| | - Pierre Hervé Luppi
- Team “SLEEP” Centre de Recherche en Neurosciences de Lyon (CRNL) UMR 5292 CNRS/U1028 INSERM and Université de Lyon Bron France
| | - Walter T. McNicholas
- School of Medicine University College Dublin, and Department of Respiratory and Sleep Medicine, St. Vincent's Hospital Group Dublin Ireland
| | - Dirk Pevernagie
- Department of Respiratory Medicine Ghent University Hospital Ghent Belgium
- Dept of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences Ghent University Ghent Belgium
| | - Giuseppe Plazzi
- Department of Biomedical Metabolic and Neural Sciences, University of Modena and Reggio Emilia Modena Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italy
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24
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[A long-term ischemic stroke risk score model in patients aged 60 years and older with obstructive sleep apnea: a multicenter prospective cohort study]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2022; 42:338-346. [PMID: 35426796 PMCID: PMC9010997 DOI: 10.12122/j.issn.1673-4254.2022.03.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To analyze the independent risk factors of long-term ischemic stroke and establish a nomogram for predicting the long-term risks in elderly patients with obstructive sleep apnea (OSA). METHODS This multicenter prospective cohort study was conducted from January, 2015 to October, 2017 among consecutive elderly patients (≥60 years) with newly diagnosed OSA without a history of cardio-cerebrovascular diseases and loss of important clinical indicators. The follow-up outcome was the occurrence of ischemic stroke. The baseline demographic and clinical data, sleep parameters, laboratory and ultrasound results were collected from all the patients, who were randomized into the modeling group (n=856) and validation group (n=258) at a 3∶1 ratio. LASSO regression was used for variable reduction and dimension screening, and the risk score prediction model of ischemic stroke was established based on Cox proportional hazard regression. RESULTS In the total of 1141 patients enrolled in this study, 58 (5.08%) patients experienced ischemic stroke during the median follow-up of 42 months (range 41-54 months). The cumulative incidence of ischemic stroke was 5.14% in the model group and 4.91% in the verification group (P < 0.05). Age (HR=3.44, 95% CI: 2.38- 7.77), fasting blood glucose (FPG) (HR=2.13, 95% CI: 1.22-3.72), internal diameter of the ascending aorta (HR=2.60, 95% CI: 1.0- 4.47), left atrial anteroposterior diameter (HR=1.98, 95% CI: 1.75-2.25) and minimum oxygen saturation (LSpO2) (HR=1.57, 95% CI: 1.20-1.93) were identified as independent risk factors for ischemic stroke (P < 0.05 or 0.01). A long-term ischemic stroke risk score model was constructed based the regression coefficient ratios of these 5 risk variables. Before and after the application of the Bootstrap method, the AUC of the cohort risk score model was 0.84 (95% CI: 0.78- 0.90) and 0.85 (95% CI: 0.78- 0.89) in the model group and was 0.83 (95% CI: 0.73-0.93) and 0.82 (95%CI: 0.72-0.90) in the verification group, respectively, suggesting a good prediction efficiency and high robustness of the model. At the best clinical cutoff point, the cumulative incidence of ischemic stroke was significantly higher in the high-risk group than in the low-risk group (P=0.021). CONCLUSION This model can help to identify high-risk OSA patients for early interventions of the risks of ischemic stroke associated with OSA.
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25
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Knisely K, Sanders CB, Edrissi C, Rathfoot C, Poupore N, Bailey-Taylor MJ, Stewart B, Nathaniel T. Retrospective analysis of comorbidities in stroke patients with a history of obstructive sleep apnea treated with thrombolytic therapy. JOURNAL OF VASCULAR NURSING 2022; 40:74-85. [DOI: 10.1016/j.jvn.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/22/2021] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
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26
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Goodwin AT, Karadoğan D, De Santis MM, Alsafadi HN, Hawthorne I, Bradicich M, Siciliano M, Şahin Duyar S, Targa A, Meszaros M, Fanaridis M, Gille T, Keir HR, Moor CC, Lichtblau M, Ubags ND, Cruz J. Highlights of the ERS Lung Science Conference and Sleep and Breathing Conference 2021 and the new ECMC members. Breathe (Sheff) 2022; 17:210080. [PMID: 35035550 PMCID: PMC8753630 DOI: 10.1183/20734735.0080-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/22/2021] [Indexed: 11/05/2022] Open
Abstract
This article provides a brief description of some of the most remarkable sessions of the @EuroRespSoc Lung Science Conference and the Sleep and Breathing Conference 2021 and presents the new incoming members of the ECMC (@EarlyCareerERS) https://bit.ly/2RSDP40.
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Affiliation(s)
- Amanda T Goodwin
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK.,These authors contributed equally
| | - Dilek Karadoğan
- Dept of Chest Diseases, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey.,These authors contributed equally
| | - Martina M De Santis
- Institute of Molecular Biotechnology of the Austrian Academy of Sciences (IMBA), Vienna BioCenter (VBC), Vienna, Austria.,These authors contributed equally
| | - Hani N Alsafadi
- Lung Bioengineering and Regeneration, Dept of Experimental Medical Sciences, Stem Cell Centre, Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden.,These authors contributed equally
| | - Ian Hawthorne
- Cellular Immunology Laboratory, Dept of Biology, Maynooth University, Maynooth, Ireland.,Kathleen Lonsdale Institute for Human Health Research, Maynooth University, Maynooth, Ireland.,These authors contributed equally
| | - Matteo Bradicich
- Dept of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland.,These authors contributed equally
| | - Matteo Siciliano
- IRCCS Fondazione Policlinico Universitario A Gemelli - Università Cattolica del Sacro Cuore, UOC Pneumologia, Rome, Italy.,These authors contributed equally
| | - Sezgi Şahin Duyar
- Pulmonology, University of Health Sciences Atatürk Chest Diseases and Thoracic Surgery Education and Research Hospital, Ankara, Turkey.,These authors contributed equally
| | - Adriano Targa
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain.,Diseases Network Research Centre on Respiratory Diseases (CIBERES), Madrid, Spain.,These authors contributed equally
| | - Martina Meszaros
- Dept of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, Zurich, Switzerland.,These authors contributed equally
| | - Michail Fanaridis
- Sleep Disorders Unit, Dept of Respiratory Medicine, Medical School, University of Crete, Heraklion, Greece.,These authors contributed equally
| | - Thomas Gille
- Inserm UMR 1272 "Hypoxia & the Lung", UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord (USPN), Bobigny, France.,Physiologie et Explorations Fonctionnelles, Hôpitaux Universitaires de Seine-Saint-Denis (HUPSSD) Avicenne/Jean Verdier/René Muret, Assistance Publique - Hôpitaux de Paris (AP-HP), Bobigny, France
| | - Holly R Keir
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital, Dundee, UK
| | - Catharina C Moor
- Dept of Respiratory Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Niki D Ubags
- Faculty of Biology and Medicine, University of Lausanne, Service de Pneumologie, CHUV, Epalinges, Switzerland
| | - Joana Cruz
- Center for Innovative Care and Health Technology (ciTechCare), School of Health Sciences (ESSLei), Polytechnic of Leiria, Leiria, Portugal
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27
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Fan XW, Yang Y, Wang S, Zhang YJ, Wang AX, Liao XL, Ma WG, Zhang N, Wang CX, Wang YJ. Impact of Persistent Poor Sleep Quality on Post-Stroke Anxiety and Depression: A National Prospective Clinical Registry Study. Nat Sci Sleep 2022; 14:1125-1135. [PMID: 35721879 PMCID: PMC9205438 DOI: 10.2147/nss.s357536] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/23/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The impact of poor sleep quality after stroke, especially persistent poor sleep quality, on poststroke anxiety and depression is unclear. We seek to investigate the impact of baseline and persistent poor sleep quality on short-term poststroke anxiety and depression. PATIENTS AND METHODS Data were analyzed for 1619 patients with acute ischemic stroke from the Impairment of Cognition and Sleep after Acute Ischemic Stroke or Transient Ischemic Attack in Chinese Patients study (ICONS). The sleep quality was assessed at 2 weeks and 3 months using the Pittsburgh Sleep Quality Index scale (PSQI). Poor sleep quality was defined as a PSQI score of >5, and persistent poor sleep quality was defined as a PSQI score of >5 at each time point. Patients were divided into three groups according to the quality of sleep: good sleep quality, baseline poor sleep quality and persistent poor sleep quality. Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 scale (GAD-7), and Modified Rankin Scale (mRS) at 3 months after stroke were taken as the study outcomes. RESULTS Persistent poor sleep quality was present in 70.2% of patients after stroke. Compared to those with good sleep quality, patients with baseline poor sleep quality did not show significant differences in disability, anxiety and depression. However, patients with persistent poor sleep were at increased risk of depression (odds ratio, OR 3.04, 95% confidence interval, CI 1.66-5.57, P < 0.01) and anxiety (OR 3.20, 95% CI 1.42-7.19, P < 0.01) at 3 months after stroke. Persistent poor sleep quality was not identified as a risk factor for functional disability at 3 months. CONCLUSION Patients with persistent poor sleep quality are at added risks for depression and anxiety after stroke.
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Affiliation(s)
- Xiao-Wei Fan
- Department of Neurology, Capital Medical University, Beijing, People's Republic of China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yang Yang
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Capital Medical University, Beijing, People's Republic of China
| | - Shuo Wang
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Capital Medical University, Beijing, People's Republic of China
| | - Yi-Jun Zhang
- Department of Neurology, Capital Medical University, Beijing, People's Republic of China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - An-Xin Wang
- Department of Neurology, Capital Medical University, Beijing, People's Republic of China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiao-Ling Liao
- Department of Neurology, Capital Medical University, Beijing, People's Republic of China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wei-Guo Ma
- Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ning Zhang
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Capital Medical University, Beijing, People's Republic of China
| | - Chun-Xue Wang
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Capital Medical University, Beijing, People's Republic of China.,Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, People's Republic of China
| | - Yong-Jun Wang
- Department of Neurology, Capital Medical University, Beijing, People's Republic of China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
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28
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Sleep and Stroke: Opening Our Eyes to Current Knowledge of a Key Relationship. Curr Neurol Neurosci Rep 2022; 22:767-779. [PMID: 36190654 PMCID: PMC9633474 DOI: 10.1007/s11910-022-01234-2] [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] [Accepted: 09/06/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW To elucidate the interconnection between sleep and stroke. RECENT FINDINGS Growing data support a bidirectional relationship between stroke and sleep. In particular, there is strong evidence that sleep-disordered breathing plays a pivotal role as risk factor and concur to worsening functional outcome. Conversely, for others sleep disorders (e.g., insomnia, restless legs syndrome, periodic limb movements of sleep, REM sleep behavior disorder), the evidence is weak. Moreover, sleep disturbances are highly prevalent also in chronic stroke and concur to worsening quality of life of patients. Promising novel technologies will probably allow, in a near future, to guarantee a screening of commonest sleep disturbances in a larger proportion of patients with stroke. Sleep assessment and management should enter in the routinary evaluation of stroke patients, of both acute and chronic phase. Future research should focus on the efficacy of specific sleep intervention as a therapeutic option for stroke patients.
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29
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Baillieul S, Dekkers M, Brill AK, Schmidt MH, Detante O, Pépin JL, Tamisier R, Bassetti CLA. Sleep apnoea and ischaemic stroke: current knowledge and future directions. Lancet Neurol 2021; 21:78-88. [PMID: 34942140 DOI: 10.1016/s1474-4422(21)00321-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/31/2021] [Accepted: 09/07/2021] [Indexed: 12/11/2022]
Abstract
Sleep apnoea, one of the most common chronic diseases, is a risk factor for ischaemic stroke, stroke recurrence, and poor functional recovery after stroke. More than half of stroke survivors present with sleep apnoea during the acute phase after stroke, with obstructive sleep apnoea being the most common subtype. Following a stroke, sleep apnoea frequency and severity might decrease over time, but moderate to severe sleep apnoea is nevertheless present in up to a third of patients in the chronic phase after an ischaemic stroke. Over the past few decades evidence suggests that treatment for sleep apnoea is feasible during the acute phase of stroke and might favourably affect recovery and long-term outcomes. Nevertheless, sleep apnoea still remains underdiagnosed and untreated in many cases, due to challenges in the detection and prediction of post-stroke sleep apnoea, uncertainty as to the optimal timing for its diagnosis, and a scarcity of clear treatment guidelines (ie, uncertainty on when to treat and the optimal treatment strategy). Moreover, the pathophysiology of sleep apnoea associated with stroke, the proportion of stroke survivors with obstructive and central sleep apnoea, and the temporal evolution of sleep apnoea subtypes following stroke remain to be clarified. To address these shortcomings, the management of sleep apnoea associated with stroke should be integrated into a multidisciplinary diagnostic, treatment, and follow-up strategy.
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Affiliation(s)
- Sébastien Baillieul
- Department of Neurology, Inselspital, University Hospital, Bern, Switzerland; Service Universitaire de Pneumologie Physiologie, Grenoble Alpes University Hospital, Grenoble, France; Inserm U1300, Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Martijn Dekkers
- Department of Neurology, Inselspital, University Hospital, Bern, Switzerland
| | - Anne-Kathrin Brill
- Department of Pulmonary Medicine, Inselspital, University Hospital, Bern, Switzerland
| | - Markus H Schmidt
- Department of Neurology, Inselspital, University Hospital, Bern, Switzerland; Ohio Sleep Medicine Institute, Dublin, OH, USA
| | - Olivier Detante
- Stroke Unit, Neurology Department, Grenoble Alpes University Hospital, Grenoble, France; Inserm U1216, Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Jean-Louis Pépin
- Service Universitaire de Pneumologie Physiologie, Grenoble Alpes University Hospital, Grenoble, France; Inserm U1300, Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Renaud Tamisier
- Service Universitaire de Pneumologie Physiologie, Grenoble Alpes University Hospital, Grenoble, France; Inserm U1300, Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France
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30
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Udholm N, Fuglsang M, Lundbye-Christensen S, Bille J, Udholm S. Obstructive Sleep Apnea and Risk of Suicide and Self-Harm: A Danish Nationwide Cohort Study. Sleep 2021; 45:6458465. [PMID: 34888700 DOI: 10.1093/sleep/zsab286] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/01/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES In this nationwide study, we used the unique Danish registries to estimate the risk of suicide and deliberate self-harm in patients with obstructive sleep apnea (OSA). METHODS We identified all Danish citizens receiving a diagnosis of OSA between 1995 and 2015. As a reference cohort, we randomly selected 10 citizens for each patient, matched by sex and birth year. Using the Fine and Gray competing risk regression, we estimated the cumulative incidences of suicide, and Cox proportional regression analysis was used to compare the risk of suicide and deliberate self-harm in patients with OSA with the reference cohort. RESULTS We identified 48,168 patients with OSA. A total of 135 patients had died by suicide, compared with 999 suicides in the reference cohort. Patients with OSA had an increased risk of dying by suicide when compared with the reference cohort (hazard ratio, 1.29; 95%CI, 1.07-1.55; and subhazard ratio, 1.23; 95%CI, 1.10-1.45). We identified 1,004 events of self-harm among patients with OSA, and 5,270 events in the reference group. The overall risk of self-harm was increased in patients with OSA when compared with the reference group (hazard ratio, 1.28; 95%CI, 1.19-1.37). CONCLUSION This is the first study to estimate the risk of suicide and deliberate self-harm in patients with OSA. We found that patients with OSA have an increased risk of both suicide and deliberate self-harm when compared with a large reference cohort, thereby highlighting the importance of a mental health screening in these patients.
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Affiliation(s)
- Nichlas Udholm
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Milos Fuglsang
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jesper Bille
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Sebastian Udholm
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
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31
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Schmidt MH, Dekkers MPJ, Baillieul S, Jendoubi J, Wulf MA, Wenz E, Fregolente L, Vorster A, Gnarra O, Bassetti CLA. Measuring Sleep, Wakefulness, and Circadian Functions in Neurologic Disorders. Sleep Med Clin 2021; 16:661-671. [PMID: 34711389 DOI: 10.1016/j.jsmc.2021.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Neurologic disorders impact the ability of the brain to regulate sleep, wake, and circadian functions, including state generation, components of state (such as rapid eye movement sleep muscle atonia, state transitions) and electroencephalographic microarchitecture. At its most extreme, extensive brain damage may even prevent differentiation of sleep stages from wakefulness (eg, status dissociatus). Given that comorbid sleep-wake-circadian disorders are common and can adversely impact the occurrence, evolution, and management of underlying neurologic conditions, new technologies for long-term monitoring of neurologic patients may potentially usher in new diagnostic strategies and optimization of clinical management.
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Affiliation(s)
- Markus H Schmidt
- Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Switzerland; Ohio Sleep Medicine Institute, 4975 Bradenton Avenue, Dublin, OH 43017, USA.
| | - Martijn P J Dekkers
- Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Switzerland
| | - Sébastien Baillieul
- Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Switzerland; Univ. Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, Grenoble 38000, France
| | - Jasmine Jendoubi
- Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Switzerland
| | - Marie-Angela Wulf
- Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Switzerland
| | - Elena Wenz
- Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Switzerland
| | - Livia Fregolente
- Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Switzerland
| | - Albrecht Vorster
- Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Switzerland
| | - Oriella Gnarra
- Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Switzerland; Sensory-Motor System Lab, IRIS, ETH Zurich, Switzerland
| | - Claudio L A Bassetti
- Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Switzerland; Department of Neurology, University of Sechenow, Moscow, Russia
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32
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Hao S, Zhong Z, Qu W, Huang Z, Sun F, Qiu M. Melatonin supplementation in the subacute phase after ischemia alleviates postischemic sleep disturbances in rats. Brain Behav 2021; 11:e2366. [PMID: 34520636 PMCID: PMC8553311 DOI: 10.1002/brb3.2366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Sleep disorders are highly prevalent among stroke survivors and impede stroke recovery. It is well established that melatonin has neuroprotective effects in animal models of ischemic stroke. However, as a modulator of endogenous physiological circadian rhythms, the effects of melatonin on poststroke sleep disorders remain unclear. In the present study, we investigated how melatonin delivered intraperitoneally once daily in the subacute phase after stroke onset, influencing neuronal survival, motor recovery, and sleep-wake profiles in rats. METHODS Transient ischemic stroke in male Sprague-Dawley rats was induced with 30 min occlusion of the middle cerebral artery. Melatonin or vehicle was delivered intraperitoneally once daily in the subacute phase, from 2 to 7 days after stroke. Electroencephalogram and electromyogram recordings were obtained simultaneously. RESULTS Compared to the effects observed in the vehicle-treated ischemic group, after 6 daily consecutive treatment of melatonin at 10 mg/kg starting at ischemic/reperfusion day 2, the infarct volume was significantly decreased (from 39.6 to 26.2%), and the degeneration of axons in the ipsilateral striatum and the contralateral corpus callosum were significantly alleviated. Sensorimotor performances were obviously improved as evidenced by significant increases in the latency to falling off the wire and in the use of the impaired forelimb. In addition to those predictable results of reducing brain tissue damage and mitigating behavioral deficits, repeated melatonin treatment during the subacute phase of stroke also alleviated sleep fragmentation through reducing sleep-wake stage transitions and stage bouts, together with increasing stage durations. Furthermore, daily administration of melatonin at 9 a.m. significantly increased the nonrapid eye movement sleep delta power during both the light and dark periods and decreased the degree of reduction of the circadian index. CONCLUSIONS Melatonin promptly reversed ischemia-induced sleep disturbances. The neuroprotective effects of melatonin on ischemic injury may be partially associated with its role in sleep modulation.
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Affiliation(s)
- Shu‐Mei Hao
- Department of NeurobiologyInstitute for Basic Research on Aging and MedicineSchool of Basic Medical ScienceFudan UniversityShanghaiChina
| | - Zhi‐Gang Zhong
- Department of NeurobiologyInstitute for Basic Research on Aging and MedicineSchool of Basic Medical ScienceFudan UniversityShanghaiChina
- Department of PharmacologySchool of Basic Medical ScienceState Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain ScienceFudan UniversityShanghaiChina
| | - Wei‐Min Qu
- Department of PharmacologySchool of Basic Medical ScienceState Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain ScienceFudan UniversityShanghaiChina
| | - Zhi‐Li Huang
- Department of PharmacologySchool of Basic Medical ScienceState Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain ScienceFudan UniversityShanghaiChina
| | - Feng‐Yan Sun
- Department of NeurobiologyInstitute for Basic Research on Aging and MedicineSchool of Basic Medical ScienceFudan UniversityShanghaiChina
| | - Mei‐Hong Qiu
- Department of NeurobiologyInstitute for Basic Research on Aging and MedicineSchool of Basic Medical ScienceFudan UniversityShanghaiChina
- Department of PharmacologySchool of Basic Medical ScienceState Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain ScienceFudan UniversityShanghaiChina
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33
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Avan A, Hachinski V. Brain health: Key to health, productivity, and well-being. Alzheimers Dement 2021; 18:1396-1407. [PMID: 34569702 DOI: 10.1002/alz.12478] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/11/2021] [Indexed: 12/25/2022]
Abstract
Brain health is essential for physical and mental health, social well-being, productivity, and creativity. Current neurological research focuses mainly on treating a diseased brain and preventing further deterioration rather than on developing and maintaining brain health. The pandemic has forced a shift toward virtual working environments that accelerated opportunities for transdisciplinary collaboration for fostering brain health among neurologists, psychiatrists, psychologists, neuro and socio-behavioral scientists, scholars in arts and humanities, policymakers, and citizens. This could shed light on the interconnectedness of physical, mental, environmental, and socioeconomic determinants of brain disease and health. We advocate making brain health the top priority worldwide, developing common measures and definitions to enhance research and policy, and finding the cause of the decline of incidence of stroke and dementia in some countries and then applying comprehensive customized cost-effective prevention solutions in actionable implementation units. Life cycle brain health offers the best single individual, communal, and global investment.
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Affiliation(s)
- Abolfazl Avan
- Department of Public Health, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vladimir Hachinski
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Robarts Research Institute, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
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- Department of Public Health, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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34
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Jaramillo V, Jendoubi J, Maric A, Mensen A, Heyse NC, Eberhard-Moscicka AK, Wiest R, Bassetti CLA, Huber R. Thalamic Influence on Slow Wave Slope Renormalization During Sleep. Ann Neurol 2021; 90:821-833. [PMID: 34516002 PMCID: PMC9291607 DOI: 10.1002/ana.26217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 09/08/2021] [Accepted: 09/11/2021] [Indexed: 02/01/2023]
Abstract
Objective Slow waves are thought to mediate an overall reduction in synaptic strength during sleep. The specific contribution of the thalamus to this so‐called synaptic renormalization is unknown. Thalamic stroke is associated with daytime sleepiness, along with changes to sleep electroencephalography and cognition, making it a unique “experiment of nature” to assess the relationship between sleep rhythms, synaptic renormalization, and daytime functions. Methods Sleep was studied by polysomnography and high‐density electroencephalography over 17 nights in patients with thalamic (n = 12) and 15 nights in patients with extrathalamic (n = 11) stroke. Sleep electroencephalographic overnight slow wave slope changes and their relationship with subjective daytime sleepiness, cognition, and other functional tests were assessed. Results Thalamic and extrathalamic patients did not differ in terms of age, sleep duration, or apnea–hypopnea index. Conversely, overnight slope changes were reduced in a large cluster of electrodes in thalamic compared to extrathalamic stroke patients. This reduction was related to increased daytime sleepiness. No significant differences were found in other functional tests between the 2 groups. Interpretation In patients with thalamic stroke, a reduction in overnight slow wave slope change and increased daytime sleepiness was found. Sleep‐ and wake‐centered mechanisms for this relationship are discussed. Overall, this study suggests a central role of the thalamus in synaptic renormalization. ANN NEUROL 2021;90:821–833
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Affiliation(s)
- Valeria Jaramillo
- Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich.,Child Development Center, University Children's Hospital Zurich, University of Zurich, Zurich
| | - Jasmine Jendoubi
- Sleep-Wake-Epilepsy Center, Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland.,Center for Experimental Neurology, Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Angelina Maric
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Armand Mensen
- Sleep-Wake-Epilepsy Center, Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland.,Center for Experimental Neurology, Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Natalie C Heyse
- Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich.,Child Development Center, University Children's Hospital Zurich, University of Zurich, Zurich
| | - Aleksandra K Eberhard-Moscicka
- Perception and Eye Movement Laboratory, Departments of Neurology and Biomedical Research, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Roland Wiest
- Department of Neuroradiology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Claudio L A Bassetti
- Sleep-Wake-Epilepsy Center, Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland.,Center for Experimental Neurology, Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Reto Huber
- Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich.,Child Development Center, University Children's Hospital Zurich, University of Zurich, Zurich.,Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich
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35
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Abstract
Es hat sich viel getan in der Welt der Schlafmedizin in der Kardiologie, weshalb eine vollwertige Überarbeitung des Positionspapiers „Schlafmedizin in der Kardiologie“ erforderlich wurde. In der aktuellen neuartigen Version finden sich nicht nur alle verfügbaren Studien, Literaturstellen und Updates zu Pathophysiologie, Diagnostik- und Therapieempfehlungen, sondern auch Ausblicke auf neue Entwicklungen und zukünftige Forschungserkenntnisse. Dieses überarbeitete Positionspapier gibt Empfehlungen für Diagnostik und Therapie von Patienten mit kardiovaskulären Erkrankungen mit schlafassoziierten Atmungsstörungen und erteilt darüber hinaus einen fundierten Überblick über verfügbare Therapien und Evidenzen, gibt aber ebenso Ratschläge wie mit Komorbiditäten umzugehen ist. Insbesondere enthält dieses überarbeitete Positionspapier aktualisierte Stellungnahmen zu schlafassoziierten Atmungsstörungen bei Patienten mit koronarer Herzerkrankung, Herzinsuffizienz, arterieller Hypertonie, aber auch für Patienten mit Vorhofflimmern. Darüber hinaus finden sich erstmals Empfehlungen zur Telemedizin als eigenes, neues Kapitel. Dieses Positionspapier bietet Kardiologen sowie Ärzten in der Behandlung von kardiovaskulären Patienten die Möglichkeit einer evidenzbasierten Behandlung der wachsend bedeutsamen und mit zunehmender Aufmerksamkeit behafteten Komorbidität schlafassoziierter Atmungsstörungen. Und nicht zuletzt besteht mit diesem neuen Positionspapier eine enge Verknüpfung mit dem neuen Curriculum Schlafmedizin der Deutschen Gesellschaft für Kardiologie, weshalb dieses Positionspapier eine Orientierung für die erworbenen Fähigkeiten des Curriculums im Umgang von kardiovaskulären Patienten mit schlafassoziierten Atmungsstörungen darstellt.
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36
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Haula TM, Puustinen J, Takala M, Holm A. Wake-up strokes are linked to obstructive sleep apnea and worse early functional outcome. Brain Behav 2021; 11:e2284. [PMID: 34291603 PMCID: PMC8413798 DOI: 10.1002/brb3.2284] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIMS Presence of sleep-disordered breathing (SDB) and especially obstructive sleep apnea (OSA) is a known risk factor for ischemic stroke. Additionally, SDB effects negatively on recovery after stroke. Up to one fourth of strokes are present on awakening. The link between OSA and wake-up stroke (WUS) has been suggested. We aim to determine the association between OSA and WUS in a Finnish stroke unit cohort. MATERIAL AND METHODS An observational prospective longitudinal study consisted of 95 TIA (transient ischemic attack) and mild to moderate stroke patients referred to a Stroke Unit in Finland. Respiratory polygraphy was performed within 72 h of hospital admission. Patients were classified into WUS and non-WUS, and functional outcome measures (mRS, rehabilitation, hospitalization time) were collected. Functional outcomes and prevalence of OSA were compared between non-WUS and WUS. RESULTS OSA (AHI > 15/h) was more frequent among WUS than non-WUS (71% and 36%, respectively, p = 0.009). Functional outcome measured with mRS was worse in patients with WUS than non-WUS on registration day and at hospital discharge (p = 0.001). Need for rehabilitation in WUS was 43% of cases compared to 23% of non-WUS (p = 0.067). Hospitalization time was longer (5-15days) in 55% of WUS and 41% of non-WUS patients (p = 0.261). CONCLUSION Moderate-to-severe OSA is related to WUS compared to non-WUS. In addition, WUS have worse short-term outcomes measured in mRS. Further studies are needed to determine if OSA is causally linked to WUS.
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Affiliation(s)
- Tuuli-Maria Haula
- Unit of Neurology, Satakunta Hospital District, Clinical Neurosciences, University of Turku, Pori, Finland
| | - Juha Puustinen
- Unit of Neurology, Satakunta Hospital District, Social Security Centre of Pori, City of Pori, Clinical Pharmacy Group, University of Helsinki, Pori, Finland
| | - Mari Takala
- Unit of Clinical Neurophysiology, Satakunta Hospital District, Pori, Finland
| | - Anu Holm
- Unit of Clinical Neurophysiology, Satakunta Hospital District, Faculty of Health and Welfare, Satakunta University of Applied Sciences, Pori, Finland
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37
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Abstract
Insomnia is an important but widely ignored health problem in modern society. Despite unequivocal evidence on its large prevalence, health and social impacts, comorbidities, and various pharmacologic and nonpharmacologic (behavioral and device-based) approaches, its effective management is still difficult and often incomplete. This article discusses the role of insomnia in modern societies, newer complicating factors, and its overall social and public health burden. Acute insomnia and sleep difficulties during pandemic and confinement are reviewed. The article also focuses on newer developments accumulating in the field of insomnia and possible future trends.
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Affiliation(s)
- Samson G Khachatryan
- Department of Neurology and Neurosurgery, National Institute of Health, Ministry of Health, Titogradyan 14, Yerevan 0087, Armenia; Sleep and Movement Disorders Center, Somnus Neurology Clinic, Titogradyan 14, Yerevan 0087, Armenia.
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38
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Tanayapong P, Kuna ST. Sleep disordered breathing as a cause and consequence of stroke: A review of pathophysiological and clinical relationships. Sleep Med Rev 2021; 59:101499. [PMID: 34020180 DOI: 10.1016/j.smrv.2021.101499] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/12/2021] [Accepted: 04/25/2021] [Indexed: 12/22/2022]
Abstract
Stroke is the leading cause of death and disability globally. Sleep disordered breathing (SDB), a potentially modifiable risk factor of stroke, is highly prevalent in stroke survivors. Evidence supports a causal, bidirectional relationship between SDB and stroke. SDB may increase the risk of stroke occurrence and recurrence, and worsen stroke outcome. While SDB is associated with an increased incidence of hypertension and cardiac arrhythmias, both of which are traditional stroke risk factors, SDB is also an independent risk factor for stroke. A number of characteristics of SDB may increase stroke risk, including intermittent hypoxemia, sympathetic activation, changes in cerebral autoregulation, oxidative stress, systemic inflammation, hypercoagulability, and endothelial dysfunction. On the other hand, stroke may also cause new SDB or aggravate preexisting SDB. Continuous positive airway pressure treatment of SDB may have a beneficial role in reducing stroke risk and improving neurological outcome after stroke. The treatment should be considered as early as possible, particularly when SDB is present post-stroke. The goal of this review is to highlight the strong link between SDB and stroke and to raise awareness for practitioners to consider the possibility of SDB being present in all stroke survivors.
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Affiliation(s)
- Pongsakorn Tanayapong
- Division of Neurology, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand; Neurology Center, Vibhavadi Hospital, Bangkok, Thailand.
| | - Samuel T Kuna
- Department of Medicine, Corporal Michael J. Crescenz VA, Medical Center, Philadelphia, PA, United States; Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Abstract
Sleep disorders, such as sleep-disordered breathing (SDB), insomnia or restless legs syndrome (RLS), are common in the general population and after stroke. In some cases, sleep disturbances are pre-existing, but can also appear de novo as a direct consequence of brain damage or due to stroke-related complications. Furthermore, some sleep conditions may act as a risk factor of stroke. This review explores the available evidence of the two-way relationship between sleep and stroke. Cardiovascular physiological changes during sleep are described, as well as the evidence on the relationship between stroke and sleep duration, SDB, RLS, insomnia, excessive daytime sleepiness (EDS), and circadian rhythm alterations. Potential changes on sleep architecture, and the links that may exist between sleep and functional outcomes after stroke are also discussed. Importantly, sleep-related disturbances may be associated with worse stroke recovery outcomes and increased cerebrovascular morbidity. It is therefore relevant that the bidirectional association between stroke and sleep is taken into consideration by clinicians taking care of these patients. Future research may focus on this mutual relationship for a better understanding of the impact of stroke on sleep, the importance of sleep in stroke incidence and recovery, and have further evidence on treatment strategies that may improve functional outcome after stroke.
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Affiliation(s)
| | - Saima Bashir
- Stroke Unit, Department of Neurology, Hospital Universitari Dr. Josep Trueta de Girona, IDIBGI, Girona, Spain
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