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Geng D, Wu B, Lin Y, Chen J, Tang W, Liu Y, He J. High total bilirubin-to-uric acid ratio predicts poor sleep quality after acute ischemic stroke: a prospective nested case-control study. Psychogeriatrics 2023; 23:897-907. [PMID: 37525331 DOI: 10.1111/psyg.12992] [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: 03/14/2023] [Revised: 05/11/2023] [Accepted: 05/29/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Sleep disorders are prevalent after stroke, resulting in high recurrence rates and mortality. But the biomarkers of sleep disorders in stroke patients remain to be elucidated. This study aimed to explore the relationship between total bilirubin-to-uric acid ratio (TUR) and sleep quality after acute ischemic stroke (AIS). METHODS Three hundred twenty-six AIS patients were recruited and followed up 1 month after stroke in our study. Serum total bilirubin and uric acid levels were obtained within 24 h after admission. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality 1 month after stroke. We conducted receiver operating characteristic (ROC) curve analysis and screened the optimal biomarker to differentiate sleep disorders after stroke. Then the TUR was stratified according to the best cut-off value (0.036) of the ROC and further analysed by binary logistic regression analysis. Additionally, the interaction was used to explore the difference in its effect on post-stroke sleep quality in different subgroups. RESULTS Three hundred thirty-one patients (40.2%) were considered as having poor sleep quality during the one-month follow-up. Compared to patients with good sleep, patients with poor sleep were more likely to have higher TUR (IQR), 0.05 (0.03-0.06) versus 0.03 (0.02-0.04), P < 0.001. After adjusting for confounding factors, binary regression analysis demonstrated that a high TUR (≥0.036) was independently related to post-stroke poor sleep quality (OR = 3.75, 95% CI = 2.02-6.96, P < 0.001). CONCLUSIONS High TUR is associated with an increased risk of poor sleep quality in AIS patients, especially in females, diabetics, and patients with hyperlipidaemia.
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Affiliation(s)
- Dandan Geng
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Beilan Wu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yisi Lin
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jiahao Chen
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenjie Tang
- The First School of Clinical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Yuntao Liu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jincai He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Simionescu K, Łoboda D, Adamek M, Wilczek J, Gibiński M, Gardas R, Biernat J, Gołba KS. Relationships between Heart Chamber Morphology or Function and Respiratory Parameters in Patients with HFrEF and Various Types of Sleep-Disordered Breathing. Diagnostics (Basel) 2023; 13:3309. [PMID: 37958204 PMCID: PMC10648695 DOI: 10.3390/diagnostics13213309] [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: 08/29/2023] [Revised: 10/08/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Sleep-disordered breathing (SDB), i.e., central sleep apnea (CSA) and obstructive sleep apnea (OSA), affects the prognosis of patients with heart failure with reduced ejection fraction (HFrEF). The study assessed the relationships between heart chamber size or function and respiratory parameters in patients with HFrEF and various types of SDB. The 84 participants were patients aged 68.3 ± 8.4 years (80% men) with an average left ventricular ejection fraction (LVEF) of 25.5 ± 6.85% who qualified for cardioverter-defibrillator implantation with or without cardiac resynchronization therapy. SDB, defined by an apnea-hypopnea index (AHI) ≥ five events/hour, was diagnosed in 76 patients (90.5%); SDB was severe in 31 (36.9%), moderate in 26 (31.0%), and mild in 19 (22.6%). CSA was the most common type of SDB (64 patients, 76.2%). A direct proportional relationship existed only in the CSA group between LVEF or stroke volume (SV) and AHI (p = 0.02 and p = 0.07), and between LVEF or SV and the percentage of total sleep time spent with hemoglobin oxygen saturation < 90% (p = 0.06 and p = 0.07). In contrast, the OSA group was the only group in which right ventricle size showed a positive relationship with AHI (for basal linear dimension [RVD1] p = 0.06), mean duration of the respiratory event (for RVD1 p = 0.03, for proximal outflow diameter [RVOT proximal] p = 0.009), and maximum duration of respiratory event (for RVD1 p = 0.049, for RVOT proximal p = 0.006). We concluded that in HFrEF patients, SDB severity is related to LV systolic function and SV only in CSA, whereas RV size correlates primarily with apnea/hypopnea episode duration in OSA.
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Affiliation(s)
- Karolina Simionescu
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, 40-635 Katowice, Poland; (K.S.); (J.W.); (M.G.); (R.G.); (K.S.G.)
- Department of Electrocardiology, Upper-Silesian Medical Centre, 40-635 Katowice, Poland
| | - Danuta Łoboda
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, 40-635 Katowice, Poland; (K.S.); (J.W.); (M.G.); (R.G.); (K.S.G.)
- Department of Electrocardiology, Upper-Silesian Medical Centre, 40-635 Katowice, Poland
| | - Mariusz Adamek
- Department of Thoracic Surgery, Medical University of Silesia, 40-055 Katowice, Poland;
- 2nd Department of Radiology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Jacek Wilczek
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, 40-635 Katowice, Poland; (K.S.); (J.W.); (M.G.); (R.G.); (K.S.G.)
- Department of Electrocardiology, Upper-Silesian Medical Centre, 40-635 Katowice, Poland
| | - Michał Gibiński
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, 40-635 Katowice, Poland; (K.S.); (J.W.); (M.G.); (R.G.); (K.S.G.)
- Department of Electrocardiology, Upper-Silesian Medical Centre, 40-635 Katowice, Poland
| | - Rafał Gardas
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, 40-635 Katowice, Poland; (K.S.); (J.W.); (M.G.); (R.G.); (K.S.G.)
- Department of Electrocardiology, Upper-Silesian Medical Centre, 40-635 Katowice, Poland
| | - Jolanta Biernat
- Department of Electrocardiology, Upper-Silesian Medical Centre, 40-635 Katowice, Poland
| | - Krzysztof S. Gołba
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, 40-635 Katowice, Poland; (K.S.); (J.W.); (M.G.); (R.G.); (K.S.G.)
- Department of Electrocardiology, Upper-Silesian Medical Centre, 40-635 Katowice, Poland
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Inoue Y, Shue F, Bu G, Kanekiyo T. Pathophysiology and probable etiology of cerebral small vessel disease in vascular dementia and Alzheimer's disease. Mol Neurodegener 2023; 18:46. [PMID: 37434208 PMCID: PMC10334598 DOI: 10.1186/s13024-023-00640-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/28/2023] [Indexed: 07/13/2023] Open
Abstract
Vascular cognitive impairment and dementia (VCID) is commonly caused by vascular injuries in cerebral large and small vessels and is a key driver of age-related cognitive decline. Severe VCID includes post-stroke dementia, subcortical ischemic vascular dementia, multi-infarct dementia, and mixed dementia. While VCID is acknowledged as the second most common form of dementia after Alzheimer's disease (AD) accounting for 20% of dementia cases, VCID and AD frequently coexist. In VCID, cerebral small vessel disease (cSVD) often affects arterioles, capillaries, and venules, where arteriolosclerosis and cerebral amyloid angiopathy (CAA) are major pathologies. White matter hyperintensities, recent small subcortical infarcts, lacunes of presumed vascular origin, enlarged perivascular space, microbleeds, and brain atrophy are neuroimaging hallmarks of cSVD. The current primary approach to cSVD treatment is to control vascular risk factors such as hypertension, dyslipidemia, diabetes, and smoking. However, causal therapeutic strategies have not been established partly due to the heterogeneous pathogenesis of cSVD. In this review, we summarize the pathophysiology of cSVD and discuss the probable etiological pathways by focusing on hypoperfusion/hypoxia, blood-brain barriers (BBB) dysregulation, brain fluid drainage disturbances, and vascular inflammation to define potential diagnostic and therapeutic targets for cSVD.
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Affiliation(s)
- Yasuteru Inoue
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Francis Shue
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Guojun Bu
- SciNeuro Pharmaceuticals, Rockville, MD 20850 USA
| | - Takahisa Kanekiyo
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224 USA
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4
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Kuznetsova A, Meyers KE, Dhanantwari P, Laney N, Frank R, Sethna CB. Sleep-related breathing disorders and cardiometabolic risk factors in pediatric kidney transplant recipients. Pediatr Transplant 2022; 26:e14355. [PMID: 35869891 DOI: 10.1111/petr.14355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/12/2022] [Accepted: 06/27/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND SRBDs have been shown to increase the risk of cardiovascular disease, which is a significant cause of mortality in kidney transplant recipients. Few studies have investigated the association between SRBDs and cardiometabolic risk factors in pediatric kidney transplant recipients. METHODS This was a cross-sectional study of pediatric kidney transplant recipients using baseline cardiometabolic data from a previous clinical trial (NCT01007994). Parents/guardians of pediatric kidney transplant recipients filled out 22-item PSQ. A score greater than 33% was defined as a diagnosis of a SRBD. Fisher's exact test, Mann-Whitney U test, and regressions were used to determine associations. RESULTS Among the 58 transplant recipients enrolled, 14.80% (n = 8) of participants identified as Black and 40.7% (n = 22) were male. The median age was 13 (IQR 8.25, 17) years and median number of years post-transplant for participants was 2 (IQR 1, 4). The prevalence of SRBDs was 26% (n = 14). The presence of a SRBD was associated with abnormalities in multiple cardiometabolic risk factors including total cholesterol level (β = 23.63; 95% CI 3.58-43.67), LDL level (β = 24.94; 95% CI 6.37-43.50), triglyceride level (β = 54.62; 95% CI 8.74-100.50), and LVH (OR = 5.12; 95% CI 1.12-23.45) when adjusted for age, sex, and race. CONCLUSIONS Similar to associations reported in the general pediatric and general CKD populations, SRBD is associated with increased cardiometabolic risk in pediatric kidney transplant recipients.
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Affiliation(s)
- Anna Kuznetsova
- Division of Nephrology, Department of Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, New York, USA
| | - Kevin E Meyers
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Preeta Dhanantwari
- Division of Cardiology, Department of Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, New York, USA
| | - Nina Laney
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Rachel Frank
- Division of Nephrology, Department of Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, New York, USA
| | - Christine B Sethna
- Division of Nephrology, Department of Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, New York, USA
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5
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Beaudin AE, Hanly PJ, Raneri JK, Younes M, Pun M, Anderson TJ, Poulin MJ. Impact of intermittent hypoxia on human vascular responses during sleep. Exp Neurol 2021; 347:113897. [PMID: 34655575 DOI: 10.1016/j.expneurol.2021.113897] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 10/05/2021] [Accepted: 10/10/2021] [Indexed: 11/27/2022]
Abstract
Exposure to intermittent hypoxia (IH) ≥15 times per hour is believed to be the primary mechanism for the increased risk of cerebrovascular and cardiovascular disease in patients with moderate to severe sleep apnea. Human experimental models of IH used to investigate this link have been predominantly employed during wakefulness, which limits extrapolation of findings to sleep apnea where IH occurs during sleep. Moreover, how IH impacts vascular regulation during sleep has not been measured quantitatively. Therefore, the objective of this study was to assess the impact sleep accompanied by IH on vascular responses to hypoxia and hypercapnia during sleep. Ten males performed two randomly scheduled 6-h overnight sleep studies. One sleep study was performed in room air (normoxia) and the other sleep study was performed during isocapnic IH (60 s hypoxia-60 s normoxia). On each night, cerebrovascular (peak blood velocity through the middle cerebral artery (V¯P); transcranial Doppler ultrasound) and cardiovascular (blood pressure, heart rate) responses to hypoxia and hypercapnia were measured before sleep onset (PM-Awake), within the first 2 h of sleep (PM-Asleep), in the 5th (out of 6) hours of sleep (AM-Asleep) and after being awoken in the morning (AM-Awake). Sleep accompanied by IH had no impact on the V¯P and blood pressure responses to hypoxia and hypercapnic at any timepoint (p ≥ 0.103 for all responses). However, the AM-Awake heart rate response to hypoxia was greater following sleep in IH compared to sleep in normoxia. Independent of the sleep environment, the V¯P response to hypoxia and hypercapnia were reduced during sleep. In conclusion, cerebral blood flow responses are reduced during sleep compared to wakefulness, but 6 h of sleep accompanied by IH does not alter cerebrovascular and cardiovascular response to hypoxia and hypercapnia during wakefulness or sleep in healthy young humans. However, it is likely that longer exposure to IH during sleep (i.e., days-to-weeks) is required to better elucidate IH's impact on vascular regulation in humans.
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Affiliation(s)
- Andrew E Beaudin
- University of Calgary, Cumming School of Medicine, Department of Physiology and Pharmacology, 3330 Hospital Drive N.W., Calgary, Alberta T2N 4N1, Canada; Hotchkiss Brain Institute, University of Calgary, Cumming School of Medicine, 3330 Hospital Drive N.W., Calgary, Alberta T2N 4N1, Canada
| | - Patrick J Hanly
- Hotchkiss Brain Institute, University of Calgary, Cumming School of Medicine, 3330 Hospital Drive N.W., Calgary, Alberta T2N 4N1, Canada; University of Calgary, Cumming School of Medicine, Department of Medicine, 3330 Hospital Drive N.W., Calgary, Alberta T2N 4N1, Canada; Sleep Centre, Foothills Medical Centre, 1403 29 St NW, Calgary, Alberta T2N 2T9, Canada
| | - Jill K Raneri
- Sleep Centre, Foothills Medical Centre, 1403 29 St NW, Calgary, Alberta T2N 2T9, Canada
| | - Magdy Younes
- University of Manitoba, Department of Medicine, 1105-255 Wellington Crescent, Winnipeg, Manitoba R3M 3V4, Canada
| | - Matiram Pun
- University of Calgary, Cumming School of Medicine, Department of Physiology and Pharmacology, 3330 Hospital Drive N.W., Calgary, Alberta T2N 4N1, Canada; Hotchkiss Brain Institute, University of Calgary, Cumming School of Medicine, 3330 Hospital Drive N.W., Calgary, Alberta T2N 4N1, Canada
| | - Todd J Anderson
- University of Calgary, Cumming School of Medicine, Department of Cardiac Science, 3330 Hospital Drive N.W., Calgary, Alberta T2N 4N1, Canada; Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marc J Poulin
- University of Calgary, Cumming School of Medicine, Department of Physiology and Pharmacology, 3330 Hospital Drive N.W., Calgary, Alberta T2N 4N1, Canada; Hotchkiss Brain Institute, University of Calgary, Cumming School of Medicine, 3330 Hospital Drive N.W., Calgary, Alberta T2N 4N1, Canada; Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.
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6
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Castro-Grattoni AL, Suarez-Giron M, Benitez I, Tecchia L, Torres M, Almendros I, Farre R, Targa A, Montserrat JM, Dalmases M, Barbé F, Gozal D, Sánchez-de-la-Torre M. The effect of chronic intermittent hypoxia in cardiovascular gene expression is modulated by age in a mice model of sleep apnea. Sleep 2021; 44:6071377. [PMID: 33417710 DOI: 10.1093/sleep/zsaa293] [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: 08/18/2020] [Revised: 11/18/2020] [Indexed: 12/13/2022] Open
Abstract
STUDY OBJECTIVES Chronic intermittent hypoxia (CIH) is a major determinant in obstructive sleep apnea cardiovascular morbidity and this effect is influenced by age. The objective of the present study was to assess the differential molecular mechanisms at gene-level expression involved in the cardiovascular remodeling induced by CIH according to chronological age. METHODS Two- and 18-month-old mice (N = 8 each) were subjected to CIH or normoxia for 8 weeks. Total messenger RNA (mRNA) was extracted from left ventricle myocardium and aortic arch, and gene expression of 46 intermediaries of aging, oxidative stress, and inflammation was measured by quantitative real-time polymerase chain reaction. RESULTS Cardiac gene expression of Nrf2 (2.05-fold increase, p < 0.001), Sod2 (1.9-fold increase, p = 0.035), Igf1r (1.4-fold increase, p = 0.028), Mtor (1.8-fold increase, p = 0.06), Foxo3 (1.5-fold increase, p = 0.020), Sirt4, Sirt6, and Sirt7 (1.3-fold increase, p = 0.012; 1.1-fold change, p = 0.031; 1.3-fold change, p = 0.029) was increased after CIH in young mice, but not in old mice. In aortic tissue, endothelial isoform of nitric oxide synthase was reduced in young mice (p < 0.001), Nrf2 was reduced in 80% (p < 0.001) in young mice and 45% (p = 0.07) in old mice, as its downstream antioxidant target Sod2 (82% reduced, p < 0.001). IL33. CONCLUSIONS CIH effect in gene expression is organ-dependent, and is modulated by age. CIH increased transcriptional expression of genes involved in cardioprotection and cell survival in young, but not in old mice. In aortic tissue, CIH reduced gene expression related to an antioxidant response in both young and old mice, suggesting vascular oxidative stress and a proaging process.
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Affiliation(s)
- Anabel L Castro-Grattoni
- Group of Translational Research in Respiratory Medicine, Respiratory Department, Hospital University Arnau de Vilanova and Santa Maria, IRB Lleida, University of Lleida, Lleida, Catalonia, Spain.,Department of Child Health, University of Missouri, School of Medicine, Columbia, MO, USA
| | | | - Ivan Benitez
- Group of Translational Research in Respiratory Medicine, Respiratory Department, Hospital University Arnau de Vilanova and Santa Maria, IRB Lleida, University of Lleida, Lleida, Catalonia, Spain
| | - Lourdes Tecchia
- Group of Translational Research in Respiratory Medicine, Respiratory Department, Hospital University Arnau de Vilanova and Santa Maria, IRB Lleida, University of Lleida, Lleida, Catalonia, Spain
| | - Marta Torres
- Agency for Health Quality and Assessment of Catalonia (AQuAS), Barcelona - CIBER de Enfermedades Respiratorias - CIBER de Epidemiología y Salud Pública, Madrid, Spain
| | - Isaac Almendros
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Ramon Farre
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Adriano Targa
- Group of Translational Research in Respiratory Medicine, Respiratory Department, Hospital University Arnau de Vilanova and Santa Maria, IRB Lleida, University of Lleida, Lleida, Catalonia, Spain
| | - Josep M Montserrat
- Laboratori del son, Servei de Pneumologia, Hospital Clínic, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Mireia Dalmases
- Group of Translational Research in Respiratory Medicine, Respiratory Department, Hospital University Arnau de Vilanova and Santa Maria, IRB Lleida, University of Lleida, Lleida, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Ferran Barbé
- Group of Translational Research in Respiratory Medicine, Respiratory Department, Hospital University Arnau de Vilanova and Santa Maria, IRB Lleida, University of Lleida, Lleida, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - David Gozal
- Department of Child Health, University of Missouri, School of Medicine, Columbia, MO, USA
| | - Manuel Sánchez-de-la-Torre
- Group of Translational Research in Respiratory Medicine, Respiratory Department, Hospital University Arnau de Vilanova and Santa Maria, IRB Lleida, University of Lleida, Lleida, Catalonia, Spain.,Group of Precision Medicine in Chronic Diseases, Hospital Arnau de Vilanova-Santa Maria, IRB Lleida, Lleida, Spain
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Mostafa SS, Baptista D, Ravelo-García AG, Juliá-Serdá G, Morgado-Dias F. Greedy based convolutional neural network optimization for detecting apnea. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 197:105640. [PMID: 32673899 DOI: 10.1016/j.cmpb.2020.105640] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/27/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Sleep apnea is a common sleep disorder, usually diagnosed using an expensive, highly specialized, and inconvenient test called polysomnography. A single SpO2 sensor based on an automated classification system can be developed to simplify the apnea detection. The main objective of this work is to develop a classifier based on a convolution neural network with the capability of detecting apnea events from one dimensional SpO2 signal. However, to find an optimum convolution neural network structure is a daunting task is usually done by a trial-and-error method. To solve this problem, a method is proposed to save time and simplify the process of searching for an optimum convolution neural network structure. METHODS Greedy based optimization is proposed to search for an optimized convolution neural network structure. Three different variants of greedy based optimization are proposed: the topology transfer, the weighted-topology transfer with rough estimation, and the weighted-topology transfer with fine tuning. The subject independent and the cross-database test are performed for the analysis. RESULTS Considering the balance between the execution time and the performance, the weighted-topology transfer with rough estimation is the best. An accuracy of 88.49% for the HuGCDN2008 database and 95.14% for the Apnea-ECG database are obtained for apnea events detection per minute. Regarding the apnea patient detection, also referred to as global classification, an accuracy of 95.71% is achieved for the HuGCDN2008 database, and 100% is achieved for the AED database without removing any subjects from both databases. CONCLUSIONS The proposed one-dimensional convolution neural network performs better in a similar situation than those presented in the literature. The greedy based methods, mainly the weighted-topology transfer with rough estimation, is an alternative method to extensive trial and error method.
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Affiliation(s)
- Sheikh Shanawaz Mostafa
- ITI/Larsys/Madeira Interactive Technologies Institute, Portugal; Universidade de Lisboa, Instituto Superior Técnico, Portugal.
| | - Darío Baptista
- ITI/Larsys/Madeira Interactive Technologies Institute, Portugal; Universidade de Lisboa, Instituto Superior Técnico, Portugal.
| | - Antonio G Ravelo-García
- Universidad de Las Palmas de Gran Canaria, Institute for Technological Development and Innovation in Communications, Spain; ITI/Larsys/Madeira Interactive Technologies Institute, Portugal.
| | - Gabriel Juliá-Serdá
- Pulmonary Medicine Department, Hospital Universitario de Gran Canaria Dr. Negrın, Las Palmas de Gran Canaria 35010, Spain.
| | - Fernando Morgado-Dias
- ITI/Larsys/Madeira Interactive Technologies Institute, Portugal; Universidade da Madeira, Portugal.
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9
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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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10
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Bogiatzi C, Azarpazhooh MR, Spence JD. Choosing the right therapy for a patient with asymptomatic carotid stenosis. Expert Rev Cardiovasc Ther 2020; 18:53-63. [PMID: 32043917 DOI: 10.1080/14779072.2020.1729127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction: Most patients with asymptomatic carotid stenosis (ACS) now have a lower risk with intensive medical therapy than with stenting (CAS) or endarterectomy (CEA); the annual risk of stroke or death with intensive medical therapy is ~ 0.5%, vs. a periprocedural risk with CAS of ~ 2.5-4.1% with CAS, and ~ 1.4-1.8% with CEA. The excess risk of CAS is greater in older patients.Areas covered: Discussed are the need for intensive medical therapy, the nature of intensive medical therapy, approaches to identifying the few patients with ACS who could benefit from CEA or CAS, and which patients would be better suited to CEA vs. CAS.Expert opinion: All patients with ACS are at high risk of cardiovascular events, soshould receive intensive medical therapy including lifestyle modification, intensive lipid-lowering, B vitamins to lower homocysteine (using methylcobalamin rather than cyanocobalamin), and appropriate antithrombotic therapy. High-risk patients who could benefit from intervention can be identified by clinical and imaging features including transcranial Doppler embolus detection, ulceration, intraplaque hemorrhage, reduced cerebrovascular reserve, plaque echolucency, silent infarction on brain imaging, and progression of stenosis. Most patients whose risk of stroke warrants intervention would be better treated with CEA than with CAS.
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Affiliation(s)
- Chrysi Bogiatzi
- Department of Neurology, McMaster University, Hamilton, Ontario, Canada
| | - M Reza Azarpazhooh
- Department of Clinical Neurological Sciences (Neurology), Western University, London, Ontario, Canada
| | - J David Spence
- Departments of Clinical Neurological Sciences (Neurology) and Internal Medicine (Clinical Pharmacology), Robarts Research Institute, London, Ontario, Canada
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Chokesuwattanaskul A, Lertjitbanjong P, Thongprayoon C, Bathini T, Sharma K, Mao MA, Cheungpasitporn W, Chokesuwattanaskul R. Impact of obstructive sleep apnea on silent cerebral small vessel disease: a systematic review and meta-analysis. Sleep Med 2019; 68:80-88. [PMID: 32028230 DOI: 10.1016/j.sleep.2019.11.1262] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/28/2019] [Accepted: 11/27/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cerebral small vessel disease (CSVD) is a well-known cause of vascular dementia, a leading medical morbidity in the aging population. Obstructive sleep apnea (OSA) has been validated as a cardiovascular risk factor. However, the relationship between these two clinical syndromes is not well established. We aimed to assess the association between OSA and CSVD. METHODS Databases were searched from inception through May 2019. Studies that reported incidence or odd ratios of CSVD in patients with OSA were included. Effect estimates from the individual studies were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird. RESULTS A total of 14 observational studies comprising of 4335 patients were included into the analysis. Compared to patients without OSA, patients with OSA were significantly associated with CSVD magnetic resonance imaging (MRI) findings of white matter hyperintensity (WMH) and asymptomatic lacunar infarction (ALI) with a pooled OR of 2.31 (95% confidence interval [CI], 1.46-3.66, I2 = 79%) and 1.78 (95% CI, 1.06-3.01, I2 = 41%), respectively. However, there was no significant association between OSA and findings of cerebral microbleeds (CMBs), with a pooled odds ratio (OR) of 2.15 (95% CI, 0.64-7.29, I2 = 55%). CONCLUSIONS Our study demonstrated the association between OSA and CSVD MRI findings of white matter hyperintensity (WMH) and asymptomatic lacunar infarction (ALI) when compared to patients without OSA. The absence of an association of CMBs findings with OSA could be due either by a lower sensitivity of neuroimaging techniques utilized to detect CMBs or a potentially different pathogenesis of CMBs.
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Affiliation(s)
- Anthipa Chokesuwattanaskul
- Division of Neurology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
| | | | | | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ, USA
| | - Konika Sharma
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA
| | - Michael A Mao
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, 32224, USA
| | | | - Ronpichai Chokesuwattanaskul
- King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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12
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Tanaka M. Improving obesity and blood pressure. Hypertens Res 2019; 43:79-89. [PMID: 31649313 DOI: 10.1038/s41440-019-0348-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/28/2019] [Accepted: 09/30/2019] [Indexed: 01/09/2023]
Abstract
Obesity-associated hypertension is a serious public health concern. Sympathetic nervous system (SNS) overactivity, especially in the kidneys, is an important mechanism linking obesity to hypertension. Some adipokines play important roles in elevating blood pressure (BP). Hyperinsulinemia caused by insulin resistance stimulates sodium reabsorption, enhances sodium retention, and increases circulating plasma volume. Hyperinsulinemia also stimulates both the renin-angiotensin-aldosterone system (RAAS) and the SNS, resulting in the acceleration of atherosclerosis through the hypertrophy of vascular smooth muscle cells, which contributes to increased peripheral vascular resistance. Obesity is associated with increased RAAS activity despite volume overload, as the tissue RAASs are stimulated in obese hypertensive individuals. Mineralocorticoid receptor-associated hypertension must also be considered in obese patients with resistant hypertension. Obstructive sleep apnea syndrome (OSAS) is the most common cause of secondary hypertension. Some components of the gut microbiota contribute to BP control; therefore, gut dysbiosis caused by obesity might lead to increased BP. The ratio of visceral fat to subcutaneous fat is higher in Japanese patients than in Caucasian patients, which may explain why Japanese patients are more susceptible to metabolic disorders even though they are less obese than Caucasian individuals. Obesity-associated kidney dysfunction directly increases BP, leading to further deterioration of kidney function. A bodyweight reduction of more than 3% or 5 kg significantly lowers BP. Gastrointestinal bypass surgery is an effective treatment for morbid obesity and its related metabolic disorders, including hypertension. Because both obesity and hypertension are representative lifestyle-related disorders, lifestyle modification, especially to improve obesity, should be performed first as a treatment for hypertension.
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Affiliation(s)
- Masami Tanaka
- Department of Endocrinology, Metabolism, and Nephrology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
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Urtnasan E, Park JU, Lee KJ. Automatic detection of sleep-disordered breathing events using recurrent neural networks from an electrocardiogram signal. Neural Comput Appl 2018. [DOI: 10.1007/s00521-018-3833-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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14
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Jung DW, Hwang SH, Cho JG, Choi BH, Baek HJ, Lee YJ, Jeong DU, Park KS. Real-Time Automatic Apneic Event Detection Using Nocturnal Pulse Oximetry. IEEE Trans Biomed Eng 2018. [DOI: 10.1109/tbme.2017.2715405] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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15
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Beaudin AE, Hartmann SE, Pun M, Poulin MJ. Human cerebral blood flow control during hypoxia: focus on chronic pulmonary obstructive disease and obstructive sleep apnea. J Appl Physiol (1985) 2017; 123:1350-1361. [DOI: 10.1152/japplphysiol.00352.2017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 08/01/2017] [Accepted: 08/07/2017] [Indexed: 01/06/2023] Open
Abstract
The brain is a vital organ that relies on a constant and adequate blood flow to match oxygen and glucose delivery with the local metabolic demands of active neurons. Thus exquisite regulation of cerebral blood flow (CBF) is particularly important under hypoxic conditions to prevent a detrimental decrease in the partial pressure of oxygen within the brain tissues. Cerebrovascular sensitivity to hypoxia, assessed as the change in CBF during a hypoxic challenge, represents the capacity of cerebral vessels to respond to, and compensate for, a reduced oxygen supply, and has been shown to be impaired or blunted in a number of conditions. For instance, this is observed with aging, and in clinical conditions such as untreated obstructive sleep apnea (OSA) and in healthy humans exposed to intermittent hypoxia. This review will 1) provide a brief overview of cerebral blood flow regulation and results of pharmacological intervention studies which we have performed to better elucidate the basic mechanisms of cerebrovascular regulation in humans; and 2) present data from studies in clinical and healthy populations, using a translational physiology approach, to investigate human CBF control during hypoxia. Results from studies in patients with chronic obstructive pulmonary disease and OSA will be presented to identify the effects of the disease processes on cerebrovascular sensitivity to hypoxia. Data emerging from experimental human models of intermittent hypoxia during wakefulness will also be reviewed to highlight the effects of intermittent hypoxia on the brain.
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Affiliation(s)
- Andrew E. Beaudin
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sara E. Hartmann
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Matiram Pun
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marc J. Poulin
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; and
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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16
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Oliveira GDP, Vago ERL, Prado GFD, Coelho FMS. The critical influence of nocturnal breathing complaints on the quality of sleep after stroke: the Pittsburgh Sleep Quality Index and STOP-BANG. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:785-788. [DOI: 10.1590/0004-282x20170137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 08/08/2017] [Indexed: 11/22/2022]
Abstract
ABSTRACT In stroke patients particularly, many factors, such as sleep-related respiratory disturbances, can impair sleep. Cheap and easy-to-use tools have been created to identify sleep quality and sleep disturbances in patients after stroke. This study described the scores of the sleep apnea screening questionnaire - STOP-BANG - in patients after a stroke, and correlated the findings with sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI). The scores of the STOP-BANG and PSQI were 4.3 ± 1.8 and 76 ± 3.9, respectively. The STOP-BANG scores were higher in poor sleepers (4.5 ± 1.6 versus 3.5 ± 1.9; p = 0.032). Logistic regression analysis was used to identify predictors of subjective sleep quality (PSQI) and the STOP-BANG as a predictor of poor quality sleep, with a relative risk of 1.6, controlled for age and sex. This study indicated that sleep quality was largely influenced by sleep breathing problems, which were well identified by the STOP-BANG, especially in younger stroke patients.
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Alex R, Watenpaugh DE, Behbehani K. Dynamic modeling of apnea induced concurrent variations in arterial blood pressure and cerebral blood flow velocity. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:4292-4295. [PMID: 28325005 DOI: 10.1109/embc.2016.7591676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Obstructive Sleep Apnea (OSA) is characterized by partial (hypopnea) or complete cessation (apnea) of airflow to the lungs during sleep. It has been previously reported that apnea episodes lead to significant rise in instantaneous blood pressure concomitant with a rise in cerebral blood flow velocity, indicating loss of cerebral autoregulation during the episodes. In this study, we have used Auto Regressive Moving Average model (ARMA (na, nb, nk)) to quantify OSA induced dynamic changes in cerebral blood flow velocity (CBFV) with beat to beat blood pressure (BP) as an input. BP and CBFV were recorded from 11 positively diagnosed sleep apnea subjects (6 Males, 5 Females; Age: 54.27±6.23 years, BMI:34.95±7.06kg/m2, AHI: 57.39±28.43). The results suggest that two separate models, ARMA (5, 9, 1) and ARMA (5, 10, 0) can be used to quantify dynamic CBFV variations during apneas with a duration of less than and greater than 30s respectively with reasonable accuracy (<;6% error).
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18
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Djurić B, Suzić S, Stojadinović B, Nestorović Z, Ivanović M, Suzić-Lazić J, Nešić D, Mazić S, Tenne T, Zikich D, Žikić D. An improved design of optical sensor for long-term measurement of arterial blood flow waveform. Biomed Microdevices 2017; 19:48. [PMID: 28560700 DOI: 10.1007/s10544-017-0196-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We present here the improved design and development of optical sensor for non-invasive measurements of arterial blood flow waveform. The sensor is based on a physical principle of reflective photoplethysmography (PPG). As the light source we used serially connected infrared diodes whereas NPN silicon phototransistors were used as light detectors. The electronic components were molded into square package and poured with silicone. Such preparation produced an elastic superficies that allowed excellent attachment of the sensor on the skin's surface. Moreover, a serial connection of infrared diodes and phototransistors completely eliminated signal artifacts caused by minor muscle contractions. The sensor recording performances were examined at the photoplethysmographic sites on three different arteries; the commune carotid, femoral and radial and, on each site the sensor demonstrated remarkable capability to make a consistent, reproducible measurements. Because of the advantageous physical and electrical properties, the new sensor is suitable for various cardiovascular diagnostics procedures, especially when long-term measurements of arterial blood flow waveform are required, for monitoring of different parameters in cardiovascular units and for research.
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Affiliation(s)
- Biljana Djurić
- Department of Medical Physiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Slavica Suzić
- Department of Medical Physiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Bojana Stojadinović
- Institute of Biophysics, Faculty of Medicine, University of Belgrade, Belgrade, 11000, Serbia
| | - Zorica Nestorović
- Institute of Biophysics, Faculty of Medicine, University of Belgrade, Belgrade, 11000, Serbia
| | - Marija Ivanović
- Vinca Institute of Nuclear Sciences, University of Belgrade, Belgrade, Serbia
| | - Jelena Suzić-Lazić
- University Clinical Center "Dr. Dragiša Mišović-Dedinje", Belgrade, Serbia
| | - Dejan Nešić
- Department of Medical Physiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sanja Mazić
- Department of Medical Physiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tamar Tenne
- Meir Medical Center, Medical Genetics Institute, Kfar Saba, Israel
| | - Dragoslav Zikich
- Sheba Medical Center, The Ella Lemelbaum Institute for Melanoma, 52621, Tel Hashomer, Israel
| | - Dejan Žikić
- Institute of Biophysics, Faculty of Medicine, University of Belgrade, Belgrade, 11000, Serbia.
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Abstract
Subspecialty pediatric practice provides comprehensive medical care for a range of ages, from premature infants to children, and often includes adults with complex medical and surgical issues that warrant multidisciplinary care. Normal physiologic variations involving different body systems occur during sleep and these vary with age, stage of sleep, and underlying health conditions. This article is a concise review of the cardiovascular (CV) physiology and pathophysiology in children, sleep-disordered breathing (SDB) contributing to CV morbidity, congenital and acquired CV pathology resulting in SDB, and the relationship between SDB and CV morbidity in different clinical syndromes and systemic diseases in the expanded pediatric population.
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Affiliation(s)
- Grace R Paul
- Division of Pulmonary and Sleep Medicine, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH 43205, USA.
| | - Swaroop Pinto
- Division of Pulmonary and Sleep Medicine, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH 43205, USA
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20
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Sico JJ, Yaggi HK, Ofner S, Concato J, Austin C, Ferguson J, Qin L, Tobias L, Taylor S, Vaz Fragoso CA, McLain V, Williams LS, Bravata DM. Development, Validation, and Assessment of an Ischemic Stroke or Transient Ischemic Attack-Specific Prediction Tool for Obstructive Sleep Apnea. J Stroke Cerebrovasc Dis 2017; 26:1745-1754. [PMID: 28416405 DOI: 10.1016/j.jstrokecerebrovasdis.2017.03.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/23/2017] [Accepted: 03/30/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Screening instruments for obstructive sleep apnea (OSA), as used routinely to guide clinicians regarding patient referral for polysomnography (PSG), rely heavily on symptomatology. We sought to develop and validate a cerebrovascular disease-specific OSA prediction model less reliant on symptomatology, and to compare its performance with commonly used screening instruments within a population with ischemic stroke or transient ischemic attack (TIA). METHODS Using data on demographic factors, anthropometric measurements, medical history, stroke severity, sleep questionnaires, and PSG from 2 independently derived, multisite, randomized trials that enrolled patients with stroke or TIA, we developed and validated a model to predict the presence of OSA (i.e., Apnea-Hypopnea Index ≥5 events per hour). Model performance was compared with that of the Berlin Questionnaire, Epworth Sleepiness Scale (ESS), the Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, and Gender instrument, and the Sleep Apnea Clinical Score. RESULTS The new SLEEP Inventory (Sex, Left heart failure, ESS, Enlarged neck, weight [in Pounds], Insulin resistance/diabetes, and National Institutes of Health Stroke Scale) performed modestly better than other instruments in identifying patients with OSA, showing reasonable discrimination in the development (c-statistic .732) and validation (c-statistic .731) study populations, and having the highest negative predictive value of all in struments. CONCLUSIONS Clinicians should be aware of these limitations in OSA screening instruments when making decisions about referral for PSG. The high negative predictive value of the SLEEP INventory may be useful in determining and prioritizing patients with stroke or TIA least in need of overnight PSG.
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Affiliation(s)
- Jason J Sico
- Neurology Service, VA Connecticut Healthcare System, West Haven, Connecticut; Department of Neurology and Center for Neuroepidemiology and Clinical Neurological Research, Yale University School of Medicine, New Haven, Connecticut; Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, Connecticut.
| | - H Klar Yaggi
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, Connecticut
| | - Susan Ofner
- Department of Biostatistics, IUPUI, Indiana University School of Medicine, Indianapolis, Indiana
| | - John Concato
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, Connecticut
| | - Charles Austin
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, Indiana; Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jared Ferguson
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, Indiana
| | - Li Qin
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut
| | - Lauren Tobias
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Stanley Taylor
- Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, Connecticut
| | - Carlos A Vaz Fragoso
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Vincent McLain
- Department of Biostatistics, IUPUI, Indiana University School of Medicine, Indianapolis, Indiana
| | - Linda S Williams
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, Indiana; Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana; Regenstrief Institute, Indianapolis, Indiana
| | - Dawn M Bravata
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, Indiana; Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana; Regenstrief Institute, Indianapolis, Indiana
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21
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Kishimoto Y, Okamoto N, Saeki K, Tomioka K, Obayashi K, Komatsu M, Kurumatani N. Bodily pain, social support, depression symptoms and stroke history are independently associated with sleep disturbance among the elderly: a cross-sectional analysis of the Fujiwara-kyo study. Environ Health Prev Med 2016; 21:295-303. [PMID: 27072924 PMCID: PMC5305981 DOI: 10.1007/s12199-016-0529-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/29/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To investigate independent effects of various factors associated with sleep disturbance among community-dwelling elderly individuals. METHODS We analyzed data obtained from 3732 individuals aged ≥65 years who responded to a self-administered questionnaire and participated in a structured interview which assessed the Pittsburgh Sleep Quality Index (PSQI), subjective bodily pain, the Jichi Medical School Social Support Scale, the Geriatric Depression Scale (GDS-15), health status, and demographic characteristics. Sleep disturbance was defined as a global PSQI score >5.5, which was used as a dependent variable in multiple logistic regression analysis to determine adjusted odds ratios (ORs) and 95 % confidence intervals (CIs) of related factors. RESULTS We identified a significant increase in the adjusted ORs for female (OR 1.56, 95 % CI 1.34-1.83), age ≥80 years (1.31, 1.01-1.69), history of stroke (1.44, 1.08-1.92), and a GDS-15 score ≥6 as compared to 0-2 (2.29, 1.86-2.81), with regard to sleep disturbance. Participants with severe or very severe bodily pain had the highest adjusted OR (3.00, 2.15-4.19), and those with very mild bodily pain also had a relatively high OR (1.30, 1.06-1.60), relative to those without subjective bodily pain. In addition, compared with participants with strong social support from spouse or family, those with weak social support had significantly increased adjusted ORs (1.21, 1.01-1.44, 1.44, 1.23-1.70, respectively). CONCLUSIONS The present study indicates that sleeping disturbances among the elderly are closely associated with social support from a spouse and family. They are also associated with pain, even at stages in which subjective bodily pain is very mild.
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Affiliation(s)
- Yuko Kishimoto
- Department of Community Health and Epidemiology, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Nozomi Okamoto
- Department of Community Health and Epidemiology, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Keigo Saeki
- Department of Community Health and Epidemiology, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Kimiko Tomioka
- Department of Community Health and Epidemiology, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Kenji Obayashi
- Department of Community Health and Epidemiology, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Masayo Komatsu
- Department of Community Health and Epidemiology, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Norio Kurumatani
- Department of Community Health and Epidemiology, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan.
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23
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Gharraf H, Zidan M, ElHoffy A. Association between obstructive sleep apnea hypopnea syndrome and normal tension glaucoma. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2016. [DOI: 10.1016/j.ejcdt.2015.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Yano Y, Ning H, Muntner P, Reis JP, Calhoun DA, Viera AJ, Levine DA, Jacobs DR, Shimbo D, Liu K, Greenland P, Lloyd-Jones D. Nocturnal Blood Pressure in Young Adults and Cognitive Function in Midlife: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Hypertens 2015; 28:1240-7. [PMID: 25783740 PMCID: PMC4580541 DOI: 10.1093/ajh/hpv028] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 02/02/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Nocturnal blood pressure (BP) is associated with risk for cardiovascular events. However, the relationship between nocturnal BP in young adults and cognitive function in midlife remains unclear. METHODS We used data from the ambulatory BP monitoring substudy of the Coronary Artery Risk Development in Young Adults Study, including 224 participants (mean age 30 years, 45% men, 63% African Americans). At the 20-year follow-up, the Stroop test (executive function), Digit Symbol Substitution Test (psychomotor speed), and Rey Auditory Verbal Learning Test (verbal memory) were assessed. RESULTS Baseline mean office, daytime, and nocturnal BP were 109/73, 120/74, and 107/59 mm Hg, respectively. Nocturnal BP dipping, calculated as (nocturnal systolic BP [SBP]--daytime SBP) × 100/daytime SBP, was divided into quartiles (Q1: -39.3% to -16.9%; Q2: -16.8% to -13.2%, Q3 [reference]: -13.1% to -7.8%, and Q4: -7.7% to +56.4%). In multiple regression analyses, the least nocturnal SBP dipping (Q4 vs. reference) and higher nocturnal diastolic BP level were associated with worse Stroop scores, with adjustments for demographic and clinical characteristics, and cumulative exposure to office BP during follow-up (β [standard error]: 0.37 [0.18] and 0.19 [0.07], respectively; all P < 0.05). Digit Symbol Substitution Test and Rey Auditory Verbal Learning Test were not significantly associated with nocturnal SBP dipping or nocturnal SBP/diastolic BP levels. CONCLUSIONS Among healthy young adults, less nocturnal SBP dipping and higher nocturnal diastolic BP levels were associated with lower executive function in midlife, independent of multiple measures of office BP during long-term follow-up.
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Affiliation(s)
- Yuichiro Yano
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA;
| | - Hongyan Ning
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alaska, USA
| | - Jared P Reis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - David A Calhoun
- Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alaska, USA
| | - Anthony J Viera
- Hypertension Research Program and Department of Family Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Deborah A Levine
- Departments of Internal Medicine and Neurology and Stroke Program, University of Michigan Health System, Veterans Affairs Health Services Research and Development Center of Excellence, Ann Arbor, Michigan, USA
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Daichi Shimbo
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University, New York, USA
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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25
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Abstract
Sleep apnea, the periodic cessation of breathing during sleep, is a common and underdiagnosed condition. Treatment can improve quality of life as well as reduce morbidity and mortality from sleep apnea-related hypertension, stroke, and traffic accidents. In this article, the authors discuss types of sleep apnea, diagnostic tools, and treatment strategies for both adults and children.
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Affiliation(s)
- Aijaz Alvi
- Mercy Health System, Crystal Lake, Illinois, USA
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26
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Kojic B, Burina A, Sinanovic O. One Year Outcome of Acute Stroke Patients with Sleep Apnea. Med Arch 2015; 69:149-52. [PMID: 26261380 PMCID: PMC4500379 DOI: 10.5455/medarh.2015.69.149-152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 05/25/2015] [Indexed: 11/11/2022] Open
Abstract
UNLABELLED The aim of this study was to analyze one year outcome of the acute stroke patients with sleep apnea in order to gender and age. METHODS It was analyzed 110 patients with acute stroke and sleep apnea. Among them 65(59%) were men. Average age of all participant was 65.13±9.27 years. The same number and gender distribution of participants with stroke and without apnea were in control group. Evaluation of sleep apnea has been done with: "The Sleep Disorders Questionnaire", "Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome" and "The Epworth Sleepiness Scale". RESULTS One year after stroke onset survived 91 (82.7%) out of 110 patients with apnea. Average age of survived patients was 63.66±8.78 years. Among them 52(80%) were men. In control group, without apnea survived 104 (94.5%) patients with average age of 65.00±8.62 years. Among them 62 (95.4%) were men. In men with apnea there is significantly lower survival range in order to patients without apnea (X(2)=8.22, p=0.004). In women there is no difference. Survival of both gender in patients with apnea (22; 64.7%) was the lowest in group older than 70 years of age. Sex ratio (men : women) was 15 (68.2%):7(58.3%). Survival in both gender in patients without apnea was the same in group older than 70 years of age: 27 (81.2%) out of 33. Average age of patients who died with apnea was significantly higher in order to patients without (t=1.97, p=0.03). CONCLUSION One year after stroke, significantly more patients survived without (94.5%) than with apnea (82.7%) (p=0.01). In order to sex survived range was significantly (p=0.004) lover in men with apnea than without but in women there is no difference. Survival range of both gender in patients with apnea was the lowest in group older than 70 years (p=0.03).
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Affiliation(s)
- Biljana Kojic
- Department of Neurology, University Clinical Center Tuzla, Medical School, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Adnan Burina
- Department of Neurology, University Clinical Center Tuzla, Medical School, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Osman Sinanovic
- Department of Neurology, University Clinical Center Tuzla, Medical School, University of Tuzla, Tuzla, Bosnia and Herzegovina
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Lim S, Meigs JB. Links between ectopic fat and vascular disease in humans. Arterioscler Thromb Vasc Biol 2014; 34:1820-6. [PMID: 25035342 DOI: 10.1161/atvbaha.114.303035] [Citation(s) in RCA: 137] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The average of overweight individual can have differential fat depots in target organs or specific compartments of the body. This ectopic fat distribution may be more of a predictive factor for cardiovascular risk than obesity. Abdominal visceral obesity, a representative ectopic fat, is robustly associated with insulin resistance and cardiovascular risk. Fat depots in the liver and muscle tissue cause adverse cardiometabolic risk by affecting glucose and lipid metabolism. Pericardial fat and perivascular fat affect coronary atherosclerosis, cardiac function, and hemodynamics. Fat around the neck is associated with systemic vascular resistance. Fat around the kidney may increase blood pressure and induce albuminuria. Fat accumulation in or around the pancreas alters glucose metabolism, conferring cardiovascular risk. Ectopic fat may act as an active endocrine and paracrine organ that releases various bioactive mediators that influence insulin resistance, glucose and lipid metabolism, coagulation, and inflammation, which all contribute to cardiovascular risk. Because both obese and apparently lean individuals can have ectopic fat, regional fat distribution may play an important role in the development of cardiovascular diseases in both nonobese and obese people.
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Affiliation(s)
- Soo Lim
- From the Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (S.L.); and General Medicine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (J.B.M.)
| | - James B Meigs
- From the Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (S.L.); and General Medicine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (J.B.M.).
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Abstract
BACKGROUND To evaluate the obstructive sleep apnea syndrome (OSAS) in patients with nonarteritic anterior ischemic optic neuropathy (NAION). METHODS We recruited 27 patients with NAION and 27 age-matched and sex-matched controls who also were similar for systemic risk factors such as diabetes mellitus, hypertension, and hypercholesterolemia. All patients and controls underwent overnight polysomnography for the diagnosis of OSAS and calculation of apnea-hypopnea index (AHI). RESULTS Patients and controls were statistically similar in terms of age, sex, gender, smoking, systemic risk factors, neck circumference, and body mass index. The subjects with AHI ≥ 20 were accepted as OSAS. Fifteen of 27 patients (55.6%) with NAION and 6 of 27 controls (22.2%) had OSAS (P < 0.05). CONCLUSION The prevalence of OSAS was higher in patients with NAION, and the difference between patient and control groups was statistically significant (P < 0.05). This result supports prior series suggesting the association between NAION and OSAS.
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Bilgin G. Normal-tension glaucoma and obstructive sleep apnea syndrome: a prospective study. BMC Ophthalmol 2014; 14:27. [PMID: 24612638 PMCID: PMC3975309 DOI: 10.1186/1471-2415-14-27] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 02/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Today, identified risk factors for normal-tension glaucoma (NTG) include abnormal ocular blood flow, abnormal blood coagulation, systemic hypotension, ischemic vascular disorders, and autoimmune diseases. However, pathogenesis of the condition remains unclear. On the other hand, there are also a few studies suggesting that the obstructive sleep apnea syndrome (OSAS) may compromise optic nerve head perfusion and cause glaucomatous optic neuropathy by creating transient hypoxemia and increasing vascular resistance. In this study, we evaluated the possible association between OSAS and NTG. METHODS We recruited 24 patients with NTG and 24 age and sex matched controls who were also similar for systemic risk factors such as diabetes mellitus (DM), hypertension (HT) and hypercholesterolemia. All patients and controls underwent over-night polysomnography (PSG) for the diagnosis of OSAS and calculation of Apnea-Hypopnea Index (AHI). RESULTS Patients and controls were statistically similar in terms of age, sex, gender, smoking, systemic risk factors, neck circumference and body mass index. The subjects with AHI ≥ 20 were accepted as OSAS. Ten (41.7%) of 24 patients with NTG and 3 (12.5%) of 24 controls had OSAS (p < 0.05). CONCLUSIONS The prevalence of OSAS was higher in patients with NTG and the difference between patient and control groups was statistically significant (p < 0.05).
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Affiliation(s)
- Gorkem Bilgin
- Ophthalmologist, Hacettepe University Gün Hospital, Beytepe, 06800 Ankara, Turkey.
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What is known about the experiences of using CPAP for OSA from the users' perspective? A systematic integrative literature review. Sleep Med Rev 2014; 18:357-66. [PMID: 24581718 DOI: 10.1016/j.smrv.2014.01.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 01/08/2014] [Accepted: 01/09/2014] [Indexed: 11/22/2022]
Abstract
UNLABELLED Economic, social and personal costs of untreated obstructive sleep apnoea (OSA) are high. Continuous positive airway pressure (CPAP) is recommended and cost effective. Increasing OSA prevalence may accompany predicted globally increasing obesity. OBJECTIVE To synthesise international evidence regarding personal experiences using CPAP for OSA. METHODS A systematic integrative literature review was conducted and quality assessment criteria applied. RESULTS 22, of 538, identified papers met inclusion criteria. Thematic analysis identified three themes: 1) users' beliefs about CPAP influence users' experiences of CPAP; 2) CPAP users are primed to reflect negatively on experiences of CPAP; and 3) spouse and family influence users' experiences of CPAP. Personality and attitude impact expectations about CPAP prior to use, whilst engagement of spouse and family also influence experiences. Analysis highlighted that users' reporting of CPAP experiences is constrained by investigator defined assessment methods. Overall, research relating to experiences using CPAP is limited. CONCLUSION Users' perspectives of CPAP are constrained by researchers' concern with non-compliance. Typically experiences are not defined by the user, but from an 'expert' healthcare perspective, using words which frame CPAP as problematic. Family and social support is a significant, but neglected area of experiencing CPAP warranting further investigation. More information from users is required to determine how CPAP can be managed successfully.
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Akilli H, Kayrak M, Bekci TT, Erdogan Hİ, Aribas A, Yildirim O, Taner A, Erer M, Unlu A. Gender-Related Changes of the Epicardial Fat Thickness and Leptin in Obstructive Sleep Apnea. Echocardiography 2013; 31:411-9. [DOI: 10.1111/echo.12392] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Hakan Akilli
- Department of Cardiology; Meram Faculty of Medicine; Necmettin Erbakan University; Konya Turkey
| | - Mehmet Kayrak
- Department of Cardiology; Meram Faculty of Medicine; Necmettin Erbakan University; Konya Turkey
| | - Taha Tahir Bekci
- Department of Pulmonary Medicine; Konya Education and Research Hospital; Konya Turkey
| | - Halil İbrahim Erdogan
- Department of Cardiology; Meram Faculty of Medicine; Necmettin Erbakan University; Konya Turkey
| | - Alpay Aribas
- Department of Cardiology; Meram Faculty of Medicine; Necmettin Erbakan University; Konya Turkey
| | - Oguzhan Yildirim
- Department of Cardiology; Meram Faculty of Medicine; Necmettin Erbakan University; Konya Turkey
| | - Alpaslan Taner
- Department of Biochemistry; Dr Faruk Sükan Maternity and Children Hospital; Konya Turkey
| | - Murat Erer
- Department of Cardiology; Meram Faculty of Medicine; Necmettin Erbakan University; Konya Turkey
| | - Ali Unlu
- Department of Biochemistry; Selcuklu School of Medicine; Selcuk University; Konya Turkey
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Lim S, Meigs JB. Ectopic fat and cardiometabolic and vascular risk. Int J Cardiol 2013; 169:166-76. [PMID: 24063931 DOI: 10.1016/j.ijcard.2013.08.077] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 06/16/2013] [Accepted: 08/28/2013] [Indexed: 12/16/2022]
Abstract
Given that the variation in how regional adipose tissue handles and stores excess dietary energy has substantial cardiometabolic implications, ectopic fat distribution might be an important predictor of cardiometabolic and vascular risk, in addition to overall obesity itself. Conceptually, ectopic fat depots may be divided into systemically acting fat depots and locally acting fat depots. Systemically acting fat depots include visceral fat, fat in the liver, muscle, or neck, and subcutaneous fat. Accumulation in the abdominal visceral area, compared with overall obesity, has an equally or more important role in the development of cardiometabolic risk. Fat depots in liver/muscle tissue cause adverse cardiometabolic effects by affecting energy metabolism. Fat depots in lower-body subcutaneous areas may be protective regarding cardiometabolic risk, by trapping remnant energy. Fat accumulation in the neck is a unique type of fat depot that may increase cardiovascular risk by increasing insulin resistance. Locally acting fat depots include pericardial fat, perivascular fat, and renal sinus fat. These fat depots have effects primarily on adjacent anatomic organs, directly via lipotoxicity and indirectly via cytokine secretion. Pericardial fat is associated with coronary atherosclerosis. Perivascular fat may play an independent role in adverse vascular biology, including arterial stiffness. Renal sinus fat is a unique fat depot that may confer additional cardiometabolic risk. Thus, ectopic fat depots may contribute to the understanding of the link between body composition and cardiometabolic risk. In this review, we focus on the role and clinical implications of ectopic fat depots in cardiometabolic and vascular risk.
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Affiliation(s)
- Soo Lim
- General Medicine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea.
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Pataka A, Riha RL. Continuous Positive Airway Pressure and Cardiovascular Events in Patients with Obstructive Sleep Apnea. Curr Cardiol Rep 2013; 15:385. [DOI: 10.1007/s11886-013-0385-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Dziewas R, Hopmann B, Humpert M, Ritter M, Dittrich R, Schäbitz WR, Ringelstein EB, Nabavi DG, Young P. Positional sleep apnea in patients with ischemic stroke. Neurol Res 2013; 30:645-8. [DOI: 10.1179/174313208x289598] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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36
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Dziewas R, Hopmann B, Humpert M, Böntert M, Dittrich R, Lüdemann P, Young P, Ringelstein EB, Nabavi DG. Capnography screening for sleep apnea in patients with acute stroke. Neurol Res 2013; 27:83-7. [PMID: 15829165 DOI: 10.1179/016164105x18359] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Sleep apnea syndrome (SAS) is a prominent clinical feature in acute stroke patients. Diagnosis is usually established by polysomnography or cardio-respiratory polygraphy (CRP). Both diagnostic procedures produce high costs, are dependent on the access to a specialized sleep laboratory, and are poorly tolerated by patients with acute stroke. In this study we therefore investigated whether capnography may work as a simple screening tool in this context. In addition to conventional CRP, 27 patients with acute stroke were studied with capnography provided by our standard monitoring system. The trend graphs of the end-tidal CO(2) values (EtCO(2)) were used to determine the capnography-based estimate of the apnea-hypopnea index (AHI(CO2)). Index events were scored when the EtCO(2) value dropped for > 50% of the previous baseline value. We found that the AHI(CO2) correlated significantly with the apnea-hypopnea index measured with conventional CRP (AHI(CRP)) (r = 0.94; p < 0.001). An AHI(CO2) > 5 turned out to be highly predictive of an AHI(CRP) > 10. According to our findings, routinely acquired capnography may provide a reliable estimate of the AHI(CRP). The equipment needed for this screening procedure is provided by the monitoring systems of most intensive care units and stroke units where stroke patients are regularly treated during the first days of their illness. Therefore, early diagnosis of SAS in these patients is made substantially easier.
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Affiliation(s)
- Rainer Dziewas
- Department of Neurology, University Hospital of Münster, Albert-Schweitzer-Str. 33, D-48129 Münster, Germany.
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Ferre A, Ribó M, Rodríguez-Luna D, Romero O, Sampol G, Molina C, Álvarez-Sabin J. Strokes and their relationship with sleep and sleep disorders. NEUROLOGÍA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.nrleng.2010.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Freet CS, Stoner JF, Tang X. Baroreflex and chemoreflex controls of sympathetic activity following intermittent hypoxia. Auton Neurosci 2013; 174:8-14. [PMID: 23305890 DOI: 10.1016/j.autneu.2012.12.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 11/25/2012] [Accepted: 12/15/2012] [Indexed: 11/29/2022]
Abstract
There is a large amount of evidence linking obstructive sleep apnea (OSA), and the associated intermittent hypoxia that accompanies it, with the development of hypertension. For example, cross-sectional studies demonstrate that the prevalence of hypertension increases with the severity of OSA (Bixler et al., 2000; Grote et al., 2001) and an initial determination of OSA is associated with a three-fold increase for future hypertension (Peppard et al., 2000). Interestingly, bouts of intermittent hypoxia have also been shown to affect sympathetic output associated with the baroreflex and chemoreflex, important mechanisms in the regulation of arterial blood pressure. As such, the possibility exists that changes in the baroreflex and chemoreflex may contribute to the development of chronic hypertension observed in OSA patients. The aim of the current article is to briefly review the response of the baroreflex and chemoreflex to intermittent hypoxic exposure and to evaluate evidence for the hypothesis that modification of these autonomic reflexes may, at least in part, support the comorbidity observed between chronic hypertension and OSA.
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Affiliation(s)
- Christopher S Freet
- The Pennsylvania State University College of Medicine, Department of Neural and Behavioral Sciences, Hershey, PA 17033, USA.
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Fibrinolytic activity and platelet function in subjects with obstructive sleep apnoea and a patent foramen ovale: is there an option for prevention of ischaemic stroke? Stroke Res Treat 2012; 2012:945849. [PMID: 23259151 PMCID: PMC3510867 DOI: 10.1155/2012/945849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 09/28/2012] [Accepted: 09/28/2012] [Indexed: 01/09/2023] Open
Abstract
Obstructive sleep apnoea (OSA) carries an increased risk of ischaemic stroke, but the underlying mechanism is not clear. As right-to-left shunting can occur through a patent foramen ovale (PFO) during periods of apnoea, we investigated nocturnal changes in fibrinolytic activity and platelet function in subjects who had OSA with or without PFO and in controls. We determined plasminogen activator inhibitor 1 (PAI-1) activity and antigen and platelet activation parameters. The severity of OSA was verified by polygraphy and PFO was detected by ear oximetry. We found a higher PAI-1 activity and antigen and a lower ratio of 2,3-dinor-PGF(1α) to 2,3-dinor-TXB(2) in the subjects with OSA than in the controls. Linear regression analysis showed the apnoea-hypopnoea index (β-coefficient, 0.499; P = 0.032) and PFO (β-coefficient, 0.594; P = 0.015) to be associated independently with PAI-1 activity in the morning, while the increment in PAI-1:Ag from evening to morning was significantly associated with the presence of PFO (r(s) = 0.563, P = 0.002). Both OSA and PFO reduce fibrinolytic activity during nocturnal sleep. We hypothesize that subjects having both OSA and PFO may develop a more severe prothrombotic state during sleep than those having either OSA or PFO alone.
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Andonova S, Petkova D, Bocheva Y. Intima-media thickness of the carotid artery in OSAS patients. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.permed.2012.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Affiliation(s)
- David J. Durgan
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX (D.J.D., R.M.B.)
| | - Robert M. Bryan
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX (D.J.D., R.M.B.)
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX (R.M.B.)
- Department of Medicine (Cardiovascular Sciences), Baylor College of Medicine, Houston, TX (R.M.B.)
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Lally F, Thakkar A, Roffe C. Sleep apnoea and stroke. SOMNOLOGIE 2011. [DOI: 10.1007/s11818-011-0523-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chung S, Yoon IY, Ju G. The association of obesity with insulin resistance in male patients with obstructive sleep apnea syndrome in Korea. Psychiatry Investig 2011; 8:245-9. [PMID: 21994512 PMCID: PMC3182390 DOI: 10.4306/pi.2011.8.3.245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 01/07/2011] [Accepted: 01/24/2011] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Obstructive sleep apnea syndrome (OSAS) has been associated with cardiovascular complications and insulin resistance has been implicated in the pathogenesis and progression of atherosclerosis. We investigated whether insulin resistance is associated with OSAS independent of obesity. METHODS A total of 183 male patients with OSAS and 52 healthy controls were assessed by nocturnal polysomnography (NPSG). After NPSG, serum concentrations of total cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, glucose and insulin were measured. Insulin resistance was determined by calculating the homeostasis model assessment for insulin resistance (HOMA-IR). RESULTS Subjects were divided into normal control, mild-to-moderate OSA group (n=96) and severe OSA group (n=87). There were no significant differences among groups in age, body mass index (BMI), neck circumference or waist circumference. Serum concentrations of total cholesterol, LDL cholesterol, triglycerides, glucose, insulin and HOMA-IR scores of normal controls did not differ from those of the mild-to-moderate or severe OSAS groups. HOMA-IR significantly correlated with anthropometric variables, oxygen desaturation index, triglyceride and LDL cholesterol. Stepwise multiple linear regression analysis showed that waist circumference (β=0.35) and triglycerides (β=0.27) were significant determinants of HOMA-IR (adjusted R(2)=20%, p<0.01). CONCLUSION Insulin resistance was related to obesity itself rather than OSAS severity or nocturnal hypoxemia-related variables. In preventing cardiovascular complications in OSAS patients, weight reduction should be considered.
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Affiliation(s)
- Seockhoon Chung
- Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - In-Young Yoon
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Gawon Ju
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
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Pellaton C, Heinzer R, Michel P, Eeckhout E. Patent foramen ovale and obstructive sleep apnoea: from pathophysiology to diagnosis of a potentially dangerous association. Arch Cardiovasc Dis 2011; 104:242-51. [PMID: 21624791 DOI: 10.1016/j.acvd.2010.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 12/14/2010] [Indexed: 11/17/2022]
Abstract
Patent foramen ovale and obstructive sleep apnoea are frequently encountered in the general population. Owing to their prevalence, they may coexist fortuitously; however, the prevalence of patent foramen ovale seems to be higher in patients with obstructive sleep apnoea. We have reviewed the epidemiological data, pathophysiology, and the diagnostic and therapeutic options for both patent foramen ovale and obstructive sleep apnoea. We focus on the interesting pathophysiological links that could explain a potential association between both pathologies and their implications, especially on the risk of stroke.
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Affiliation(s)
- Cyril Pellaton
- Service of cardiology, CHU Vaudois (CHUV), University of Lausanne, 46, rue du Bugnon, 1011 Lausanne, Switzerland
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Tsivgoulis G, Zhang Y, Alexandrov AW, Harrigan MR, Sisson A, Zhao L, Brethour M, Cava L, Balucani C, Barlinn K, Patterson DE, Giannopoulos S, DeWolfe J, Alexandrov AV. Safety and tolerability of early noninvasive ventilatory correction using bilevel positive airway pressure in acute ischemic stroke. Stroke 2011; 42:1030-4. [PMID: 21372308 DOI: 10.1161/strokeaha.110.600221] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Hypercapnia can induce intracranial blood-flow steal from ischemic brain tissues, and early initiation of noninvasive ventilator correction (NIVC) may improve cerebral hemodynamics in acute ischemic stroke. We sought to determine safety and tolerability of NIVC initiated on hospital admission without polysomnography study. SUBJECTS AND METHODS Consecutive acute ischemic stroke patients were evaluated for the presence of a proximal arterial occlusion, daytime sleepiness, or history of obstructive sleep apnea, and acceptable pulse oximetry readings while awake (96%-100% on 2 to 4 L supplemental oxygen delivered by nasal cannula). NIVC was started on hospital admission as standard of care when considered necessary by treating physicians. NIVC was initiated using bilevel positive airway pressure at 10 cmH(2)O inspiratory positive airway pressure and 5 cmH(2)O expiratory positive airway pressure in combination with 40% fraction of inspired oxygen. All potential adverse events were prospectively documented. RESULTS Among 356 acute ischemic stroke patients (median NIHSS score, 5; interquartile range, 2-13), 64 cases (18%) received NIVC (median NIHSS score, 12; interquartile range, 6-17). Baseline stroke severity was higher and proximal arterial occlusions were more frequent in NIVC patients compared to the rest (P<0.001). NIVC was not tolerated by 4 patients (7%). Adverse events in NIVC included vomiting (n=1), aspiration pneumonia (n=1), respiratory failure/intubation (n=1), hypotension requiring pressors (n=1), and facial skin breakdown (n=3). The in-hospital mortality rate was 13% in NIVC patients and 8% in the rest (P=0.195). Neurological improvement during hospitalization tended to be greater in the NIVC group (median NIHSS score decrease, 2 points; interquartile range, 0-4) compared to the rest (median NIHSS score decrease, 1; interquartile range, 0-2; P=0.078). CONCLUSIONS In acute ischemic stroke patients with proximal arterial occlusion and excessive sleepiness or obstructive sleep apnea, NIVC can be initiated early with good tolerability and a relatively small risk of serious complications.
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Affiliation(s)
- Georgios Tsivgoulis
- Comprehensive Stroke Center, University of Alabama at Birmingham Hospital, Birmingham, AL, USA
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Kwok KL, Yung TC, Ng DK, Chan CH, Lau WF, Fu YM. Heart rate variability in childhood obstructive sleep apnea. Pediatr Pulmonol 2011; 46:205-10. [PMID: 21246757 DOI: 10.1002/ppul.21268] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 04/14/2010] [Accepted: 04/15/2010] [Indexed: 11/09/2022]
Abstract
The identification of patients with obstructive sleep apnea (OSA) is important because of morbidities associated with OSA. A previous adult study demonstrated the use of heart rate variability (HRV) as a tool to identify patients with moderate to severe OSA. Either a reduction in time parameters or an increase in LF/HF ratio was seen at overnight or 24-hr studies suggestive of increased sympathetic modulation. To study the feasibility of daytime HRV as a screening tool, a short-term recording of HRV is studied. Since it was shown in adult study that increased normalized LF, decreased normalized HF and increased LF/HF ratio could be detectable during supine rest at daytime awake period, the authors hypothesize that the differences are also detectable in children. Children who underwent sleep polysomnography for suspected OSA were recruited. Subjects were classified OSA if apnea-hypopnea index (AHI) > 1.5/hr and non-OSA if AHI ≤ 1.5/hr. Continuous 1-hr electrocardiographic monitoring was recorded in awake children during the day. Parameters from time domain and frequency domain were analyzed. Seventy-four male and 17 female snoring subjects were included in this study. Fifty-one (56%) and 40 (44%) of them were classified as "non-OSA" and "OSA," respectively. pNN50, a parameter for parasympathetic modulation, was significantly reduced in the OSA group when compared with the non-OSA group. Using multiple regression, all time domain variables were shown to be decreased in OSA group. Our results suggest that 1-hr study of HRV may be a feasible tool in identifying children with OSA.
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Affiliation(s)
- Ka-Li Kwok
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong SAR, China.
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Chen TI, Lai CJ, Hsieh CJ, Tsai KL, Yang KT. Differences in left ventricular cardiomyocyte loss induced by chronic intermittent hypoxia between spontaneously hypertensive and Wistar-Kyoto rats. Sleep Breath 2010; 15:845-54. [PMID: 21136300 DOI: 10.1007/s11325-010-0448-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 11/12/2010] [Accepted: 11/18/2010] [Indexed: 02/07/2023]
Abstract
RATIONALE Chronic intermittent hypoxia (CIH) is thought to induce several cardiovascular effects in patients with obstructive sleep apnoea (OSA). However, the effects of CIH on patients with long-standing hypertension are unknown. PURPOSE This prospective study aimed to investigate the influence of combined OSA and hypertension on cardiomyocyte death. METHODS Wistar-Kyoto rats (WKY) and spontaneously hypertensive rats (SHR) were exposed to repetitive hypoxia-reoxygenation cycles (30 s of 5% O(2); 45 s of 21% O(2)) or room air for 6 h/day during the light phase (10 a.m.-4 p.m.) for 10, 20, or 30 days, and the levels of necrosis and apoptosis induced in their left ventricular cardiomyocyte were examined. RESULTS CIH increased the accumulation of reactive oxygen species, which induced cardiomyocyte necrosis in WKY and SHR (both p < 0.05). Cardiomyocyte oxidative stress levels by CIH were higher in SHR than in WKY (p < 0.05); therefore, cardiomyocyte necrosis was amplified (p < 0.05). Notably, if a superoxide-scavenging agent is injected beforehand, cardiomyocyte necrosis can be effectively inhibited (p < 0.05). When WKY and SHR are exposed to CIH, increases in mitochondria-released cytochrome c and activation of caspase-3 are found in the cytosolic fraction only in WKY. CONCLUSIONS CIH causes cardiomyocyte loss in SHR mainly through cardiomyocyte necrosis. In WKY however, CIH simultaneously induces apoptosis and necrosis of cardiomyocytes.
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Affiliation(s)
- Tsung-I Chen
- Institute of Medical Sciences, College of Medicine, Tzu Chi University, Hualien, Taiwan
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Ferre A, Ribó M, Rodríguez-Luna D, Romero O, Sampol G, Molina CA, Álvarez-Sabin J. Strokes and their relationship with sleep and sleep disorders. Neurologia 2010; 28:103-18. [PMID: 21163212 DOI: 10.1016/j.nrl.2010.09.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 08/26/2010] [Accepted: 09/18/2010] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION In the current population, strokes are one of the most important causes of morbidity and mortality, to which new risk factors are increasingly being attributed. Of late, there is increased interest in the relationship between sleep disorders and strokes as regards risk and prognosis. DEVELOPMENT This article presents the changes in sleep architecture and brain activity in stroke patients, as well as the interaction between stroke and sleep disorders, including those which may also influence the outcome and recovery from strokes. The different treatments discussed in the literature are also reviewed, as correct treatment of such sleep disorders may not only improve quality of life and reduce after-effects, but can also increase life expectancy. CONCLUSIONS Sleep disorders are becoming increasingly associated with stroke. In addition to being a risk factor, they can also interfere in the outcome and recovery of stroke patients. This article aims to present an exhaustive and current review on strokes and their relationship with sleep alterations and sleep disorders.
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Affiliation(s)
- A Ferre
- Servicio de Neurofisiología Clínica, Unidad de Sueño, Hospital Universitario de la Vall d'Hebron, Barcelona, España.
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Abstract
Stroke is the third leading cause of death in the United States and the number one cause of adult long-term disability. Disability in stroke survivors includes hemiparesis, aphasia, inability to walk without assistance, dependence on others for activities of daily living, depression, and institutionalization. Immediate recognition of acute ischemic stroke (AIS) signs and symptoms is required because many treatment options are time sensitive. Hospital transport via activation of 911 and emergency medical services (EMSs) removes delays to urgent diagnosis and intervention. Intravenous (IV) recombinant tissue plasminogen (rt-PA) is a time-sensitive reperfusion strategy. The American Heart Association (AHA) and American Stroke Association (ASA) recently revised recommendations that the time window for IV rt-PA be expanded from 3 hours to 4.5 hours after symptom onset in patients with mild to moderate stroke. Supportive therapies include crystalloid IV solutions, adequate oxygenation, and normothermia. Best rest is desired along with oxygen supplementation. Avoidance of fever is paramount since fever can contribute to negative outcomes. It is the purpose of this article to review risk factors, stroke symptoms, epidemiology, and current drug therapy of AIS. Standards of care will be reviewed.
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Affiliation(s)
| | - Stacey L. McCoy
- Emergency Department, Baptist Medical Center Jacksonville, FL, USA
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