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Lisabeth LD, Zhang G, Chervin RD, Shi X, Morgenstern LB, Campbell M, Tower S, Brown DL. Longitudinal Assessment of Sleep Apnea in the Year After Stroke in a Population-Based Study. Stroke 2023; 54:2356-2365. [PMID: 37485665 PMCID: PMC10527822 DOI: 10.1161/strokeaha.123.042325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/05/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND The aim of this study was to characterize change in sleep-disordered breathing severity in the year following stroke, overall, and by ethnicity, within the population-based Brain Attack Surveillance in Corpus Christi Project. METHODS First-ever ischemic strokes (n=414) were ascertained by active and passive surveillance and validated by stroke-trained physicians. Patients with stroke were invited to participate in portable sleep apnea testing (ApneaLink Plus) at baseline and 3, 6, and 12 months poststroke. Sleep-disordered breathing severity was assessed by the respiratory event index (apneas and hypopneas/hour of recording). The component obstructive apnea index and central apnea index were also assessed. Time and ethnicity effects on outcomes, as well as ethnic differences in time effects, were analyzed using generalized estimating equations with multivariable adjustment for confounding factors. RESULTS Mean age (n=414) was 63.9 years (SD=10.9); 68.4% were Mexican American. Baseline mean respiratory event index, obstructive apnea index, and central apnea index were 21.3 (SD=16.6), 8.6 (SD=11.5), and 1.5 (SD=3.2), respectively. There was no time effect on respiratory event index (P=0.35) but obstructive apnea index increased over time (P<0.01). Averaged over follow-up, respiratory event index and obstructive apnea index were significantly higher in Mexican American than non-Hispanic White persons. No ethnic difference in the time effect was found for either outcome. For central apnea index, there was an ethnicity-time interaction (P=0.01) such that central apnea index increased in non-Hispanic White but did not change in Mexican American persons. CONCLUSIONS Sleep-disordered breathing severity was significant and stable for most individuals in the year after stroke. These results do not confirm previous reports of diminishing sleep-disordered breathing severity over time after stroke and would support early assessment and treatment where indicated.
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Affiliation(s)
- Lynda D Lisabeth
- Department of Epidemiology (L.D.L., L.B.M.), University of Michigan School of Public Health, Ann Arbor
- Stroke Program (L.D.L., L.B.M., D.L.B.), University of Michigan Health System
| | - Guanghao Zhang
- Department of Biostatistics (G.Z., X.S.), University of Michigan School of Public Health, Ann Arbor
| | - Ronald D Chervin
- Michael S Aldrich Sleep Disorders Laboratory (R.D.C.), University of Michigan Health System
| | - Xu Shi
- Department of Biostatistics (G.Z., X.S.), University of Michigan School of Public Health, Ann Arbor
| | - Lewis B Morgenstern
- Department of Epidemiology (L.D.L., L.B.M.), University of Michigan School of Public Health, Ann Arbor
- Stroke Program (L.D.L., L.B.M., D.L.B.), University of Michigan Health System
| | | | | | - Devin L Brown
- Stroke Program (L.D.L., L.B.M., D.L.B.), University of Michigan Health System
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Frange C, Elias RM, Siengsukon C, Coelho FMS. Physical activity for obstructive sleep apnea after stroke? A pilot study assessing the contribution of body fluids. Sleep Breath 2023; 27:1343-1350. [PMID: 36327028 DOI: 10.1007/s11325-022-02735-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/10/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) and physical inactivity are common after stroke. Physical inactivity can lead to/or exacerbate edema following stroke, and the resultant overnight fluid shift may increase the risk of OSA. We aimed to investigate the effect of physical activity on nocturnal rostral fluid shift, sleep pattern, and edematous state of hemiparetic patients. METHODS Neck circumference (tape measured) and arms, legs, and trunk fluid volume (bioelectrical impedance spectrum analyzer) were measured before and after 2 polysomnography (PSG) examinations. In the lab, a whole night PSG was performed after the intervention. The intervention consisted of inactivity (lying down and sitting) or activity (standing, performing calf muscle contractions while standing, walking, and climbing stairs) between 13 and 21 h, after the randomization of the participants. With a 7-day interval, participants crossed over to the other group. RESULTS From 126 eligible participants, 8 with hemiparetic post-first-ever ischemic stroke at the subacute phase were recruited (age: 53.2 ± 16.2; 6 women). Physical activity reduced AHI from 19 to 13 n°/h and wake after sleep onset from 76.5 to 60.3 min and increased fluid volume of paretic and non-paretic arms and trunk before sleep compared to inactivity. CONCLUSION An acute bout of physical activity reduced OSA classification based on AHI (from moderate to mild) and sleep fragmentation. Our results provide preliminary evidence of a possible link between physical activity in patients after stroke as an intervention to counteract OSA severity and improve sleep.
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Affiliation(s)
- Cristina Frange
- Neurology and Neurosurgery Department, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
| | - Rosilene Motta Elias
- Nephrology Division, Department of Medicine of the Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Catherine Siengsukon
- Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kanasas, USA
| | - Fernando Morgadinho Santos Coelho
- Neurology and Neurosurgery Department, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
- Psychobiolgy Department, UNIFESP, São Paulo, Brazil
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Tsai CY, Huang HT, Liu M, Cheng WH, Hsu WH, Kuan YC, Majumdar A, Lee KY, Feng PH, Tseng CH, Chen KY, Kang JH, Lee HC, Wu CJ, Liu WT. Associations between air pollution, intracellular-to-extracellular water distribution, and obstructive sleep apnea manifestations. Front Public Health 2023; 11:1175203. [PMID: 37397706 PMCID: PMC10310528 DOI: 10.3389/fpubh.2023.1175203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/16/2023] [Indexed: 07/04/2023] Open
Abstract
Background Exposure to air pollution may be a risk factor for obstructive sleep apnea (OSA) because air pollution may alter body water distribution and aggravate OSA manifestations. Objectives This study aimed to investigate the mediating effects of air pollution on the exacerbation of OSA severity through body water distribution. Methods This retrospective study analyzed body composition and polysomnographic data collected from a sleep center in Northern Taiwan. Air pollution exposure was estimated using an adjusted nearest method, registered residential addresses, and data from the databases of government air quality motioning stations. Next, regression models were employed to determine the associations between estimated air pollution exposure levels (exposure for 1, 3, 6, and 12 months), OSA manifestations (sleep-disordered breathing indices and respiratory event duration), and body fluid parameters (total body water and body water distribution). The association between air pollution and OSA risk was determined. Results Significant associations between OSA manifestations and short-term (1 month) exposure to PM2.5 and PM10 were identified. Similarly, significant associations were identified among total body water and body water distribution (intracellular-to-extracellular body water distribution), short-term (1 month) exposure to PM2.5 and PM10, and medium-term (3 months) exposure to PM10. Body water distribution might be a mediator that aggravates OSA manifestations, and short-term exposure to PM2.5 and PM10 may be a risk factor for OSA. Conclusion Because exposure to PM2.5 and PM10 may be a risk factor for OSA that exacerbates OSA manifestations and exposure to particulate pollutants may affect OSA manifestations or alter body water distribution to affect OSA manifestations, mitigating exposure to particulate pollutants may improve OSA manifestations and reduce the risk of OSA. Furthermore, this study elucidated the potential mechanisms underlying the relationship between air pollution, body fluid parameters, and OSA severity.
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Affiliation(s)
- Cheng-Yu Tsai
- Department of Civil and Environmental Engineering, Imperial College London, London, United Kingdom
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Huei-Tyng Huang
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Ming Liu
- Department of Biology, University of Oxford, Oxfordshire, United Kingdom
| | - Wun-Hao Cheng
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Respiratory Therapy, Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan
| | - Wen-Hua Hsu
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Chun Kuan
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
| | - Arnab Majumdar
- Department of Civil and Environmental Engineering, Imperial College London, London, United Kingdom
| | - Kang-Yun Lee
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Po-Hao Feng
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Chien-Hua Tseng
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Kuan-Yuan Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Jiunn-Horng Kang
- Research Center of Artificial Intelligence in Medicine, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Nanomedicine and Medical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Hsin-Chien Lee
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Cheng-Jung Wu
- Department of Otolaryngology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Wen-Te Liu
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Research Center of Artificial Intelligence in Medicine, Taipei Medical University, Taipei, Taiwan
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Kawasaki Y, Kitamura E, Kasai T. Impact of Body Composition on Sleep and Its Relationship with Sleep Disorders: Current Insights. Nat Sci Sleep 2023; 15:375-388. [PMID: 37220427 PMCID: PMC10200107 DOI: 10.2147/nss.s340946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 05/04/2023] [Indexed: 05/25/2023] Open
Abstract
Sleep is involved in many physiological processes and is essential for both physical and mental health. Obesity and sleep deprivation due to sleep disorders are major public health issues. Their incidence is increasing, and they have a wide range of adverse health-related consequences, including life-threatening cardiovascular disease. The impact of sleep on obesity and body composition is well-known, and many studies have shown an association between insufficient or excessive sleep duration and obesity, body fat percentage, and weight gain. However, there is growing evidence of the effects of body composition on sleep and sleep disorders (particularly sleep disordered breathing) through anatomical and physiological mechanisms (nocturnal fluid shift, core body temperature, or diet). Although some research has been conducted on the bidirectional effects of sleep-disordered breathing and body composition, the specific effects of obesity and body composition on sleep and the underlying mechanisms that explain these effects remain unclear. Therefore, this review summarizes the findings on the effects of body composition on sleep and draws conclusions and proposals for future research in this field.
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Affiliation(s)
- Yu Kawasaki
- Department of Obstetrics and Gynecology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Eri Kitamura
- Department of Obstetrics and Gynecology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Cardiovascular Management and Remote Monitoring, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Gao Y, Zhao LB, Li K, Su X, Li X, Li J, Zhao Z, Wang H, He Z, Fang F, Xu W, Qian X, Fan L, Liu L. The J-shape Association between Total Bilirubin and Stroke in Older Patients with Obstructive Sleep Apnea Syndrome: A Multicenter Study. J Nutr Health Aging 2023; 27:692-700. [PMID: 37754208 DOI: 10.1007/s12603-023-1965-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 06/05/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVES To explore the relationship between total bilirubin (TBil) and stroke risk in older patients with obstructive sleep apnea syndrome (OSAS). METHODS A total of 1,007 patients with OSAS without stroke history aged ≥ 60 years and with complete serum TBil records were enrolled in this study. The median follow-up was 42 months. Participants were divided into four groups based on the quartile of the baseline serum TBil concentration. Multivariate Cox proportional hazards analysis and restricted cubic spline (RCS) were used to investigate the association of TBil with the incidence of new-onset stroke. RESULTS The PRIMARY part: the third quantile TBil level group had the lowest prevalence of stroke among the four groups. The RCS functions depicted a J-type curve relationship between TBil (3.3-33.3 µmol/L) and stroke (nonlinear P < 0.05). When the TBil level was in the range of 3.3 to 11.5 µmol/L, the possible protective influence of bilirubin against stroke in patients with OSAS enhanced with an increasing TBil level. However, when the TBil level exceeded 11.5 µmol/L and gradually increased, the effect of TBil on stroke risk became more and more pronounced. The SECONDARY part: for every 1 µmol/L increase in TBil levels in the range of 11.5 to 33.3 µmol/L, the risk of stroke in patients with OSAS increased by 16.2% (P < 0.001). In addition, there was a higher risk in women with OSAS (hazard ratio (HR)=1.292, 95% confidence interval (95%CI): 1.093-1.528; P = 0.003). Moreover, an increased TBil level alone was significantly associated with stroke in subjects aged < 75 years (HR: 1.190, 95%CI: 1.069-1.324), patients with mild-to-moderate OSAS (HR: 1.215, 95%CI: 1.083-1.364), and individuals without atrial fibrillation (AF) (HR: 1.179, 95%CI: 1.083-1.285) within a TBil level in the range of 11.5 to 33.3 µmol/L. CONCLUSIONS Both lower and higher bilirubin levels may increase the risk of stroke in older persons with OSAS, and there was a J-type dose-response relationship. The risk of stroke was lowest when the TBil level was approximately 11.5 µmol/L.
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Affiliation(s)
- Y Gao
- Lin Liu, MD, Department of Pulmonary and Critical Care Medicine of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China. ; Li Fan, MD, Cardiology Department of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China. ; Xiaoshun Qian, MD, Department of Pulmonary and Critical Care Medicine of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China.
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Sleep and Stroke: Opening Our Eyes to Current Knowledge of a Key Relationship. Curr Neurol Neurosci Rep 2022; 22:767-779. [PMID: 36190654 PMCID: PMC9633474 DOI: 10.1007/s11910-022-01234-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW To elucidate the interconnection between sleep and stroke. RECENT FINDINGS Growing data support a bidirectional relationship between stroke and sleep. In particular, there is strong evidence that sleep-disordered breathing plays a pivotal role as risk factor and concur to worsening functional outcome. Conversely, for others sleep disorders (e.g., insomnia, restless legs syndrome, periodic limb movements of sleep, REM sleep behavior disorder), the evidence is weak. Moreover, sleep disturbances are highly prevalent also in chronic stroke and concur to worsening quality of life of patients. Promising novel technologies will probably allow, in a near future, to guarantee a screening of commonest sleep disturbances in a larger proportion of patients with stroke. Sleep assessment and management should enter in the routinary evaluation of stroke patients, of both acute and chronic phase. Future research should focus on the efficacy of specific sleep intervention as a therapeutic option for stroke patients.
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