Cerebral Hemodynamics in Obstructive Sleep Apnea

Siebler, Mario; Nachtmann, Andreas

doi:10.1378/chest.103.4.1118

Cited by 51 publications

(48 citation statements)

References 11 publications

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“…The latter might be secondary to (1) sympathetic surge-induced arterial hypertension and hypertensive arteriosclerosis, (2) vascular dysregulation due to imbalance between nitric oxide (vasodilator) and endothelin (vasoconstrictor), (3) abnormal platelet aggregation and activation leading to microinfarcts in the optic nerve, or (4) episodic-raised intracranial pressure. 6,15,17,18 The absence of statistically significant differences between the incidences of hightension glaucoma in the OSA arm (3.66%) and control arm (2.94%) in our study, speaks against the hypothesis of unrecognized, nocturnal high-tension glaucoma as a cause of the optic neuropathy, which was suggested by Marcus et al…”

Section: Discussioncontrasting

confidence: 46%

“…[1][2][3][4] OSA is well known to result in a number of health consequences: fragmentation of sleep leads to chronic sleep deprivation and daytime somnolence, hence affecting the patients' daily cognitive function and quality of life, increasing incidences of work-related and motor vehicle accidents; cardio-respiratory disturbances lead to elevated risks of complications such as hypertension, pulmonary hypertension, cardiac arrhythmia, myocardial infarction, congestive cardiac failure, and stroke. [1][2][3][4][5][6] Recently, possible ocular manifestations, including optic neuropathy in the form of visual field (VF) defect and disc oedema, normal-tension glaucoma (NTG), pseudotumour cerebri, nonarteritic anterior ischaemic optic neuropathy (NAAION); and anterior segment complications such as floppy eyelid syndrome, upper lid ptosis, lower lid ectropion, blepharochalasis, trichiasis, chronic conjunctivitis, keratoconus, exposure keratopathy, dry eyes, recurrent corneal erosion (RCE), keratitis, and progressive endotheliopathy have aroused ophthalmologists' concern. [7][8][9][10][11][12][13][14][15] However, there are limited evidences in published articles of causal relationship between OSA and the various ocular manifestations, especially in the Chinese locality.…”

Section: Introductionmentioning

confidence: 99%

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Moderate to severe obstructive sleep apnoea patients is associated with a higher incidence of visual field defect

Tsang

Chong

et al. 2005

Eye

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Purpose To compare the visual fields (VFs) and optic nerve head changes between obstructive sleep apnoea (OSA) in normotensive patients and an age-matched non-OSA population. Design Case-control study. Participants A total of 41 ethnic Chinese patients diagnosed with moderate to severe OSA referred from the Sleep Laboratory, ENT Department, Tuen Mun Hospital. A total of 35 age-matched non-OSA subjects recruited from the Ophthalmology Department, North District Hospital. Methods Comprehensive ophthalmological and systemic history, complete ophthalmological examination, including central-30 computerized perimetry for all studied patients. Main outcome measures Polysomnographic data, VF indices, optic disc changes Results In the OSA arm, VF indices were significantly subnormal and the incidence of suspicious glaucomatous disc changes was four times higher than that of the control arm. None of the studied patients suffered from any form of anterior segment complications. Conclusions Moderate to severe OSA is associated with a higher incidence of VF defect and glaucomatous optic nerve changes.

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Section: Discussioncontrasting

confidence: 46%

Section: Introductionmentioning

confidence: 99%

Moderate to severe obstructive sleep apnoea patients is associated with a higher incidence of visual field defect

Tsang

Chong

et al. 2005

Eye

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“…Studies with transcranial Doppler, xenon inhalation or single-photon emission CT have shown a reduction in cerebral blood flow during non-REM sleep and an increase during REM sleep [49,50,51]. …”

Section: Confounding Risk Factors or Potential Mediators For Stroke Imentioning

confidence: 99%

Sleep-Disordered Breathing and Acute Stroke

et al. 2009

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Background: Sleep-disordered breathing (SDB) is a disease of increasing importance and it is frequent in stroke patients. SDB is being recognized as an independent risk factor for several clinical consequences, including cardiovascular and cerebrovascular disease. Methods: The present review summarizes the current evidence for an independent association between SDB and stroke, defining SDB subgroups, mechanisms, confounding factors and other epidemiological aspects. We analyze stroke outcome and prognosis in SDB patients. A search for recent data on this issue was made in several population-based studies and reference lists of articles. Results: Many recent studies have shown an association between SDB and stroke. Moreover, there is a high prevalence of sleep apnea in patients with stroke. The pathogenesis of stroke in obstructive sleep apnea syndrome is not completely understood and likely to be multifactorial. Several mechanisms like hemodynamic disturbances and inflammatory or endothelial dysfunction could be involved. The presence of SDB in stroke patients may lead to a poor outcome and recurrence. Noninvasive treatments such as continuous positive airway pressure may decrease the risk of stroke in terms of secondary, and possibly, primary prevention. Conclusions: SDB is associated with cerebrovascular morbidity and an unfavorable clinical course. The presence of SDB should be systematically screened in patients with acute stroke. Further studies are needed to determine whether continuous positive airway pressure treatment ameliorates stroke outcome and prognosis.

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“…TCD has been used to measure BF during sleep since 1990s. [23][24][25][26] However, TCD faces similar technical challenges of obtaining clean signals while patients were asleep, since the requirement to keep the Doppler probe in place in the medial cerebral artery during sleep was di±cult. 27 In addition TCD re°ects hemodynamics of the middle arteries but not of the arterioles, which are responsible for mediating cerebral autoregulation.…”

Section: Introductionmentioning

confidence: 99%

Near-infrared spectroscopy (NIRS) as a useful tool to evaluate the treatment efficacy of positive airways pressure therapy in patients with obstructive sleep apnea syndrome (OSAS): A pilot study

Zhang

Schneider

Fritschi

et al. 2014

J. Innov. Opt. Health Sci.

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In obstructive sleep apnea syndrome (OSA) the periodic reduction or cessation of breathing due to narrowing or occlusion of the upper airway during sleep leads to an impaired cerebral vascular autoregulation that is associated with an increased cardiovascular risk, including stroke. Continuous positive airways pressure (CPAP) therapy at night is the most e®ective treatment for OSA and has been shown to reduce the cardiovascular risk in OSA patients. However, there is no suitable bedside monitoring method evaluating the recovery of cerebral hemodynamics during CPAP therapy. Near-infrared spectroscopy (NIRS) is ideally suited for non-invasive monitoring the cerebral hemodynamics during sleep due to its properties of local measurement, totally safe application and good tolerance to motion. In this pilot study, we monitored cerebral hemodynamics during standard CPAP therapy at night in three patients with severe OSA using NIRS. We found periodic oscillations in HbO 2 , HHb, tissue oxygenation index (TOI) and blood volume (BV) associated with periodic apnea events without CPAP in all OSA patients. These oscillations were eliminated under the optimal CPAP pressures in all patients. These results suggested that the recovery of cerebral hemodynamics impaired by apnea events can be evaluated by bedside NIRS measurements in real time during all night CPAP therapy. NIRS is a useful bedside monitoring tool to evaluate the treatment e±cacy of CPAP therapy in patients with OSA.

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Cerebral Hemodynamics in Obstructive Sleep Apnea

Cited by 51 publications

References 11 publications

Moderate to severe obstructive sleep apnoea patients is associated with a higher incidence of visual field defect

Moderate to severe obstructive sleep apnoea patients is associated with a higher incidence of visual field defect

Sleep-Disordered Breathing and Acute Stroke

Near-infrared spectroscopy (NIRS) as a useful tool to evaluate the treatment efficacy of positive airways pressure therapy in patients with obstructive sleep apnea syndrome (OSAS): A pilot study

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