Continuous Positive Airway Pressure Treatment in Sleep Apnea Prevents New Vascular Events After Ischemic Stroke

Martínez‐García, Miguel Ángel; Galiano-Blancart, Rafael; Román-Sánchez, Pilar; Soler-Cataluña, Juan José; Cabero-Salt, Luis; Salcedo-Maiques, Enmanuel

doi:10.1378/chest.128.4.2123

Cited by 192 publications

(96 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A potential causal association between OSA and stroke is also consistent with an uncontrolled study demonstrating reduced recurrent vascular events in patients who experienced strokes and OSA who were treated with positive airway pressure therapy compared with patients with untreated OSA (35). However, a small intervention study of OSA treatment in stroke patients did not show improved outcomes in treated compared with untreated patients (36).…”

Section: Discussionsupporting

confidence: 69%

Obstructive Sleep Apnea–Hypopnea and Incident Stroke

Redline¹,

Yenokyan

Gottlieb³

et al. 2010

Am J Respir Crit Care Med

1,120

494

View full text Add to dashboard Cite

Rationale: Although obstructive sleep apnea is associated with physiological perturbations that increase risk of hypertension and are proatherogenic, it is uncertain whether sleep apnea is associated with increased stroke risk in the general population. Objectives: To quantify the incidence of ischemic stroke with sleep apnea in a community-based sample of men and women across a wide range of sleep apnea. Methods: Baseline polysomnography was performed between 1995 and 1998 in a longitudinal cohort study. The primary exposure was the obstructive apnea-hypopnea index (OAHI) and outcome was incident ischemic stroke. Measurements and Main Results: A total of 5,422 participants without a history of stroke at the baseline examination and untreated for sleep apnea were followed for a median of 8.7 years. One hundred ninety-three ischemic strokes were observed. In covariate-adjusted Cox proportional hazard models, a significant positive association between ischemic stroke and OAHI was observed in men (P value for linear trend: P 5 0.016). Men in the highest OAHI quartile (.19) had an adjusted hazard ratio of 2.86 (95% confidence interval, 1.1-7.4). In the mild to moderate range (OAHI, 5-25), each one-unit increase in OAHI in men was estimated to increase stroke risk by 6% (95% confidence interval, 2-10%). In women, stroke was not significantly associated with OAHI quartiles, but increased risk was observed at an OAHI greater than 25. Conclusions: The strong adjusted association between ischemic stroke and OAHI in community-dwelling men with mild to moderate sleep apnea suggests that this is an appropriate target for future stroke prevention trials.Keywords: sleep apnea; stroke; epidemiology Approximately 15.3 million strokes occur annually worldwide, and about one-third of these are fatal (1). Stroke is not only the second leading cause of death globally, but it also accounts for significant disability, institutionalization, and health care costs (2). Because stroke rates increase exponentially with advancing age, the public health importance of strokes is likely to increase as the population ages. The risk of stroke is particularly high in African Americans, American Indians, and elderly women (2). Numerous studies have identified risk factors for stroke, including hypertension, atrial fibrillation, diabetes, and smoking (2-5). Even after considering these well-recognized risk factors, there is substantial variation in stroke rates and stroke-related outcomes.Emerging data implicate obstructive sleep apnea (OSA) in the pathogenesis of risk factors associated with ischemic stroke (i.e., hypertension, coronary heart disease, diabetes, and atrial fibrillation) (6). These associations are believed to be mediated by adverse physiological responses to recurrent periods of pharyngeal occlusion and consequent oxyhemoglobin desaturation-resaturation. These responses result in free radical generation, release of proinflammatory and prothrombotic mediators, and surges in sympathetic nervous system activity and blood pressure. Th...

show abstract

Section: Discussionsupporting

confidence: 69%

Obstructive Sleep Apnea–Hypopnea and Incident Stroke

Redline¹,

Yenokyan

Gottlieb³

et al. 2010

Am J Respir Crit Care Med

1,120

494

View full text Add to dashboard Cite

show abstract

“…Stroke Several publications suggest that CPAP treatment could have favourable effects in stroke patients with OSA [137][138][139][140][141]. Despite this, CPAP acceptance represents a major problem in treating this type of patient.…”

Section: Exercisementioning

confidence: 99%

Recommendations for the management of patients with obstructive sleep apnoea and hypertension

Parati

Lombardi²,

Hedner³

et al. 2013

Eur Respir J

212

132

View full text Add to dashboard Cite

on behalf of the EU COST Action B26 members ABSTRACT: This article is aimed at addressing the current state-of-the-art in epidemiology, pathophysiology, diagnostic procedures and treatment options for appropriate management of obstructive sleep apnoea (OSA) in cardiovascular (in particular hypertensive) patients, as well as for the management of cardiovascular diseases (in particular arterial hypertension) in OSA patients. The present document is the result of work performed by a panel of experts participating in the European Union COST (Cooperation in Scientific and Technological research) Action B26 on OSA, with the endorsement of the European Respiratory Society and the European Society of Hypertension. In particular, these recommendations are aimed at reminding cardiovascular experts to consider the occurrence of sleep-related breathing disorders in patients with high blood pressure. They are also aimed at reminding respiration experts to consider the occurrence of hypertension in patients with respiratory problems at night.

show abstract

“…Oxygen, mechanical ventilation, and tracheostomy are available options in patients with central sleep apnea, central hypoventilation, and Cheyne-Stroke respiration. Although CPAP compliance was 70% in the rehabilitation setting, in the acute phase the rate remains at approximately 25% [101]. In another study, stroke patients with SDB who did not tolerate CPAP had higher 5-year mortality than those who tolerated CPAP [102].…”

Section: Sleep Disordered Breathingmentioning

confidence: 99%

Treatment of Risk Factors to Prevent Stroke

Aoki

Uchino

2011

Neurotherapeutics

View full text Add to dashboard Cite

Much of the decline in stroke incidence and mortality for the past several decades in Western countries has been attributed to better treatment of risk factors. Many epidemiological studies and clinical trials confirmed the importance of managing hypertension. Comparative trials of anti-hypertensive drugs or drug classes have not yielded clear results, but blood pressure variability may play an important role beyond the absolute value of blood pressure. Diabetes therapy remains a conundrum. Although diabetes is clearly a risk factor for ischemic stroke, treatment trials targeting different glycemic goals have not indicated that glucose lowering results in stroke prevention. Trials focused on insulin resistance are ongoing and they may be able to help establish the management of diabetes/impaired glucose tolerance. Evidence for treatment of dyslipidemia has contrasted science to diabetes mellitus. Dyslipidemia has not been strongly or consistently linked to ischemic stroke but the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial showed the impact of statin treatment in stroke prevention. The results of clinical trials investigating dabigatran and rivaroxaban clearly indicate alternative strategies to vitamin K antagonists in stroke prevention for persons with atrial fibrillation. Evidence for stroke prevention by life style modification, treating metabolic syndrome, sleep disordered breathing, lipoprotein (a), hyperhomocysteinemia, and coagulation disorders are also discussed.

show abstract

Continuous Positive Airway Pressure Treatment in Sleep Apnea Prevents New Vascular Events After Ischemic Stroke

Cited by 192 publications

References 35 publications

Obstructive Sleep Apnea–Hypopnea and Incident Stroke

Obstructive Sleep Apnea–Hypopnea and Incident Stroke

Recommendations for the management of patients with obstructive sleep apnoea and hypertension

Treatment of Risk Factors to Prevent Stroke

Contact Info

Product

Resources

About