Effect of continuous positive airway pressure on regional cerebral blood flow during wakefulness in obstructive sleep apnea

Shiota, Satomi; Inoue, Yuichi; Takekawa, Hidenori; Kotajima, Masaki; Nakajyo, Mami; Usui, Chie; Yoshioka, Yasuko; Koga, Tatsuo; Takahashi, Kazuhisa

doi:10.1007/s11325-013-0881-9

Cited by 24 publications

(19 citation statements)

References 28 publications

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“…Hypoperfusions in the ventral, medial and orbital prefrontal cortex, as well as in the insula were found in previous OSA studies. 1,2,[4][5][6] Similarly, reduced rCBF in temporal and sensorimotor regions were also reported in OSA subjects. 1-3, 5, 6 Therefore, our study brings new insight into the discrepancies across brain regions that have been reported as hypoperfused in previous OSA studies: differences in the numbers of apneas and hypopneas during REM and NREM sleep could explain why different brain locations show abnormal daytime rCBF in different studies.…”

Section: Spect As a Sensitive Tool To Detect Cerebral Dysfunctions Inmentioning

confidence: 72%

“…Consistently, continuous positive airway pressure (CPAP) was previously shown to be effective in reversing at least partially daytime rCBF changes in OSA individuals. 4,6 Moreover, many OSA patients treated with CPAP remove their mask before the end of the night, which is where most REM sleep occurs. This could lead to up to 60 % of REM sleep untreated with an average CPAP use.…”

Section: Clinical Significance Of Rem Sleep Osamentioning

confidence: 99%

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Obstructive sleep apnea during REM sleep and daytime cerebral functioning: A regional cerebral blood flow study using high-resolution SPECT

Baril

Gagnon

Brayet

et al. 2018

J Cereb Blood Flow Metab

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Obstructive sleep apnea (OSA) predominantly during rapid eye movement (REM) sleep may have impacts on brain health, even in milder OSA cases. Here, we evaluated whether REM sleep OSA is associated with abnormal daytime cerebral functioning using high-resolution single-photon emission computed tomography (SPECT). We tested 96 subjects (25 F, age: 65.2 ± 6.4) with a wide range of OSA severity from no OSA to severe OSA (apnea–hypopnea index: 0–97 events/h). More respiratory events during REM sleep were associated with reduced daytime regional cerebral blood flow (rCBF) in the bilateral ventromedial prefrontal cortex and in the right insula extending to the frontal cortex. More respiratory events during non-REM (NREM) sleep were associated with reduced daytime rCBF in the left sensorimotor and temporal cortex. In subjects with a lower overall OSA severity (apnea–hypopnea index<15), more respiratory events during REM sleep were also associated with reduced daytime rCBF in the insula and extending to the frontal cortex. Respiratory events that characterized OSA during NREM versus REM sleep are associated with distinct patterns of daytime cerebral perfusion. REM sleep OSA could be more detrimental to brain health, as evidenced by reduced daytime rCBF in milder forms of OSA.

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Section: Spect As a Sensitive Tool To Detect Cerebral Dysfunctions Inmentioning

confidence: 72%

Section: Clinical Significance Of Rem Sleep Osamentioning

confidence: 99%

Obstructive sleep apnea during REM sleep and daytime cerebral functioning: A regional cerebral blood flow study using high-resolution SPECT

Baril

Gagnon

Brayet

et al. 2018

J Cereb Blood Flow Metab

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show abstract

“…In patients with OSA, this leads to nocturnal apneas and hypopneas, intermittent hypoxia, reoxygenation and hyper-/hypocapnia events, along with sleep fragmentation, and changes in cerebral blood flow (Baril et al, 2015, Shiota et al, 2014, Yadav et al, 2013). The prevalence of OSA is noticeable in general population and around 50% in patients with cardiovascular or metabolic disorders (Khazaie et al, 2013, Khazaie et al, 2011, Lévy et al, 2015, Lurie, 2011).…”

Section: Introductionmentioning

confidence: 99%

Structural and functional neural adaptations in obstructive sleep apnea: An activation likelihood estimation meta-analysis

Tahmasian

Rosenzweig

Eickhoff

et al. 2016

Neuroscience & Biobehavioral Reviews

108

102

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HighlightsThe right basolateral amygdala, the hippocampus and the right insular cortex are important nodes in obstructive sleep apnea (OSA).Functional characterization of these regions suggested associated dysfunction of emotional, sensory, and limbic processes in OSA.Connectivity analysis demonstrated that these regions are part of a joint network comprising the anterior insula, posterior-medial frontal cortex and thalamus.

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“…Not all morbidly obese patients are routinely tested and diagnosed for OSA by a polysomnography (PSG) test, which is a test that enables OSA to be diagnosed objectively [ 15 , 16 ]. Patients diagnosed for OSA receive the advice to use continuous positive airway pressure (CPAP), which is effective in treating obstructive sleep apnea [ 17 , 18 ]. Clinicians often use the STOP-Bang questionnaire to estimate the OSA risk involved [ 19 ] as this questionnaire has a well predictive power [ 20 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

STOP-Bang and the effect on patient outcome and length of hospital stay when patients are not using continuous positive airway pressure

et al. 2014

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BackgroundIn patients undergoing surgical interventions under general anesthesia, obstructive sleep apnea syndrome (OSA) can cause serious perioperative cardiovascular or respiratory complications leading to fatal consequences, even sudden death. In this study we test the hypothesis that morbidly obese patients diagnosed by a polysomnography test and using continuous positive airway pressure (CPAP) therapy have fewer and less severe perioperative complications and a shorter hospital stay than patients who have a medical history that meets at least three STOP-Bang criteria and are not using CPAP therapy.MethodsPostoperative hospital stay and pulmonary complications were analyzed in three groups of morbidly obese patients undergoing bariatric surgery (Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy) between January 2009 and November 2013 (n = 693). Group A comprised 99 patients who were preoperatively diagnosed with OSA based on polysomnography results. These patients used CPAP therapy before and after surgery. Group B consisted of 182 patients who met at least three STOP-Bang criteria but who were not diagnosed with OSA based on polysomnography results. These patients did not use CPAP. Group C, the reference group, comprised 412 patients who scored one to two items on the STOP-Bang.ResultsDuring the perioperative period, Group B patients had a significantly (p < 0.001) higher cumulative rate of pulmonary complications, worse oxygen saturation, respiratory rates, and increased length of stay in hospital. There was also two cases of sudden death in this group.ConclusionBased on these results, we conclude that patients meeting at least three STOP-BANG criteria have higher postoperative complications and an increased length of hospital stay than patients using CPAP.

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Effect of continuous positive airway pressure on regional cerebral blood flow during wakefulness in obstructive sleep apnea

Abstract: When awake, patients with severe OSA were shown to have reversible decreases in rCBF, especially in the frontal lobe, and an appropriate CPAP treatment was thought to improve rCBF in this area. Our results support the importance of appropriate CPAP treatment for severe OSA patients.

Cited by 24 publications

References 28 publications

Obstructive sleep apnea during REM sleep and daytime cerebral functioning: A regional cerebral blood flow study using high-resolution SPECT

Obstructive sleep apnea during REM sleep and daytime cerebral functioning: A regional cerebral blood flow study using high-resolution SPECT

Structural and functional neural adaptations in obstructive sleep apnea: An activation likelihood estimation meta-analysis

STOP-Bang and the effect on patient outcome and length of hospital stay when patients are not using continuous positive airway pressure

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