Impaired Vascular Regulation in Patients with Obstructive Sleep Apnea

Reichmuth, Kevin J.; Dopp, John M.; Barczi, Steven R.; Skatrud, James B.; Wojdyla, Piotr; Hayes, Don; Morgan, Barbara J.

doi:10.1164/rccm.200903-0393oc

Cited by 91 publications

(114 citation statements)

References 42 publications

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“…This has been supported by numerous studies demonstrating impaired endothelial function and signs of early atherosclerosis, such as increased carotid intima-media thickness in OSA and improvement with effective CPAP therapy [46][47][48][49][50][51][52]. In support of a key role of intermittent hypoxia in this process, the severity of the nocturnal oxygen desaturation has been shown to be predictive of subclinical atherosclerosis [46].…”

Section: Systemic Inflammationmentioning

confidence: 85%

Sleep apnoea and the heart

et al. 2013

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Sleep apnoea is associated with significant daytime functioning impairment and marked cardiovascular morbidities, leading to a significant increase in mortality. Sympathetic activation, oxidative stress and systemic inflammation have been shown to be the main intermediary mechanisms associated with sleep apnoea and intermittent hypoxia. There are now convincing data regarding the association between hypertension, arrhythmias, coronary heart disease, heart failure, increased cardiovascular mortality and sleep apnoea. This has been evidenced in sleep apnoea patients and is supported by experimental data obtained in intermittent hypoxia. Whether treating sleep apnoea enables chronic cardiovascular consequences to be reversed is not fully established as regard coronary heart disease, arrhythmias and heart failure. In this late condition, complex bidirectional relationships occur, with obstructive sleep apnoea being a risk factor for heart failure whilst central sleep apnoea mainly appears as a consequence of heart failure. It remains to be established in adequately designed studies, i.e. large randomised controlled trials, whether treating sleep apnoea can improve heart failure morbidity and mortality. @ERSpublications Sleep apnoea is associated with arrhythmias, coronary disease and heart failure through intermittent hypoxia http://ow.ly/ne19T

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Section: Systemic Inflammationmentioning

confidence: 85%

Sleep apnoea and the heart

et al. 2013

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“…22 Notably, former studies indicate that impaired vasomotor reactivity can be reversed relatively rapidly when nightly exposure to intermittent hypoxia is eliminated with continuous positive airway pressure in patients with OSAS. 2 Thus, it may be postulated that improving cerebral autoregulation with NIVC in the setting of acute cerebral ischemia may lead to improved functional outcomes. The findings of a current study from our group indicating the presence of intracranial steal phenomenon in OSAS patients with acute cerebral ischemia attributable to proximal arterial occlusion may be related to greater neurological deterioration during hospitalization are in line with the former hypothesis.…”

Section: Discussionmentioning

confidence: 99%

“…1 Vasodilator responses to chemical stimuli in the cerebral circulation are impaired in many patients with obstructive sleep apnea (OSA). Some of these impairments have been corrected by continuous positive airway pressure, 2 but this method is often poorly tolerated because of difficulty exhaling against elevated airway pressures. More recently, bilevel positive airway pressure devices that incorporate both inspiratory positive airway pressure to support inspiration and expiratory positive airway pressure to ease expiration have become popular.…”

mentioning

confidence: 99%

Safety and Tolerability of Early Noninvasive Ventilatory Correction Using Bilevel Positive Airway Pressure in Acute Ischemic Stroke

Tsivgoulis

Zhang

Alexandrov

et al. 2011

Stroke

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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 (PϽ0.001). NIVC was not tolerated by 4 patients (7%). Adverse events in NIVC included vomiting (nϭ1), aspiration pneumonia (nϭ1), respiratory failure/intubation (nϭ1), hypotension requiring pressors (nϭ1), and facial skin breakdown (nϭ3). The in-hospital mortality rate was 13% in NIVC patients and 8% in the rest (Pϭ0.195). 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; Pϭ0.078). 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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“…5,6 Surprisingly, little is known about the mechanism of increased stroke and neurological injury in children with sickle cell anemia. Potential candidate mechanisms for stroke include: (1) the vaso-occlusive properties of sickled red cells and their increased adherence to the endothelial lining of blood vessels; 7,8 (2) a lack of vascular reactivity or vasodilatory reserve to physiological stimuli including hypercarbia, hypoxemia, and increased neuronal activity, 9,10 and (3) anemia-mediated tissue hypoxia.…”

Section: Introductionmentioning

confidence: 99%

Functional and anatomical evidence of cerebral tissue hypoxia in young sickle cell anemia mice

Cahill

Gazdzinski

Tsui

et al. 2016

J Cereb Blood Flow Metab

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Cerebral ischemia is a significant source of morbidity in children with sickle cell anemia; however, the mechanism of injury is poorly understood. Increased cerebral blood flow and low hemoglobin levels in children with sickle cell anemia are associated with increased stroke risk, suggesting that anemia-induced tissue hypoxia may be an important factor contributing to subsequent morbidity. To better understand the pathophysiology of brain injury, brain physiology and morphology were characterized in a transgenic mouse model, the Townes sickle cell model. Relative to age-matched controls, sickle cell anemia mice demonstrated: (1) decreased brain tissue pO 2 and increased expression of hypoxia signaling protein in the perivascular regions of the cerebral cortex; (2) elevated basal cerebral blood flow , consistent with adaptation to anemia-induced tissue hypoxia; (3) significant reduction in cerebrovascular blood flow reactivity to a hypercapnic challenge; (4) increased diameter of the carotid artery; and (5) significant volume changes in white and gray matter regions in the brain, as assessed by ex vivo magnetic resonance imaging. Collectively, these findings support the hypothesis that brain tissue hypoxia contributes to adaptive physiological and anatomic changes in Townes sickle cell mice. These findings may help define the pathophysiology for stroke in children with sickle cell anemia.

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Impaired Vascular Regulation in Patients with Obstructive Sleep Apnea

Abstract: Vasodilator responses to chemical stimuli in the cerebral circulation and the forearm are impaired in many patients with obstructive sleep apnea. Some of these impairments can be improved with continuous positive airway pressure.

Cited by 91 publications

References 42 publications

Sleep apnoea and the heart

Sleep apnoea and the heart

Safety and Tolerability of Early Noninvasive Ventilatory Correction Using Bilevel Positive Airway Pressure in Acute Ischemic Stroke

Functional and anatomical evidence of cerebral tissue hypoxia in young sickle cell anemia mice

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