Obstructive Sleep Apnea and Cardiovascular Disease

Kato, Masahiko; Adachi, Taro; Koshino, Yuki; Somers, Virend K.

doi:10.1253/circj.cj-09-0364

Cited by 106 publications

(74 citation statements)

References 131 publications

(130 reference statements)

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“…Several mechanisms might link SDB with ischemic stroke. [7][8][9][10][11] Multiple changes during respiratory events including cardiac arrhythmias, BP swings, inflammatory changes, and coagulation changes may be responsible for stroke onset during sleep in patients with SDB. 22 Previous studies described changes of coagulation in SDB patients including increased blood fibrinogen and platelet aggregation.…”

Section: Discussionmentioning

confidence: 99%

“…6 Multiple mechanisms might link SDB with the onset of cerebral ischemia during the sleep, including coagulation changes, hemodynamic changes, blood pressure (BP) surges, inflammatory overactivity, increased arterial stiffness, increased sympathetic tone, paradoxical embolization, or the development of cardiac arrhythmias. [7][8][9][10][11] Currently, WUS patients are excluded from revascularization therapy; therefore, a thorough search for predictors and risk factors of WUS is desirable. The aim of this study was to compare polysomnographic, clinical, and laboratory characteristics of WUS and NWUS with mild-to-moderate severity.…”

Section: Introductionmentioning

confidence: 99%

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Association of Sleep Disordered Breathing with Wake-Up Acute Ischemic Stroke: A Full Polysomnographic Study

Šiarnik

Kollár

Čarnická

et al. 2016

Journal of Clinical Sleep Medicine

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Study Objectives: Sleep disordered breathing (SDB) is a frequent comorbidity in stroke patients. SDB is one of the independent risk factors for ischemic stroke. Conversely, stroke may contribute to SDB onset or aggravate premorbid SDB. Multiple mechanisms underlying SDB might be responsible for the development of stroke. The aim of this study was to compare polysomnographic, clinical, and laboratory characteristics of wake-up (WUS) and non-wake-up acute ischemic strokes (NWUS). Methods: We prospectively enrolled 88 patients with acute ischemic stroke. Clinical characteristics of the population were recorded on admission, and blood samples were obtained in the fasting condition following morning. SDB was assessed using standard overnight polysomnography in the acute phase of the stroke. Results: WUS were present in 16 patients (18.2%), and NWUS in 72 patients (81.8%). In WUS compared to NWUS, we observed significantly higher values of apnea-hypopnea index (24.8 vs. I NTRO DUCTI O NA recent population-based study has shown that wake-up strokes (WUS) comprise 14% of all ischemic strokes. The same study concludes, that WUS do not differ from non-wake up strokes (NWUS) in clinical features, risk factors, or outcome.1 There is a diurnal variation in the onset of stroke. Sleep tends to promote ischemic stroke, and there is a higher frequency of strokes occurring in the morning.2,3 Sleep disordered breathing (SDB) is present in up to 72% of stroke patients and is one of the independent risk factors for stroke. 4,5 However, stroke may also aggravate premorbid SDB or even contribute to SDB onset. 6 Multiple mechanisms might link SDB with the onset of cerebral ischemia during the sleep, including coagulation changes, hemodynamic changes, blood pressure (BP) surges, inflammatory overactivity, increased arterial stiffness, increased sympathetic tone, paradoxical embolization, or the development of cardiac arrhythmias. 7-11Currently, WUS patients are excluded from revascularization therapy; therefore, a thorough search for predictors and risk factors of WUS is desirable. The aim of this study was to compare polysomnographic, clinical, and laboratory characteristics of WUS and NWUS with mild-to-moderate severity. SCIENTIFIC INVESTIGATIONS Association of Sleep M ETHO DSThe study population consists of patients hospitalized in the stroke unit of the 1 st Department of Neurology, Comenius University Bratislava from January 2011 to December 2014 with the BRIEF SUMMARY Current Knowledge/Study Rationale: Currently, wake-up stroke patients are excluded from revascularization therapy, so a precise search for predictors and risk factors of wake-up strokes is desirable. The aim of this study was to compare polysomnographic, clinical, and laboratory characteristics of wake-up strokes and non-wake-up strokes with mild-to-moderate severity. Study Impact: We emphasize the importance of significantly higher frequency of moderate-to-severe sleep apnea syndrome among the wake-up stroke population, as this population is indicated for positive...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association of Sleep Disordered Breathing with Wake-Up Acute Ischemic Stroke: A Full Polysomnographic Study

Šiarnik

Kollár

Čarnická

et al. 2016

Journal of Clinical Sleep Medicine

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“…Generally, OSAHS always co-existed with CAD, and they have many identical risk factors (5,14). Weiss et al (15) reported that the morbidity rate in patients with OSAHS (23.8 % accompanied by ischemic heart disease) is 3.4 times higher than in the control group.…”

Section: Discussionmentioning

confidence: 99%

“…The syndrome associates somnolence and one or two of the following symptoms: severe snoring, nocturnal respiratory arrest, repeated nocturnal awakening, non-recuperative sleep, diurnal fatigue, and altered concentration (3 4). OSAHS may act to cause and promote the progression of hypertension, coronary artery disease (CAD), acute myocardial infarction (AMI) and cerebral vascular disease (1,5). It is reported that its incidences in adult women is 2 %, and in adult men is 4 % (6).…”

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confidence: 99%

The effect of obstructive sleep apnea-hypopnea syndrome on acute myocardial infarction

Zhang¹,

Sun²,

Li³

et al. 2012

BLL

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Background and objectives: Obstructive sleep apnea-hypopnea syndrome (OSAHS) is the most clinically common type of sleep-related breathing disorders. In this study, the effect of OSAHS on ST segment elevation myocardial infarction (STEMI) was investigated. Methods: Seventy-fi ve patients with STEMI were included in this study. The patients were divided into two groups: STEMI accompanied by OSAHS (O + ) group (33 patients) and STEMI without OSAHS (O -) group (42 patients). The differences of the clinical characteristics between the two groups were compared. The relationship between oxyhemoglobin desaturation index (ODI) and Gensini Score, and the relationships between OSAHS and clinical parameters were analyzed by a regression analysis. Results: AMI mainly occurred from 10 pm to 6 am in the O + group (45.5 %) and from 6 am to 2 pm in the O -group (52.3 %). The peak of serous creatine kinase (CK), high-sensitivity C-reactive protein (hs-CRP), N-terminal Pro-brain natriuretic peptide (NT-proBNP), and left ventricle end-diastolic volume index (LVEDVI) were significantly increased in the O + group compared to the O -group, while the left ventricular ejection fraction (LVEF) were signifi cantly decreased. The regression analysis showed that ODI was positively correlated with Gensini Score, while serous CK, hs-CRP, NT-proBNP, and OSAHS were independently associated with left ventricular insuffi ciency (LVI), and the incidence of LVI in O + group was 5.8 times as O -group. Conclusions: In STEMI patients with OSAHS, myocardial infarction mainly occurred from 10 pm to 6 am, and the incidence of LVI was signifi cantly higher than STEMI patients without OSAHS (Tab. 5, Fig. 2 Obstructive sleep apnea-hypopnea syndrome (OSAHS) is the most common type of sleep-related breathing disorders, which was caused by throat obstruction (1, 2). The syndrome associates somnolence and one or two of the following symptoms: severe snoring, nocturnal respiratory arrest, repeated nocturnal awakening, non-recuperative sleep, diurnal fatigue, and altered concentration (3 4). OSAHS may act to cause and promote the progression of hypertension, coronary artery disease (CAD), acute myocardial infarction (AMI) and cerebral vascular disease (1, 5). It is reported that its incidences in adult women is 2 %, and in adult men is 4 % (6). While in China, its incidence is about 3.62 % in people beyond 30 years, which means that there are more than 47 million of patients in China by now (7).Numerous studies showed that OSAHS is closely associated with the development and progression of CAD. The changes of hemodynamics, enhancement of the sympathetic activity, and oxidative stress that are caused by OSAHS can accelerate the process of artherosclerosis (8, 9). Peker et al (10) reported that the incidence of OSAHS is higher in the patients with CAD than in normal people, and OSAHS can raise the mortality of angiocardiopathy, while patients treated by continuous positive airway pressure (CPAP) can reverse this state. The results of Peker et al (10) al...

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“…Sleep apnoea hypopnoea syndrome (SAHS) causes repetitive nocturnal hypoxemia, which could promote the progression of hypertension, arrhythmia, coronary artery disease (CAD) and cerebral vascular disease (1,2). There are many reports regarding the effect of SAHS on high blood pressure (3,4) and arrhythmia (5,6).…”

Section: Introductionmentioning

confidence: 99%

The relationship between apnoea hypopnoea index and Gensini score in patients with acute myocardial infarction undergoing emergency primary percutaneous coronary intervention

Zhu

Wang

et al. 2017

J. Thorac. Dis.

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Background: Sleep apnoea hypopnoea syndrome (SAHS) is characterised by repetitive nocturnal hypoxemia and has a high prevalence among patients with acute myocardial infarction (AMI). But there are few studies on patients with AMI undergoing emergency primary percutaneous coronary intervention (pPCI).In this study, we want to find the prevalence of SAHS among patients with AMI undergoing emergency pPCI and determine whether SAHS would worsen the condition among these people, and especially affect the damage degree of the coronary artery Methods: Over four months, 95 patients admitted for the first time for AMI were observed. All of them had emergency primary PCIs. A total of 86 patients accepted the sleep study and were divided into four groups according to the apnoea hypopnoea index (AHI): SAHS was diagnosed when AHI ≥5/h and was defined as mild for AHI ≥5/h and <15/h, moderate for AHI ≥15/h and <30/h, and severe for AHI ≥30/h. On the contrary, the patients whose AHI <5/h were Non-SAHS. And the characteristics of the patients among these four groups were compared. According to the time of chest pain onset, the number of the patients between SAHS and non-SAHS, and patients' AHI during three intervals of one day were measured and compared;Makers including the sensitivity of serum troponin T (hs-TnT), creatine kinase isoenzyme MB (CK-MB), left ventricular ejection fraction (LVEF), pro-brain-type natriuretic peptide (pro-BNP), Gensini score and collateral vessels between the SAHS and non-SAHS were compared. And the relationships between the AHI of these patients and the markers were analysed. Results: Of the 86 patients studied, 65 had SAHS, representing a SAHS prevalence of 75.58% among patients with AMI undergoing emergency pPCI. There were significant differences in average ages, smoking and arrhythmia (P<0.05) between these four groups. There was no significant difference between AMI patients with or without SAHS regarding the day-night pattern. But there showed significant differences between SAHS and non-SAHS in Gensini score (P<0.05) and pro-BNP (P<0.05). Also, there were positive correlations between AHI and Gensini score (r=0.490, P<0.05) and pro-BNP (r=0.338, P<0.05). Conclusions: Among patients with AMI undergoing emergency pPCI, there is a high prevalence of SAHS.There are also positive correlations between AHI and Gensini score, and pro-BNP. Therefore, guided by the results, should we conduct a routine screening to those patients normally and could we relieve the damage to the coronary artery by curing the SAHS?

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Obstructive Sleep Apnea and Cardiovascular Disease

Cited by 106 publications

References 131 publications

Association of Sleep Disordered Breathing with Wake-Up Acute Ischemic Stroke: A Full Polysomnographic Study

Association of Sleep Disordered Breathing with Wake-Up Acute Ischemic Stroke: A Full Polysomnographic Study

The effect of obstructive sleep apnea-hypopnea syndrome on acute myocardial infarction

The relationship between apnoea hypopnoea index and Gensini score in patients with acute myocardial infarction undergoing emergency primary percutaneous coronary intervention

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