Abstract WP437: Sleep Apnea and Cerebral Blood Flow: the Role of Autoregulation

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sara K Rostanski ◽  
Andrew J Westwood ◽  
Mehran Baboli ◽  
Randolph S Marshall
Keyword(s):  
Risk Factor ◽  
Sleep Apnea ◽  
Phase Shift ◽  
Cerebral Autoregulation ◽  
Apnea Hypopnea Index ◽  
Stroke Risk Factor ◽  
Vasomotor Reactivity ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Dynamic Cerebral Autoregulation

Objective: Obstructive sleep apnea (OSA) is a stroke risk factor and is increasingly recognized as a risk factor for cognitive impairment. Altered cerebral autoregulation may play a role in these relationships. We measured the association between OSA and two forms of cerebral autoregulation: (1) dynamic cerebral autoregulation (DCA), which plays a homeostatic role; and (2) vasomotor reactivity (VMR), which is a measure of cerebrovascular reserve. We hypothesized that both VMR and DCA would be impaired in subjects with OSA. Methods: We recruited subjects with untreated OSA. VMR and DCA were measured with continuous transcranial Doppler (TCD) of the middle cerebral arteries (MCA). DCA was measured with phase shift analysis where lower degrees of phase shift indicate greater impairment; values <24 degrees are abnormal. VMR was measured as % change in MCA velocity in response to 5% CO2 inhalation; values <2% change are abnormal. We assessed the relationship between apnea-hypopnea index (AHI) and autoregulation using bivariate correlations (Pearson coefficient). We also assessed the association between moderate to severe OSA (AHI≥15) and abnormal autoregulation (Fisher’s exact test). Results: Twelve subjects were enrolled; 11 had TCD data. Mean age was 53 (SD 11) and the majority had moderate to severe OSA (median AHI 27, IQR 16-37). Mean VMR (% change in MCA velocity) was 3.1 (SD 0.7); mean phase shift was 34 degrees (SD 15). There was a moderate association between AHI and phase shift (r=-0.40); the correlation with VMR was weaker (r=-0.25). The proportion of subjects with abnormal DCA was greater among those with moderate-severe OSA compared to those with mild OSA (66.7% vs. 0%, p=0.2). No enrolled subjects had abnormal VMR. Conclusion: Moderate to severe OSA is associated with abnormal dynamic cerebral autoregulation and normal vasomotor reactivity. The mechanism underlying this dissociation may involve OSA-mediated inflammation and endothelial dysfunction. Further study may clarify how this dissociation relates to increased risk of cerebral ischemia among patients with OSA.

Abstract MP63: Childhood-onset Obstructive Sleep Apnea Is Associated With Increased Risk Of Adolescent Hypertension

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Julio Fernandez-Mendoza ◽  
Fan He ◽  
Susan Calhoun ◽  
Alexandros Vgontzas ◽  
Duanping Liao ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Risk Factor ◽  
Sleep Apnea ◽  
Apnea Hypopnea Index ◽  
Childhood Onset ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Transition To Adolescence

Introduction: Obstructive sleep apnea (OSA) is an established risk factor for hypertension in adults. However, the association of childhood OSA with an increased risk of hypertension has remained elusive. Hypothesis: Childhood-onset OSA is longitudinally associated with hypertension in adolescence. Methods: We tested this hypothesis in a population-based sample of 421 children (5-12 years) from the Penn State Child Cohort who were followed-up 6-13 years later as adolescents (12-23 years). In-lab polysomnography, to ascertain the apnea/hypopnea index (AHI), and seated blood pressure were assessed at baseline and at follow-up. The presence of hypertension at follow-up was defined based on pediatric criteria dependent upon the subject’s age (below and above 13 years). Logistic regression analyses adjusted for sex, race/ethnicity, age, body mass index percentile and systolic blood pressure percentile at baseline. Results: Childhood OSA that persisted in the transition to adolescence was associated with 2.9-fold (95%CI=1.1-7.4) higher odds of adolescent hypertension. In contrast, childhood OSA that remitted in the transition to adolescence was not associated with increased odds of adolescent hypertension (OR=0.9, 95%CI=0.3-2.6). Adolescent-onset OSA was associated with 1.7-fold (95%CI=1.1-2.9) increased odds of adolescent hypertension. Conclusions: Childhood-onset persistent OSA is a risk factor for hypertension in adolescence. Remission of childhood OSA during this transitional period, which previous research has shown to be highly determined by weight loss, does not confer a significant risk of adolescent hypertension. Early life chronic adverse sleep exposures predict cardiovascular risk in adolescence, a critical developmental period.

scholarly journals Tae-Eum Type as an Independent Risk Factor for Obstructive Sleep Apnea

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Seung Ku Lee ◽  
Dae Wui Yoon ◽  
Hyeryeon Yi ◽  
Si Woo Lee ◽  
Jong Yeol Kim ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Risk Factor ◽  
Sleep Apnea ◽  
Independent Risk Factor ◽  
Population Based ◽  
Apnea Hypopnea Index ◽  
Sasang Constitution ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Constitution Type

Obstructive sleep apnea (OSA) is prevalent and associated with several kinds of chronic diseases. There has been evidence that a specific type of Sasang constitution is a risk factor for metabolic and cardiovascular diseases that can be found in patients with OSA, but there are no studies that address the association between the Sasang constitution type (SCT) and OSA. The purpose of this study was to investigate the association between the SCT and OSA. A total of 652 participants were included. All participants were examined for demographic information, medical history, and completed an interviewer-administered questionnaire on life style and sleep-related variables. Biochemical analyses were performed to determine the glucose and lipid profiles. An objective recording of OSA was done with an unattended home PSG using an Embla portable device. The apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) were significantly higher in the Tae-eum (TE) type as compared to the So-eum (SE) and the So-yang (SY) types. Even after adjusting for confounding variables, the TE type still had a 2.34-fold (95% CI, 1.11–4.94;P=0.0262) increased risk for OSA. This population-based cohort study found that the TE constitutional type is an independent risk factor for the development of OSA.

scholarly journals Early diagnosis and treatment of obstructive sleep apnea after stroke: Are we neglecting a modifiable stroke risk factor?

2013 ◽  
Vol 3 (5) ◽  
pp. 369-371 ◽  
Author(s):  
N. K. Sethi ◽  
M. L. Sacchetti ◽  
A. P. Davis ◽  
M. E. Billings ◽  
W. T. Longstreth ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Risk Factor ◽  
Sleep Apnea ◽  
Early Diagnosis ◽  
Stroke Risk ◽  
Diagnosis And Treatment ◽  
Stroke Risk Factor ◽  
Obstructive Sleep

Defining Risk of Postoperative Obstructive Sleep Apnea in Patients With 22q11.2DS Undergoing Pharyngeal Flap Surgery for Velopharyngeal Dysfunction Using Polysomnographic Evaluation

2020 ◽  
Vol 57 (7) ◽  
pp. 808-818
Author(s):  
Alfred Lee ◽  
Brian L. Chang ◽  
Cynthia Solot ◽  
Terrence B. Crowley ◽  
Vamsee Vemulapalli ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Tertiary Care ◽  
22Q11.2 Deletion Syndrome ◽  
Deletion Syndrome ◽  
Apnea Hypopnea Index ◽  
Pressure Therapy ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Pharyngeal Flap

Objective: To determine pre- and postoperative prevalence of obstructive sleep apnea (OSA) in patients with 22q11.2 deletion syndrome (DS) undergoing wide posterior pharyngeal flap (PPF) surgery for velopharyngeal dysfunction (VPD). Design: Retrospective study using pre- and postoperative polysomnography (PSG) to determine prevalence of OSA. Medical records were reviewed for patients’ medical comorbidities. Parents were surveyed about snoring. Setting: Academic tertiary care pediatric hospital. Patients: Forty patients with laboratory confirmed 22q11.2DS followed over a 6-year period. Interventions: Pre- and postoperative PSG, speech evaluation, and parent surveys. Main Outcome Measure: Severity and prevalence of OSA, defined by obstructive apnea hypopnea index (OAHI), before and after PPF surgery to determine whether PPF is associated with increased risk of OSA. Results: Mean OAHI did not change significantly after PPF surgery (1.1/h vs 2.1/h, P = .330). Prevalence of clinically significant OSA (OAHI ≥ 5) was identical pre- and postoperatively (2 of 40), with both cases having severe-range OSA requiring positive airway pressure therapy. All other patients had mild-range OSA. Nasal resonance was graded as severe preoperatively in 85% of patients. None were graded as severe postoperatively. No single patient factor or parent-reported concern predicted risk of OSA (OAHI ≥ 1.5). Conclusions: Patients with 22q11.2DS are medically complex and are at increased risk of OSA at baseline. Wide PPF surgery for severe VPD does not significantly increase risk of OSA. Careful perioperative planning is essential to optimize both speech and sleep outcomes.

Obstructive sleep apnea and the progression of thoracic aortic aneurysm: a prospective cohort study

2020 ◽  
pp. 2003322
Author(s):  
Thomas Gaisl ◽  
Protazy Rejmer ◽  
Maurice Roeder ◽  
Patrick Baumgartner ◽  
Noriane A. Sievi ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Risk Factor ◽  
Sleep Apnea ◽  
Elective Surgery ◽  
Positive Association ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Apnea Hypopnea Index ◽  
Aortic Sinus ◽  
Obstructive Sleep

BackgroundObstructive sleep apnea (OSA) is associated with an increased prevalence of aortic aneurysms, and it has also been suggested that severe OSA furthers aneurysm expansion in the abdomen. We evaluated whether OSA is a risk factor for the progression of ascending thoracic aortic aneurysms (TAA).MethodsPatients with TAA underwent yearly standardised echocardiographic measurements of the ascending aorta over 3 years, and two level-III sleep studies. The primary outcome was the expansion rate of TAA in relation to the apnea-hypopnea-index (AHI). Secondary outcomes included surveillance for aortic events (composite endpoints of rupture, dissection, elective surgery, and death).ResultsBetween July 2014 and March 2020, 230 patients (median age 70 years, 78% male) participated in the cohort. At baseline, 34.8% of patients had an AHI of ≥15 events·h−1. There was no association between TAA diameters and the AHI at baseline. After 3 years mean expansion rates were 0.55±1.25 mm at the aortic sinus and 0.60±1.12 mm at the ascending aorta. In the regression analysis, after controlling for baseline diameter and cardiovascular risk factors, there was strong evidence for a positive association of TAA expansion with AHI (aortic sinus estimate 0.025 mm [95%CI 0.009 to 0.040], p<0.001; ascending aorta estimate 0.026 mm [95%CI 0.011 to 0.041], p=0.001). Twenty participants (8%) experienced an aortic event, however, there was no association with OSA severity.ConclusionOSA may be a modest but independent risk factor for faster TAA expansion and thus potentially contributes to life-threatening complications in aortic disease.

scholarly journals Clinical significance of obstructive sleep apnea in patients with acute coronary syndrome in relation to diabetes status

2019 ◽  
Vol 7 (1) ◽  
pp. e000737 ◽  
Author(s):  
Xiao Wang ◽  
Jingyao Fan ◽  
Yunhui Du ◽  
Changsheng Ma ◽  
Xinliang Ma ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Acute Coronary Syndrome ◽  
Sleep Apnea ◽  
Arterial Oxygen Saturation ◽  
Arterial Oxygen ◽  
Apnea Hypopnea Index ◽  
Coronary Syndrome ◽  
Diabetes Status ◽  
Obstructive Sleep ◽  
Increased Risk

ObjectiveThe prognostic significance of obstructive sleep apnea (OSA) in patients with acute coronary syndrome (ACS) according to diabetes mellitus (DM) status remains unclear. We aimed to elucidate the association of OSA with subsequent cardiovascular events in patients with ACS with or without DM.Research design and methodsIn this prospective cohort study, consecutive eligible patients with ACS underwent cardiorespiratory polygraphy between June 2015 and May 2017. OSA was defined as an Apnea Hypopnea Index ≥15 events/hour. The primary end point was major adverse cardiovascular and cerebrovascular events (MACCEs), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for unstable angina or heart failure.ResultsAmong 804 patients, 248 (30.8%) had DM and 403 (50.1%) had OSA. OSA was associated with 2.5 times the risk of 1 year MACCE in patients with DM (22.3% vs 7.1% in the non-OSA group; adjusted HR (HR)=2.49, 95% CI 1.16 to 5.35, p=0.019), but not in patients without DM (8.5% vs 7.7% in the non-OSA group, adjusted HR=0.94, 95% CI 0.51 to 1.75, p=0.85). Patients with DM without OSA had a similar 1 year MACCE rate as patients without DM. The increased risk of events was predominately isolated to patients with OSA with baseline glucose or hemoglobin A1c levels above the median. Combined OSA and longer hypoxia duration (time with arterial oxygen saturation <90%>22 min) further increased the MACCE rate to 31.0% in patients with DM.ConclusionsOSA was associated with increased risk of 1 year MACCE following ACS in patients with DM, but not in non-DM patients. Further trials exploring the efficacy of OSA treatment in high-risk patients with ACS and DM are warranted.

scholarly journals Analysis of Metabolites Changes on Obstructive Sleep Apnea Patients After Multilevel Sleep Surgery

2020 ◽  
Author(s):  
Abdulmohsen Alterki ◽  
Shibu Joseph ◽  
Thangavel Alphonse Thanaraj ◽  
Irina Al-Khairi ◽  
Preethi Cherian ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Metabolic Status ◽  
Apnea Hypopnea Index ◽  
P Value ◽  
Upper Airways ◽  
Sleep Surgery ◽  
Post Surgery ◽  
Obstructive Sleep ◽  
Increased Risk

Background: Obstructive sleep apnea (OSA) is caused by partial or complete obstruction of the upper airways. Corrective surgeries aim at removing obstructions in the nasopharynx, oropharynx, and hypopharynx. OSA is associated with increased risk of various metabolic diseases. Our objective was to evaluate the effect of surgery on the plasma metabolome. Methods: This study included 39 OSA patients who underwent Multilevel Sleep Surgery (MLS). Clinical and anthropometric measures were taken at baseline and 5 months after surgery. Results: The mean Apnea Hypopnea Index (AHI) significantly dropped from 22.0 &plusmn; 18.5 events/hour to 8.97 &plusmn; 9.57 events/hour (p-Value &lt;0.001). The Epworth&rsquo;s sleepiness Score (ESS) dropped from 12.8 &plusmn; 6.23 to 2.95 &plusmn; 2.40 (p-Value &lt;0.001) indicating success of the surgery in treating OSA. Plasma levels of metabolites, phosphocholines (PC) PC.41.5, PC.42.3, ceremide (Cer) Cer.44.0, and triglyceride (TG) TG.53.6, TG.55.6 and TG.56.8 were decreased (p-Value&lt;0.05) whereas lysophosphatidylcholines (LPC) 20.0 and PC.39.3 were increased (p-Value&lt;0.05) after surgery. Conclusion: This study highlights the success of MLS in treating OSA. Treatment of OSA resulted in improvement in metabolic status that was characterized by decreased TG, PCs and Cer metabolites post-surgery indicating that the success of the surgery positively impacted the metabolic status of these patients.

scholarly journals Obstructive Sleep Apnea as a Risk Factor for Intracerebral Hemorrhage

Stroke ◽  
2021 ◽  
Author(s):  
Jacqueline H. Geer ◽  
Guido J. Falcone ◽  
Kevin N. Vanent ◽  
Audrey C. Leasure ◽  
Daniel Woo ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Logistic Regression ◽  
Risk Factor ◽  
Sleep Apnea ◽  
Intracerebral Hemorrhage ◽  
Odds Ratio ◽  
Berlin Questionnaire ◽  
Multivariable Logistic Regression Model ◽  
Obstructive Sleep ◽  
Increased Risk

Background and Purpose: To determine whether obstructive sleep apnea (OSA) is associated with intracerebral hemorrhage (ICH) risk, we assessed premorbid OSA exposure of patients with nontraumatic ICH and matched controls. Methods: Ethnic/Racial Variations of Intracerebral Hemorrhage is a multicenter, case-control study evaluating risk factors for ICH that recruited 3000 cases with ICH and 3000 controls. OSA status was ascertained using the Berlin Questionnaire as a surrogate for premorbid OSA. We performed logistic regression analyses to evaluate the association between OSA and ICH. Results: Two thousand and sixty-four (71%) cases and 1516 (52%) controls were classified as having OSA by the Berlin Questionnaire. Cases with OSA were significantly more likely to be male and have hypertension, heart disease, hyperlipidemia, and higher body mass index compared with those without OSA. OSA was more common among cases compared with controls (71% versus 52%, odds ratio, 2.28 [95% CI, 2.05–2.55]). In a multivariable logistic regression model, OSA was associated with increased risk for ICH (odds ratio, 1.47 [95% CI, 1.29–1.67]). Conclusions: OSA is a risk factor for ICH.

Abstract 120: Prevalence and Impact of Patent Foramen Ovale in Patients with Obstructive Sleep Apnea

2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Phillip Camp ◽  
Abinash Achrekar ◽  
Umar Malik ◽  
Warren Laskey
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Patent Foramen Ovale ◽  
Right Atrial ◽  
Apnea Hypopnea Index ◽  
Foramen Ovale ◽  
Contrast Injection ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Study Population

Introduction: It is well known that obstructive sleep apnea (OSA) prevalence increases as body mass index (BMI) increases. Lesser known is patent foramen ovale (PFO) is found in 12 to 35 percent of adults. Patients with OSA experience nocturnal apnea which result in hypoxemia, elevation of right atrial pressure, and an increase in right to left shunting and a theoretical increased risk of stroke. A few studies have suggested an association between the severity of OSA and a PFO. As such, OSA diagnosis and therapy may be tailored to address right-to-left shunting in these patients. If the prevalence of PFO in OSA patients is increased, it may be appropriate to include transthoracic echocardiography (TTE) testing as a component of routine evaluation of patients with OSA. Hypothesis: We hypothesize that patients with hypoxemia related to OSA are more likely to have a PFO with right-to-left shunting than those with less dramatic hypoxemia. We hope to determine the prevalence and clinical relevance of intra-cardiac shunting in patients with OSA by prospectively analyzing and correlating polysomnography and TTE findings. Methods: 80 patients with OSA were referred for TTE by the UNM Sleep Center. All patients underwent saline contrast TTE in the UNM echo lab. The prevalence of PFO in the general UNM echo population was calculated over the last year for comparison. Results: Of 80 patients with varying degrees of OSA, 12.5% had right to left shunting. PFO was not statistically associated with DI (Desaturation Index), nor any AHI (Apnea Hypopnea Index). The only statistically significant association was between OSA and BMI (p=0.013). BMI associated with DI and AHI was statistically significant (p=0.003 and p=0.005, respectively). Over the last year, 216 PFO’s were found from 1858 echo studies with contrast injection performed at UNM with a prevalence rate of 11.6%. Conclusions: In contrast to previous studies, there was no association between OSA of any severity and PFO in our study population. There was a statistically significant association between BMI and OSA, which is well established. Our study prevalence was found to be similar to the UNM general echo population as well, indicating that OSA patients within our study group were not as likely to have an associated PFO.

scholarly journals Targeted Metabolomics Analysis on Obstructive Sleep Apnea Patients after Multilevel Sleep Surgery

Metabolites ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 358
Author(s):  
Abdulmohsen Alterki ◽  
Shibu Joseph ◽  
Thangavel Alphonse Thanaraj ◽  
Irina Al-Khairi ◽  
Preethi Cherian ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Metabolic Diseases ◽  
Metabolic Status ◽  
Apnea Hypopnea Index ◽  
P Value ◽  
Upper Airways ◽  
Sleep Surgery ◽  
Obstructive Sleep ◽  
Increased Risk

Background: Obstructive sleep apnea (OSA) is caused by partial or complete obstruction of the upper airways. Corrective surgeries aim at removing obstructions in the nasopharynx, oropharynx, and hypopharynx. OSA is associated with an increased risk of various metabolic diseases. Our objective was to evaluate the effect of surgery on the plasma metabolome. Methods: This study included 39 OSA patients who underwent Multilevel Sleep Surgery (MLS). Clinical and anthropometric measures were taken at baseline and five months after surgery. Results: The mean Apnea-Hypopnea Index (AHI) significantly dropped from 22.0 ± 18.5 events/hour to 8.97 ± 9.57 events/hour (p-Value < 0.001). Epworth’s sleepiness Score (ESS) dropped from 12.8 ± 6.23 to 2.95 ± 2.40 (p-Value < 0.001), indicating the success of the surgery in treating OSA. Plasma levels of metabolites, phosphocholines (PC) PC.41.5, PC.42.3, ceremide (Cer) Cer.44.0, and triglyceride (TG) TG.53.6, TG.55.6 and TG.56.8 were decreased (p-Value < 0.05), whereas lysophosphatidylcholines (LPC) 20.0 and PC.39.3 were increased (p-Value < 0.05) after surgery. Conclusion: This study highlights the success of MLS in treating OSA. Treatment of OSA resulted in an improvement of the metabolic status that was characterized by decreased TG, PCs, and Cer metabolites after surgery, indicating that the success of the surgery positively impacted the metabolic status of these patients.

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