Incidence of ischemic stroke in patients with periodic limb movements in sleep: one-year follow-up

Objective. To assess the influence of periodic limb movements in sleep on the incidence of acute cardiovascular events. Design and methods. Fifty-six participants aged 60–75 years were included in the study. Eligibility criteria included no history of acute cardiovascular events and the presence of 1 or more risk factors for cardiovascular diseases. Nocturnal actigraphy and cardiorespiratory monitoring were performed. Patients with apnea/hypopnea index > 5/h were excluded (n = 6). Based on periodic limb movements index (PLMI) two groups were formed: main (PLMI ≥ 15/h, n = 26) and controls (PLMI < 15/h, n = 24). The groups were prospectively observed during 1 year. The endpoints of the study were cases of acute cardiovascular events. Results. Despite the similar prevalence of common risk factors for cardiovascular diseases in two groups, the patients with PLMI ≥ 15/h have a higher incidence of ischemic stroke within 1 year (odds ratio 1,07). Conclusions. Elevated PLMI might be regarded as a potential predictor for higher risk for ischemic stroke. Nevertheless, further investigations in the field are needed.

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One-year Versus Five-year Hospital Readmission after Ischemic Stroke and TIA

10.21203/rs.2.90/v1 ◽

2018 ◽

Author(s):

Anna Therese Bjerkreim ◽

Halvor Naess ◽

Andrej Netland Khanevski ◽

Lars Thomassen ◽

Ulrike Waje-Andreassen ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Functional Outcome ◽

Cox Regression ◽

Index Admission ◽

Unplanned Readmission ◽

Cardiovascular Comorbidity ◽

Factors Associated ◽

Artery Disease ◽

One Year

Abstract Background: The burden of readmission after stroke is substantial, but little knowledge exists on factors associated with long-term readmission after stroke. In a cohort composing patients with ischemic stroke and transient ischemic attack (TIA), we examined and compared factors associated with readmission within 1 year and first readmission during year 2-5. Methods: Patients with ischemic stroke or TIA who were discharged alive between July 2007 and October 2012, were followed for five years by review of medical charts. Timing and cause of the first unplanned readmission were registered. Cox regression was used to identify independent risk factors for readmission within 1 year and first readmission during year 2-5 after discharge. Results: The cohort included 1453 patients, of whom 568 (39.1%) were readmitted within 1 year. Of the 830 patients that were alive and without readmission 1 year after discharge, 439 (52.9%) were readmitted within 5 years. Patients readmitted within 1 year were older, had more severe strokes, poorer functional outcome, and a higher occurrence of complications during index admission than patients readmitted during years 2-5. Cardiovascular comorbidity did not differ between the two groups of readmitted patients. Higher age, poorer functional outcome, coronary artery disease and hypertension were independently associated with first readmission within both 1 year and during year 2-5. Peripheral artery disease was independently associated with readmission within 1 year, and atrial fibrillation was associated with first readmission during year 2-5. Conclusions: More than half of all patients who survived the first year after stroke without any readmissions were readmitted within 5 years. Patients readmitted within 1 year and between years 2-5 shared many risk factors for readmission, but they differed in age, functional outcome and occurrence of complications during the index admission.

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Retrospective Analysis of Risk Factors for Periodic Limb Movements in a Large Cohort of Insomnia and Chronic Fatigue Patients

Pharmacopsychiatry ◽

10.1055/a-0991-0498 ◽

2019 ◽

Vol 53 (02) ◽

pp. 71-77

Author(s):

Els Tobback ◽

Olivier Desmet ◽

Ignace Hanoulle ◽

Liesbeth Delesie ◽

Dirk Pevernagie ◽

...

Keyword(s):

Risk Factors ◽

Substance Use ◽

Retrospective Study ◽

Selective Serotonin Reuptake Inhibitors ◽

Chronic Fatigue ◽

Periodic Limb Movements ◽

Limb Movements ◽

Periodic Limb Movement Disorder ◽

Drug Classes ◽

The One

Abstract Introduction Although the pathophysiology of periodic limb movements in sleep (PLMS) is not well understood, there is increasing belief that management of PLMS can modulate humans’ general health. The aim of this study is to investigate the associations between risk factors including the use of antidepressants, hypnotics, and antihistamines as well as of caffeine, alcohol, and nicotine and the occurrence of PLMS and periodic limb movement disorder (PLMD). Methods Patients with either chronic fatigue or insomnia who underwent polysomnography as standardized clinical assessment were included in a retrospective study. Associations were calculated between substance use and sleep variables. Results Tricyclic antidepressants and serotonin and norepinephrine reuptake inhibitor (SNRI) are significantly associated with higher rates of PLMS. Additionally, SNRI is significantly positive associated with PLMD, as also seen for selective serotonin reuptake inhibitors (SSRI). The most frequently used SSRI escitalopram was significantly positively associated with PLMS and PLMD. A significantly negative association was found between paroxetine and PLMS. Benzodiazepines are negatively associated with PLMS and PLMD. Sedative antidepressants, antihistamines, and substance use are not associated with PLMS nor PLMD in this study. Discussion This retrospective study adds supportive evidence to the association of drug classes with PLMS and PLMD. These findings may impact on clinical management of patients with a combined anxiety or mood disorder in need for these drug classes on the one hand and a significant sleep architecture disturbance through PLMS, potentially contributing to daytime symptoms, on the other hand.

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Abstract P699: Trends in Ischemic Stroke Risk Factors and Outcomes in a Rural Population in the United States

Stroke ◽

10.1161/str.52.suppl_1.p699 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Durgesh Chaudhary ◽

Ayesha Khan ◽

Shima Shahjouei ◽

Mudit Gupta ◽

Clare Lambert ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Atrial Fibrillation ◽

Ischemic Stroke ◽

Rural Population ◽

The United States ◽

Stroke Recurrence ◽

Stroke Mortality ◽

One Year ◽

The One

Introduction: The stroke mortality rate has gradually declined due to improved interventions and controlled risk factors. We investigated the trends in stroke risk factors and outcomes among a rural population in the United States between 2004 and 2018. Methods: We built a comprehensive stroke database called “Geisinger NeuroScience Ischemic Stroke (GNSIS)” for this study. Clinical data were extracted from multiple sources, including electronic health records and quality data. Results: Our cohort comprised of 8,561 consecutive ischemic stroke patients (mean age: 70.1±13.9 years, men: 51.6%, 95.1% Caucasian). Hypertension was the most prevalent risk factor (75.2%). The rate of hypertension, diabetes, dyslipidemia, and history of stroke increased significantly over the fifteen years window. The one-year recurrence and mortality rates were 6.3% and 15.8%, respectively. Although the one-year stroke recurrence increased from 2004 to 2018 (Cochran-Armitage test Z = -3.66, p<0.001), the one-year stroke mortality rate decreased significantly (Cochran-Armitage test Z = 2.39, p=0.008). Age >65 years, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality in stratified Cox proportional hazards model. In the Fine-Gray competing risk model, diabetes mellitus and age <65 years was found to be associated with one-year ischemic stroke recurrence. In the logistic regression, chronic kidney disease (CKD), diabetes, and prior ischemic stroke were predictors of one-year recurrence while age >65 years, atrial fibrillation or flutter, CKD, heart failure, prior hemorrhagic and ischemic stroke, history of neoplasm, myocardial infarction, and rheumatic diseases were predictors of one-year mortality. Conclusion: Although stroke mortality has decreased, stroke recurrence and several vascular risk factors have significantly increased in our rural population between 2004-2018. Older age, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality while diabetes mellitus and age less than 65 years were predictors of ischemic stroke recurrence.

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Investigation of the vital status and nonfatal cardiovascular events in the prospective cohort study of the epidemiology of cardiovascular diseases and their risk factors in different regions of the Russian Federation (ESSE-RF)

Profilakticheskaya meditsina ◽

10.17116/profmed201417626-31 ◽

2014 ◽

Vol 17 (6) ◽

pp. 26 ◽

Cited By ~ 2

Author(s):

A. V. Kapustina ◽

S. E. Evstifeeva ◽

G. A. Muromtseva ◽

V. V. Konstantinov ◽

Iu. A. Balanova ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Cardiovascular Diseases ◽

Prospective Cohort Study ◽

Russian Federation ◽

Prospective Cohort ◽

Cardiovascular Events ◽

Vital Status ◽

The Russian Federation

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Intermediate risk of cardiac events and recurrent stroke after stroke admission in young adults

International Journal of Stroke ◽

10.1177/1747493017733929 ◽

2017 ◽

Vol 13 (6) ◽

pp. 576-584 ◽

Cited By ~ 3

Author(s):

Peter Jin ◽

Ivan Matos Diaz ◽

Laura Stein ◽

Alison Thaler ◽

Stanley Tuhrim ◽

...

Keyword(s):

Risk Factors ◽

Young Adults ◽

Ischemic Stroke ◽

Cardiovascular Events ◽

Recurrent Stroke ◽

Intermediate Risk ◽

Cardiac Events ◽

Vascular Events ◽

Increased Risk ◽

Index Stroke

Background In older adults with stroke, there is an increased risk of cardiovascular events in the intermediate period, up to one year after stroke. The risk of cardiovascular events in this period in young adults after stroke has not been studied. We hypothesized that in the intermediate risk period, young adults with ischemic stroke have an increased risk of recurrent stroke and a smaller increase of cardiac events. Methods Using the National Readmissions Database during the year 2013, we identified ischemic stroke admissions among those aged 18–45 years using International Classification of Disease, Ninth Revision, Clinical Modification codes to identify index vascular events and risk factors. Primary outcomes were readmission for cardiac events and stroke. Multivariable Cox proportional hazard models and Kaplan–Meier analysis were used to estimate risk of primary outcomes. Results We identified 12,392 young adults with index stroke. The readmission rate due to recurrent stroke was higher than for cardiac events (2913.3.1 vs. 1132.4 per 100,000 index hospitalizations at 90 days). There was a higher cumulative risk of both cardiac events and recurrent stroke in the presence of baseline diabetes and hypercholesterolemia. Conclusion In a large, nationally representative database, the intermediate risk of recurrent stroke after index stroke in young adults was higher than the risk of cardiac events. The presence of vascular risk factors augmented this risk but did not entirely account for it. The aggressive control of hypercholesterolemia and diabetes may play an important role in secondary prevention in young adults with stroke.

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Periodic limb movements during sleep in stroke/TIA

Neurology ◽

10.1212/wnl.0000000000005471 ◽

2018 ◽

Vol 90 (19) ◽

pp. e1663-e1672 ◽

Cited By ~ 13

Author(s):

Mauro Manconi ◽

Francesco Fanfulla ◽

Raffaele Ferri ◽

Silvia Miano ◽

Josè Haba-Rubio ◽

...

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Time Course ◽

Chronic Phase ◽

Periodic Limb Movements ◽

Limb Movements ◽

Previous Diagnosis ◽

History Of ◽

The Mean ◽

Care Study

ObjectiveTo define the prevalence, time course, and associated factors of periodic limb movements during sleep (PLMS) in patients with ischemic stroke or TIA.MethodsPatients enrolled in the prospective Sleep-Disordered Breathing in Transient Ischemia Attack (TIA)/Ischemic Stroke and Continuous Positive Airway Pressure (CPAP) Treatment Efficacy (SAS-CARE) study underwent a double polysomnographic investigation in the acute and chronic phases after stroke/TIA, together with a MRI brain scan and a 24-hour blood pressure evaluation. The prevalence of PLMS in patients was compared with that in a matched sample of randomly selected healthy controls from the HypnoLaus cohort. One hundred sixty-nine recordings were performed in the acute phase and 191 after 3 months (210 recordings were obtained from the same 105 patients in both phases) and were compared to those of 162 controls.ResultsThe mean number of PLMS per hour and the percentage of participants with a PLMS index >10 and >15 per hour were similar between patients and controls. PLMS remained stable from the acute to the chronic phase after stroke. Factors positively associated with PLMS were age, body mass index, and history of hypertension. Blood pressure over 24 hours and the burden of cerebrovascular damage were similar between the groups with PLMS and without PLMS.ConclusionsPLMS are equally frequent in patients with stroke/TIA and the general population. The absence of higher blood pressure values and of a greater vascular brain damage found in patients with PLMS compared to those without PLMS might be due to a greater use of antihypertensive medication among patients with PLMS, which corresponds to a higher prevalence of previous diagnosis of hypertension in these patients.

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Ischemic stroke due to protein C deficiency

Bangladesh Critical Care Journal ◽

10.3329/bccj.v4i2.30029 ◽

2016 ◽

Vol 4 (2) ◽

pp. 123-124

Author(s):

Debasish Kumar Saha ◽

ASM Areef Ahsan ◽

Kaniz Fatema ◽

Madhurima Saha ◽

Fatema Ahmed ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Cardiovascular Diseases ◽

Protein C ◽

Young Patients ◽

High Morbidity ◽

Protein C Deficiency ◽

Common Causes ◽

The World ◽

The Common

Cardiovascular diseases are one of the common causes of high morbidity and mortality all over the world. Usually stroke occur in elderly, but stroke in younger group (age <45 years) are increasingly common now-a-days. The disease can occur in young patients without any apparent risk factors. It is therefore important to exclude all aetiological causes in order to reduce their chances for a subsequent event.Bangladesh Crit Care J September 2016; 4 (2): 123-124

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Wake-Up Sleepyhead: Unilateral Diencephalic Stroke Presenting with Excessive Sleepiness

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_258_18 ◽

2019 ◽

Vol 10 (01) ◽

pp. 145-147 ◽

Cited By ~ 1

Author(s):

R. Pradeep ◽

Dhananjay Gupta ◽

Anish Mehta ◽

R. Srinivasa ◽

Mahendra Javali ◽

...

Keyword(s):

Ischemic Stroke ◽

Sleep Disordered Breathing ◽

Reciprocal Relationship ◽

Sleep Architecture ◽

Periodic Limb Movements ◽

Limb Movements ◽

Stroke Patients ◽

Excessive Sleepiness ◽

Sleep Abnormalities ◽

Disordered Breathing

ABSTRACTAltered sleep architecture and stroke share a reciprocal relationship. More than half of the stroke patients display sleep abnormalities including hypersomnia, insomnia, parasomnia, periodic limb movements, or sleep-disordered breathing. Conversely, one of the major causes of severe organic hypersomnia is acute brainstem strokes, involving thalamic infarctions, which may be reversible over 6–12 months. Here, we report a patient with increased lethargy and drowsiness who was diagnosed to have a right thalamic and hypothalamic ischemic stroke.

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