scholarly journals Risk of fatal sinus arrest induced by low-grade subarachnoid hemorrhage: A case of a young patient with obstructive sleep apnea

2020 ◽  
Vol 11 ◽  
pp. 156
Author(s):  
Naoki Wakuta ◽  
Satoshi Yamamoto
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Sleep Apnea ◽  
Nervous Activity ◽  
Sleep Apnea Syndrome ◽  
Sympathetic Nervous Activity ◽  
Low Grade ◽  
Sinus Arrest ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Temporary Pacemaker

Background: Sleep apnea syndrome (SAS) and subarachnoid hemorrhage (SAH) are both considered possible causes of secondary arrhythmias. However, there are limited reports on the increased risk of bradyarrhythmia for arrhythmia-free SAS patients with SAH. Case Description: A 31-year-old woman with SAS developed low-grade SAH and underwent coil embolization on postbleed day 1. Following a coiling procedure, she experienced worsening episodes of sinus arrest lasting up to 12 s and required a temporary pacemaker. Frequent episodes of sinus arrest were detected for the next 4 days. Thereafter, all types of arrhythmias gradually decreased, and she eventually recovered to be arrhythmia free. Conclusion: Acceleration of sympathetic nervous activity caused by acute SAH may predispose patients to bradyarrhythmia with SAS and elicit asystole. The coexistence of SAS and SAH should be recognized as a cause of life-threatening sinus arrest, even if the severity of SAH is low grade.

scholarly journals Obstructive Sleep Apnea and Inflammation: Proof of Concept Based on Two Illustrative Cytokines

2019 ◽  
Vol 20 (3) ◽  
pp. 459 ◽  
Author(s):  
Leila Kheirandish-Gozal ◽  
David Gozal
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Inflammatory Diseases ◽  
Sleep Apnea Syndrome ◽  
Special Focus ◽  
Normal Body Mass Index ◽  
Low Grade ◽  
Obstructive Sleep ◽  
Inflammatory Processes ◽  
Factor Α

Obstructive sleep apnea syndrome (OSAS) is a markedly prevalent condition across the lifespan, particularly in overweight and obese individuals, which has been associated with an independent risk for neurocognitive, behavioral, and mood problems as well as cardiovascular and metabolic morbidities, ultimately fostering increases in overall mortality rates. In adult patients, excessive daytime sleepiness (EDS) is the most frequent symptom leading to clinical referral for evaluation and treatment, but classic EDS features are less likely to be reported in children, particularly among those with normal body-mass index. The cumulative evidence collected over the last two decades supports a conceptual framework, whereby sleep-disordered breathing in general and more particularly OSAS should be viewed as low-grade chronic inflammatory diseases. Accordingly, it is assumed that a proportion of the morbid phenotypic signature in OSAS is causally explained by underlying inflammatory processes inducing end-organ dysfunction. Here, the published links between OSAS and systemic inflammation will be critically reviewed, with special focus on the pro-inflammatory cytokines tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6), since these constitute classical prototypes of the large spectrum of inflammatory molecules that have been explored in OSAS patients.

Postoperative treatment of the patient with obstructive sleep apnea

2000 ◽  
Vol 122 (2) ◽  
pp. 233-236 ◽  
Author(s):  
Keith M. Ulnick ◽  
Richard F. Debo
Keyword(s):  
Intensive Care Unit ◽  
Obstructive Sleep Apnea ◽  
Intensive Care ◽  
Sleep Apnea ◽  
Sleep Apnea Syndrome ◽  
Study Groups ◽  
Postoperative Treatment ◽  
Arterial Oxygen ◽  
Obstructive Sleep ◽  
Increased Risk

>OBJECTIVE The postoperative management of patients with obstructive sleep apnea syndrome (OSAS) has been based primarily on the potential loss of the airway. Our hypothesis is that not all patients with OSAS require placement in the intensive care unit after surgery. METHODS We undertook a prospective, nonrandomized study (N = 38). Data included demographics, polysomnograms, body mass index (BMI), and postoperative course, including any complications within 72 hours. RESULTS The average respiratory disturbance index was 66, and the average BMI was 29. The average preoperative and postoperative maximal arterial oxygen desaturation values were 82% and 94%, respectively. Patients with BMIs less than 35 did not have desaturation values below 90%. No complications occurred. DISCUSSION Within the first 72 hours after surgery, no complications were observed in our study groups. Patients with BMIs greater than 35 were at increased risk for postoperative desaturations. The uncomplicated OSAS patient, one without significant comorbid factors, can be treated in a safe and prudent fashion outside of an intensive care unit.

scholarly journals Obstructive Sleep Apnea Presenting as Pseudopheochromocytoma: A Case Report

2004 ◽  
Vol 89 (5) ◽  
pp. 2033-2038 ◽  
Author(s):  
L. J. Hoy ◽  
M. Emery ◽  
J. A. Wedzicha ◽  
A. G. Davison ◽  
S. L. Chew ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Nervous Activity ◽  
Systemic Blood Pressure ◽  
Primary Treatment ◽  
Sympathetic Nervous Activity ◽  
Urinary Catecholamine ◽  
Urinary Catecholamines ◽  
Obstructive Sleep ◽  
Continuous Positive Airways Pressure

Sudden arousal from sleep causes a transient surge in sympathetic nervous activity. Repeated arousals, as occur in obstructive sleep apnea (OSA), are well documented to cause a more prolonged sympathetic overactivity and consequent elevations in 24-h urinary catecholamine levels. We describe here a series of five patients, each presenting with a clinical and biochemical picture indistinguishable from that of pheochromocytoma. Thorough investigations have failed to find catecholamine-secreting tumor in any of these subjects, but all have been diagnosed with OSA. Primary treatment of OSA with nasal continuous positive airways pressure has led to normalization of systemic blood pressure and urinary catecholamines. Pseudopheochromocytoma is therefore a rare, but treatable, presentation of obstructive sleep apnea.

scholarly journals Inflammatory Markers and Obstructive Sleep Apnea in Obese Children: The NANOS Study

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Alex Gileles-Hillel ◽  
María Luz Alonso-Álvarez ◽  
Leila Kheirandish-Gozal ◽  
Eduard Peris ◽  
José Aurelio Cordero-Guevara ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Inflammatory Markers ◽  
Sleep Apnea Syndrome ◽  
Community Dwelling ◽  
Low Grade ◽  
Obese Children ◽  
Blood Draw ◽  
Obstructive Sleep ◽  
Pai 1

Introduction.Obesity and obstructive sleep apnea syndrome (OSA) are common coexisting conditions associated with a chronic low-grade inflammatory state underlying some of the cognitive, metabolic, and cardiovascular morbidities.Aim.To examine the levels of inflammatory markers in obese community-dwelling children with OSA, as compared to no-OSA, and their association with clinical and polysomnographic (PSG) variables.Methods.In this cross-sectional, prospective multicenter study, healthy obese Spanish children (ages 4–15 years) were randomly selected and underwent nocturnal PSG followed by a morning fasting blood draw. Plasma samples were assayed for multiple inflammatory markers.Results.204 children were enrolled in the study; 75 had OSA, defined by an obstructive respiratory disturbance index (RDI) of 3 events/hour total sleep time (TST). BMI, gender, and age were similar in OSA and no-OSA children. Monocyte chemoattractant protein-1 (MCP-1) and plasminogen activator inhibitor-1 (PAI-1) levels were significantly higher in OSA children, with interleukin-6 concentrations being higher in moderate-severe OSA (i.e., AHI > 5/hrTST;P<0.01), while MCP-1 levels were associated with more prolonged nocturnal hypercapnia(P<0.001).Conclusion.IL-6, MCP-1, and PAI-1 are altered in the context of OSA among community-based obese children further reinforcing the proinflammatory effects of sleep disorders such as OSA. This trial is registered with ClinicalTrials.govNCT01322763.

Increased risk of cerebral white matter lesions in obstructive sleep apnea syndrome

2016 ◽  
Vol 15 (1) ◽  
pp. 49-55
Author(s):  
Rauf Oguzhan Kum ◽  
Deniz Baklaci ◽  
Muge Ozcan ◽  
Deniz Sozmen Ciliz ◽  
Yavuz Fuat Yilmaz ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
White Matter ◽  
Sleep Apnea Syndrome ◽  
White Matter Lesions ◽  
Cerebral White Matter ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Cerebral White Matter Lesions ◽  
Apnea Syndrome

Protective Effects of Obstructive Sleep Apnea on Outcomes After Subarachnoid Hemorrhage: A Nationwide Analysis

Neurosurgery ◽  
2020 ◽  
Vol 87 (5) ◽  
pp. 1008-1015
Author(s):  
Christian Kaculini ◽  
David J Wallace ◽  
Audrey E Haywood ◽  
Joel Michalek ◽  
Justin Mascitelli ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Subarachnoid Hemorrhage ◽  
Sleep Apnea ◽  
Tobacco Use ◽  
Univariate Analysis ◽  
Protective Effects ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Poor Outcomes ◽  
The Impact

Abstract BACKGROUND Obstructive sleep apnea (OSA) is typically associated with an increased risk of cardiovascular and cerebrovascular disease. Recent studies, however, have suggested that hypercapnia and chronic intermittent hypoxia may potentially provide protection against ischemic events like stroke. OBJECTIVE To evaluate the impact of OSA with presentation, hospital course, and treatment outcomes of patients with subarachnoid hemorrhage (SAH). METHODS Data for patients with SAH between the years 2011 and 2015 were extracted from the Nationwide Inpatient Sample (NIS) and stratified based on diagnosis codes for OSA. Univariate analysis was used to assess the prevalence of comorbidities in OSA patients diagnosed with SAH and several covariates, including patient demographics, aneurysmal treatment, in-hospital morality rate, length of stay, and costs. Multivariate logistic regression models analyzed the relationship between several comorbidities, including OSA, tobacco use, and hypertension, and poor outcomes after SAH. RESULTS Data from 49 265 SAH patients were used in this study, of which 2408 (4.9%) also had a concomitant OSA diagnosis. Patients with OSA compared to all other SAH patients had a significantly lower in-hospital mortality rate, as well as statistically significant lower odds of vasospasm, stroke, and poor outcomes. Additionally, hypercholesterolemia, obesity, and tobacco use disorder were also associated with more favorable outcomes. CONCLUSION SAH patients with OSA are significantly less likely to have a poor outcome when compared to non-OSA patients, despite having an increased risk of several comorbidities.

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