Poruchy spánku predstavujú častú komorbiditu u pacientov s cievnou mozgovou príhodou (CMP). Vzájomné vzťahy medzi poruchami spánku a CMP sú komplexné a obojsmerné. Poruchy spánku môžu jednak predstavovať rizikový faktor vzniku CMP, na druhej strane môže lézia centrálneho nervového systému navodiť narušenie spánku. Spánkové poruchy a ich liečba môžu vo výraznej miere modifikovať proces rekonvalescencie pacienta a ovplyvňovať aj riziko recidívy CMP. V nasledujúcom texte približujeme uvedenú problematiku. Pozornosť venujeme nielen detailne preskúmanému spánkovému apnoe, ale objasňujeme aj úlohu porúch hybnosti viazaných na spánok a insomnie. Interakcie CMP s hypersomniami, poruchami cirkadiánnej rytmicity a parasomniami budú musieť detailnejšie odhaliť až budúce prospektívne štúdie.
Sleep disorders represent a common comorbidity in patients with stroke. Their relationships are complex and bidirectional. Sleep disorders can act as a risk factor for the development of stroke. On the other hand, lesions in the central nervous system can lead to sleep disturbances. Sleep disorders and their treatment can significantly modify the recovery process of the patient and also affect the risk of stroke recurrence. In the following text, we present the mentioned topic. We focus not only on the well-studied sleep apnea but also explain the role of sleep-related movement disorders and insomnia. The interactions of stroke with hypersomnias, circadian rhythm disorders, and parasomnias will need to be more thoroughly investigated by future prospective studies.
- MeSH
- cévní mozková příhoda * diagnóza etiologie klasifikace prevence a kontrola MeSH
- klinická studie jako téma MeSH
- lidé MeSH
- poruchy cirkadiánního rytmu (spánek) diagnóza klasifikace komplikace MeSH
- poruchy iniciace a udržování spánku diagnóza klasifikace komplikace MeSH
- poruchy spánku a bdění * diagnóza etiologie klasifikace komplikace MeSH
- poruchy spánku z vnitřních příčin diagnóza klasifikace komplikace MeSH
- syndromy spánkové apnoe diagnóza klasifikace komplikace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
BACKGROUND: Wake-up stroke (WUS) is a certain type of ischemic stroke in which a patient wakes up with a new neurological deficit due to cerebral ischemia. Sleep-disordered breathing is an independent risk factor for stroke, but the role of nocturnal oxygen desaturation in the pathophysiology of WUS is still insufficiently explored. According to several studies, patients with WUS have a significantly more severe sleep apnea syndrome and lower mean blood oxygen saturation. This study aimed to assess the severity of nocturnal desaturations in acute WUS and non-WUS patients using nocturnal pulse oximetry. MATERIAL AND METHODS: The cohort of 225 consecutive patients with neuroimaging-verified acute cerebral ischemia was prospectively enrolled. For further analyses, 213 subjects with known WUS/non-WUS status were selected (111 males and 102 females, average age 70.4 ±12.9, median baseline NIHSS = 5, median baseline mRS = 3). Patients were divided into the WUS group (n = 45) and the non-WUS group (n = 168). Overnight pulse oximetry was performed within 7 days of the stroke onset and data of both of the studied groups were compared. RESULTS: We found oxygen desaturation index (ODI) in the WUS group was 14.5 vs. 16.6 (p = 0.728) in the non-WUS group, basal O2 saturation was 92.2% vs. 92.5% (p = 0.475), average low O2 saturation was 90.3% vs. 89.6% (p = 0.375), minimal O2 saturation was 79.5% vs. 80.6% (p = 0.563), and time with O2 saturation <90% (T90) was 4.4% vs. 4.7% (p = 0.729). CONCLUSIONS: In the studied sample, monitored respiratory parameters including ODI, basal O2 saturation, average low O2 saturation, minimal O2 saturation, and T90 did not significantly differ between groups of WUS and non-WUS patients.
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Obstructive sleep apnea (OSA) activates several pathophysiological mechanisms which can lead to the development of vascular diseases. Endothelial dysfunction (ED) is an initial step in the development of atherosclerosis. The association between ED and OSA has been described in several studies, even in previously healthy subjects. High-density lipoproteins (HDL) were generally considered to be atheroprotective, and low-density lipoprotein (LDL) to be an atherogenic component of lipoproteins. However, recent findings suggest a pro-atherogenic role of small HDL subfractions (8-10) and LDL subfractions (3-7). This study aimed to evaluate the relationship between endothelial function and lipid subfractions in previously healthy OSA subjects. MATERIAL AND METHODS: We prospectively enrolled 205 subjects with sleep monitoring. Plasma levels of triacylglycerols, total cholesterol, LDL, HDL, and their subfractions were assessed. Endothelial function was determined using peripheral arterial tonometry, and reperfusion hyperemia index (RHI) was assessed. RESULTS: Plasma levels of small and intermediate HDL subfractions have statistically significant pro-atherogenic correlations with endothelial function (p = 0.015 and p = 0.019). In other lipoprotein levels, no other significant correlation was found with RHI. In stepwise multiple linear regression analysis, small HDL (beta = -0.507, p = 0.032) was the only significant contributor in the model predicting RHI. CONCLUSIONS: In our studied sample, a pro-atherogenic role of small HDL subfractions in previously healthy subjects with moderate-to-severe OSA was proven.
- Publikační typ
- časopisecké články MeSH
Úvod: Totálna náhrada kolenného kĺbu je jednou z najčastejších a najúspešnejších operačných metód v ortopédii u pacientov s diagnózou pokročilej artrózy. V tejto retrospektívnej analýze sa zameriavame na porovnanie funkčných a klinických výsledkov u pacientov podstupujúcich unilaterálnu výmenu a u pacientov s bilaterálnou výmenou v rámci jedného operačného zákroku. Metódy: Do štúdie bolo zaradených celkovo 54 pacientov (bilaterálna 19, unilaterálna 35), ktorí na našom pracovisku podstúpili totálnu náhradu kolenného kĺbu. U pacientov bola sledovaná dĺžka hospitalizácie. Na objektívne zhodnotenie sme použili štandardizované dotazníky WOMAC a KSS 1, KSS 2, rozsah pohybu v operovanom kolennom kĺbe a výskyt pooperačných komplikácii. Výsledky: Obe skupiny pacientov boli vekom, body mass index a zastúpením pohlaví pomerne homogénne. Dĺžka hospitalizácie bola v unilaterálnej skupine 4,7±1,3 nesignifikantne kratšia ako v bilaterálnej skupine 5,6±2,0. Pacienti operovaní unilaterálne dosahovali rok po operácii flexiu 114,9±9,3, bilaterálna skupina dosahovala flexiu 112,6±8,6. Tak v unilaterálnej skupine u WOMAC, KSS1 a KSS2, ako aj v bilaterálnej skupine dochádza pri porovnaní s predoperačnými hodnotami k signifikantnému zlepšeniu jeden rok pooperačne. Pri porovnaní výsledkov WOMAC, KSS1 a KSS2 unilaterálnej a bilaterálnej skupiny 3, 6 a 12 mesiacov pooperačne, sú rozdiely hodnôt nesignifikantné. Revidovanosť implantátov v dvojročnom sledovaní dosahovala v unilaterálnej skupine 1,5 % a 1,4 % v bilaterálnej skupine. Záver: Unilaterálna aj bilaterálna implantácia endoprotézy kolenného kĺbu ako úspešné operačné metódy majú svoje zastúpenie v každodennej ortopedickej praxi. Pri dôslednej indikácii pacientov môže byť bilaterálna implantácia výhodnejšou alternatívou liečby, nakoľko pacient podstupuje len jeden operačný zákrok a riziká s ním spojené.
Introduction: Total knee replacement is one of the most common surgical methods in diagnosis of end staged osteoarthritis. In this retrospective analysis, we focus on comparison of functional and clinical outcome in patients undergoing unilateral and bilateral replacement within a single surgical procedure. Methods: 54 patients (bilateral 19, unilateral 35) underwent total knee replacement in our clinic participated in the current study. The length of hospital stay was monitored in all patients. Assessment of functional results was based on the WOMAC score, KSS 1, KSS2, range of motion and presence of complications in both groups. Results: Both groups of patients were homogeneous with age, body mass index and sex. The length of hospital stay in the unilateral group was 4.7±1.3 and 5.6±2.0 in the bilateral group. Patients operated on unilaterally achieved flexion of 114.9±9.3 after one year, bilateral group 112.6±8.6, the difference was insignificant. In both groups, there is a significant improvement one year postoperatively at WOMAC, KSS1 and KSS2. Comparing WOMAC, KSS1 and KSS2 between the unilateral and bilateral groups 3, 6, 12 months postoperatively, the differences are insignificant. The revision of implants in two-year follow-up reached 1.5% in unilateral group and 1.4% in bilateral group. Conclusion: Unilateral and bilateral knee joint endoprosthesis implantation is a successful surgical method in orthopedic practice. With conscious selection of patients, bilateral implantation may be more advantageous alternative, as the patient undergoes one operation and the associated risks.
Spánkové poruchy dýchania predstavujú významný rizikový faktor cerebrovaskulárnych ochorení. Syndróm spánkového apnoe (SAS) je u pacientov s cievnou mozgovou príhodou (CMP) častý a nepriaznivo ovplyvňuje ich zdravotný stav. Napriek tomu ostáva veľká časť pacientov s CMP po tejto stránke nediagnostikovaných a prichádza o potenciálny benefit pretlakovej ventilačnej liečby. V tomto článku sa podrobnejšie venujeme špecifikám epidemiológie, etiopatogenézy, diagnostiky a liečby SAS práve v populácii pacientov s CMP. Zaoberáme sa aj vzájomnými vzťahmi a súvislosťami medzi týmito dvoma samostatnými nozologickými jednotkami.
Sleep-disordered breathing is a significant risk factor for cerebrovascular diseases. Sleep apnea syndrome is common among patients with stroke and negatively influences outcomes of patients. However, most cases of sleep apnea in patients with stroke remain undiagnosed and patients are losing potential benefits of positive airway pressure therapy. In this article, we focus in detail on the specific aspects of epidemiology, etiopathogenesis, diagnostic process, and therapy of sleep apnea syndrome in stroke patients. We also deal with the relationships and connections between these two separate nosological units.
- MeSH
- cévní mozková příhoda komplikace MeSH
- lidé MeSH
- syndromy spánkové apnoe * diagnóza terapie MeSH
- ventilace umělá s přerušovaným přetlakem MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Autonomic nervous system (ANS) disorders are common in multiple sclerosis (MS). Previous studies showed differences in insulin resistance (IR) and lipoprotein levels in MS subjects compared to controls. Lipolysis caused by increased sympathetic activity could be one of the possible linking mechanisms leading to dyslipidemia in MS. Our study aimed to evaluate ANS activity in the context of glucose and lipid metabolism in people with MS. We prospectively measured short-term heart rate variability (HRV), fasting lipoprotein concentrations, and calculated IR indices based on plasma glucose and insulin levels during oral glucose tolerance test (oGTT) in 32 patients with MS and 29 healthy controls matched for age, sex and body mass index in our study. There was no significant difference in HRV parameters and lipoprotein levels between MS and controls. A significant positive correlation was found between low/high-frequency power ratio (LF/HF) and triglycerides (r=0.413, p=0.021) in MS subjects but not in controls. A significantly lower whole-body insulin sensitivity index (ISIMat) was found in patients with MS compared to the control group (7.3±3.7 vs. 9.8±5.6, p=0.041). No significant correlations were found between LF/HF and IR parameters. In MS subjects, the positive correlation of LF/HF with triglycerides could reflect the effects of sympathetic activity on lipolysis. Positive correlations of sympathetic activity with increased lipoprotein levels could rather reflect processes associated with immune system activation/inflammation, than processes involved in glucose homeostasis maintenance.
- MeSH
- autonomní nervový systém patofyziologie MeSH
- dospělí MeSH
- inzulinová rezistence * MeSH
- lidé MeSH
- lipidy krev MeSH
- lipolýza * MeSH
- mladý dospělý MeSH
- prospektivní studie MeSH
- roztroušená skleróza krev patofyziologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Recent studies reported association of sleep-disordered breathing (SDB) with testosterone and vitamin D deficiency. Low testosterone and vitamin D levels have been linked to fatigue and excessive daytime sleepiness (EDS). However, the impact of testosterone and vitamin D deficiency on EDS in subjects with SDB remains unknown. The aim of this study was to explore the predictors of EDS in habitual snorers. Role of testosterone, and vitamin D was studied in detail. We also looked for associations between testosterone, vitamin D, and sleep-related indices. We prospectively enrolled 291 consecutive male patients with habitual snoring. Baseline clinical characteristics were recorded on admission. Standard overnight polysomnography was performed to detect SDB, and Epworth Sleepiness Scale (ESS) was used to assess EDS. Blood samples were obtained in a fasting condition in the morning after polysomnography to determine levels of testosterone and vitamin D. Respiratory disturbance index (RDI) (95 % CI: 1.004-1.024, p=0.005) and the use of antihistamines (95 % CI: 1.083-11.901, p=0.037) were the only independent variables significantly associated with EDS in binary logistic regression analysis. In linear multiple regression analysis, body mass index (BMI) (Beta=-0.282, p<0.001) and oxygen desaturation index (Beta=-0.150, p=0.043) were the only independent variables significantly associated with testosterone levels, and BMI (Beta=-0.142, p=0.016) was the only independent variable significantly associated with vitamin D. We failed to find any independent association of testosterone and vitamin D with subjectively rated EDS among habitual snorers. Our results suggest an independent association between the magnitude of nocturnal desaturation and testosterone levels.
- MeSH
- index tělesné hmotnosti * MeSH
- lidé středního věku MeSH
- lidé MeSH
- nedostatek vitaminu D krev patologie MeSH
- obstrukční spánková apnoe krev patologie MeSH
- polysomnografie metody MeSH
- poruchy nadměrné spavosti krev patologie MeSH
- prospektivní studie MeSH
- testosteron krev MeSH
- vitamin D krev MeSH
- vitaminy krev MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Spojené království MeSH
Obštrukčné spánkové apnoe predstavuje časté ochorenie, ktoré postihuje približne jednu štvrtinu bežnej populácie. Jeho prevalencia je ešte vyššia v populáciách s vysokým vaskulárnym rizikom. Obštrukčné spánkové apnoe predstavuje významný rizikový faktor pre vznik arteriálnej hypertenzie, pričom arteriálnou hypertenziou trpí až 50% pacientov so spánkovým apnoe. Napriek jasne dokázanej asociácii medzi obštrukčným spánkovým apnoe a arteriálnou hypertenziou, doposiaľ nie sú jednoznačne objasnené patomechanizmy, ktoré spájajú obe tieto ochorenia. Predpokladá sa významná úloha aktivácie sympatikového nervového systému, stimulácie systému renín- angiotenzín- aldosterón a endoteliálnej dysfunkcie. Neustále však pribúdajú dôkazy, ktoré svedčia aj o úlohe črevnej dysbiózy v tomto procese. Tento článok uvádza možné mechanizmy, ktoré spájajú obštrukčné spánkové apnoe so vznikom arteriálnej hypertenzie, pričom detailnejšiu pozornosť venuje práve úlohe črevného mikrobiómu.
Obstructive sleep apnea is common disorder affecting approximately one quarter of the common population. Prevalence is even higher in a population with increased vascular risk. Obstructive sleep apnea is a significant risk factor for hypertension, with approximately 50% of obstructive sleep apnea patients suffering hypertension. While the relationship between sleep apnea and hypertension has been firmly established, mechanisms linking these disorders are still poorly understood. Importance of sympathetic nervous system and renin-angiotensin-aldosterone system hyperactivity as well as endothelial dysfunction is suspected. There is increasing evidence supporting gut dysbiosis as one of the underlying mechanisms. Current article describes possible mechanisms linking obstructive sleep apnea with the development of hypertension. The role of gut microbiota in this process is discussed more closely.
- MeSH
- hypertenze MeSH
- lidé MeSH
- obstrukční spánková apnoe * patofyziologie MeSH
- střevní mikroflóra MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
BACKGROUND AND PURPOSE: Autonomic nervous system (ANS) seems to play an important role in the post-stroke immunosuppression syndrome with increased susceptibility to infections. The aim of this study was to investigate if ANS activity measured at admission is associated with post-stroke infections. METHODS: We prospectively analyzed patients with acute ischemic stroke. ANS was measured using the cross-correlational baroreflex sensitivity (BRS) at admission. The occurrence and cause of in-hospital infections was assessed based on the clinical and laboratory examination. Demographic and clinical variables including initial stroke severity, dysphagia, procedures as nasogastric tubes, central venous and urinary catheters and mechanical ventilation were included in the analysis. RESULTS: We included 161 patients with ischemic stroke, of those 49 (30.4%) developed a nosocomial infection during the first 7 days of hospital stay. Patients with infections had significantly lower BRS (median 3 vs 5 ms/mmHg, p < .001) higher initial NIHSS (median 15 vs 5, p < .001), had more often non-lacunar etiology and underwent more invasive procedures. In the multivariable regression model decreased BRS (adjusted OR 1.21, 95% CI 1.03-1.41, p = .02), admission NIHSS (adjusted OR 1.10, 95% CI 1.02-1.19, p = .02) and invasive procedures (adjusted OR 1.46, 95% CI 1.03-2.06, p = .03) were independently associated with infection after ischemic stroke. CONCLUSIONS: Decreased BRS was independently associated with infections after ischemic stroke. Autonomic shift may play an important role in increased susceptibility to infections after stroke. The possible diagnostic and therapeutic relevance of this finding deserves further research.
- MeSH
- baroreflex fyziologie MeSH
- cévní mozková příhoda diagnóza patofyziologie MeSH
- dospělí MeSH
- infekce spojené se zdravotní péčí diagnóza patofyziologie MeSH
- ischemie mozku diagnóza patofyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- prospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
DWI-FLAIR mismatch has been recently proven to identify patients with unknown onset stroke (UOS) eligible for thrombolysis. However, this concept may exclude patients from thrombolysis who may eventually benefit as well. We aimed to examine the feasibility, safety and potential efficacy of thrombolysis in wake-up stroke (WUS) and UOS patients using a modified DWI-FLAIR mismatch allowing for partial FLAIR positivity. WUS/UOS patients fulfilling the modified DWI-FLAIR mismatch and treated with intravenous thrombolysis (IVT) were compared to propensity score matched WUS/UOS patients excluded from IVT due to FLAIR positivity. The primary endpoint was a symptomatic intracranial hemorrhage (SICH), the secondary endpoints were improvement of ≥ 4 in NIHSS score and mRS score at 3 months. 64 IVT-treated patients (median NIHSS 9) and 64 controls (median NIHSS 8) entered the analysis (p = 0.2). No significant difference in SICH was found between the IVT group and the controls (3.1% vs. 1.6%, p = 0.9). An improvement of ≥ 4 NIHSS points was more frequent in IVT patients as compared to controls (40.6% vs. 18.8%, p = 0.01). 23.4% of IVT patients achieved a mRS score of 0-1 at 3 months as compared to 18.8% of the controls (p = 0.8). SICH, improvement of NIHSS ≥ 4 and mRS 0-1 at 3 months were comparable in thrombolyzed patients with negative FLAIR images versus those thrombolyzed with partial positive FLAIR images (3% vs. 3%, p = 0.9; 40% vs. 41%, p = 0.9; 19% vs. 22%, p = 0.8). Our study signalizes that thrombolysis may be feasible in selected WUS/UOS patients with partial FLAIR signal positivity.
- MeSH
- časové faktory MeSH
- cévní mozková příhoda diagnostické zobrazování farmakoterapie patofyziologie MeSH
- difuzní magnetická rezonance * MeSH
- dospělí MeSH
- fibrinolytika aplikace a dávkování škodlivé účinky MeSH
- intrakraniální krvácení chemicky indukované MeSH
- klinické rozhodování MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční angiografie MeSH
- mozková angiografie metody MeSH
- mozkový krevní oběh MeSH
- obnova funkce MeSH
- posuzování pracovní neschopnosti MeSH
- prediktivní hodnota testů MeSH
- registrace MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- studie proveditelnosti MeSH
- trombolytická terapie škodlivé účinky metody MeSH
- výběr pacientů MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
