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
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
Spánkové poruchy dýchania patria medzi časté ochorenia, ktoré postihujú približne jednu štvrtinu bežnej populácie dospelých ľudí. Početné štúdie potvrdzujú úzky vzťah medzi spánkovým apnoe a ložiskovou ischémiou mozgu, ako aj medzi spánkovým apnoe a kognitívnym deficitom. Kľúčovým mechanizmom podieľajúcim sa na oboch procesoch by mohla byť cerebrálna hypoperfúzia a hemodynamické zmeny pri apnoických epizódach. V nasledujúcom texte uvádzame prehľad vyšetrovacích metód použiteľných na stanovenie prietoku krvi mozgom u pacientov s obštrukčným spánkovým apnoe. Uvádzame taktiež naše skúsenosti s použitím UZ modulovanej "blízkej" infračervenej spektroskopie v priebehu celonočnej polysomnografie, ktoré doteraz nebolo v literatúre opísané.
Sleep-disordered breathing is a frequent disorder that affects approximately one quarter of the common population of adults. Numerous studies suggest a tight link between sleep apnea and ischemic stroke as well as between sleep apnea and cognitive impairment. Cerebral hypoperfusion and hemodynamic changes during apneic events could be a key mechanism involved in both processes. In a current paper, we present an overview of diagnostic methods that could be potentially used for a blood flow monitoring in obstructive sleep apnea patients. We also report our experience with the use of US tagged near-infrared spectroscopy during overnight polysomnography which was not previously reported in the literature.
- Klíčová slova
- ultrazvukom modulovaná NIRS,
- MeSH
- diagnostické zobrazování metody MeSH
- ischemie mozku prevence a kontrola MeSH
- lidé MeSH
- objem krve v mozku * MeSH
- obstrukční spánková apnoe * patofyziologie MeSH
- ultrasonografie dopplerovská transkraniální metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
