JOURNAL OF PHYSIOLOGY AND PHARMACOLOGY 2008, 59, Suppl 6,
|
|
- Annis Miles
- 5 years ago
- Views:
Transcription
1 JOURNAL OF PHYSIOLOGY AND PHARMACOLOGY 2008, 59, Suppl 6, R. ROLA 1, H. JAROSZ 1, A. WIERZBICKA 2, A. WICHNIAK 3, P. RICHTER 1, D. RYGLEWICZ 1, W. JERNAJCZYK 2 SLEEP DISORDERED BREATHING AND RECURRENCE OF CEREBROVASCULAR EVENTS, CASE-FATALITY, AND FUNCTIONAL OUTCOME IN PATIENTS WITH ISCHEMIC STROKE OR TRANSIENT ISCHEMIC ATTACK 1 First Department of Neurology, 2 Department of Clinical Neurophysiology, and 3 Third Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland Ninety one patients with stroke or transient ischemic attack (TIA) were screened for sleep-disordered breathing (SDB). Case fatality, rate of recurrence of cerebrovascular events, and functional outcome were analyzed during a 2-year follow-up. The patients were stratified into groups: without (AH 5) and with SDB (AHI >5). SDB was present in 61 (67.7%) patients with stroke or TIA. The rate of recurrence of TIA or stroke in patients with SDB was significantly higher (12 patients, OR=1.52, P<0.05) as compared with patients without SDB (3 patients) within two years of observation. Case-fatality rates were not significantly different (4 patients with SDB and 2 patients without SDB). Our data show that SDB significantly increases the incidence of recurrent cerebrovascular events in patients with TIA or stroke in a two-year follow-up. SDB in patient with stroke or TIA did not influence functional outcome of stroke during the long-term observation. Key words: AHI, ischemic stroke, NIHSS, sleep-disordered breathing, transient ischemic attack INTRODUCTION Sleep-disordered breathing (SDB) is defined as cessation or reduction of air flow in the airways associated with a consecutive decrease of blood oxygenation. The first SDB described was the crescendo-decrescendo pattern of breathing followed by cessation of airflow reported by Cheyne and Stokes (1, 2) in the 19 th
2 616 century. In the 1956 Burwell et al (3) described a Pickwickian syndrome (3). Following years gave tremendous development of the knowledge in the field of sleep-disordered breathing. Palomaki et al (4, 5) have shown that snoring, a manifestation of SDB, is the risk factor for cardiovascular events and ischemic stroke. These results were further confirmed by other authors in subsequent studies (6, 7). The most prevalent SDB is the obstructive sleep apnea syndrome (OSAS) caused by an obstruction along the upper airway (8, 9). Another example of SDB is the central sleep apnea syndrome (CSAS), where apnea is secondary to the lack of respiratory drive and followed by lack of inspiratory muscle contraction (10). Mixed apneas are a combination of both apnea types. Overlapping syndromes are a frequent occurrence in clinical practice. The prevalence of OSAS is at least 2% in women and 4% in men in the general population (9). According to some authors, in selected populations, e.g., in men aged 30-60, the prevalence of OSAS exceeds 10% or even 20% (11-15). Ischemic stroke is the third leading cause of death worldwide (15). There are many convincing results from large cohort studies showing that SDB, especially obstructive sleep apneas, are associated with increased risk of stroke and are regarded as a risk factor independent of other cardiovascular risk factors (12-16). The aim of the present study was to assess the long-term influence of the sleep-disordered breathing on health status of patients with ischemic stroke or transient ischemic attacks. Our previous studies have shown that the incidence of SDB, especially obstructive sleep apneas, is quite high in the population of Polish patients with stroke or transient ischemic attacks (17, 18). We also found a correlation between the severity of the neurological deficit on admission and discharge from the hospital and the severity of sleep-disordered breathing and desaturation events (18). The present study was focused on the long-term consequences of sleep-disordered breathing in patients with cerebrovascular events, especially on the recurrence of the cerebrovascular event and case fatality. Patients MATERIAL AND METHODS Patients recruited to the study were admitted to the First Department of Neurology at the Institute of Psychiatry and Neurology in Warsaw, Poland, with the diagnosis of the first-ever ischemic stroke or transient ischemic attack within the years The diagnosis was determined by neurologists on the basis of clinical symptoms according to the guidelines of the American Academy of Neurology. CT brain scan was performed within the first 6 hours after admission. Patients with significant reduction of consciousness (Glasgow Coma Scale, GCS<10), symptoms of severe neurological deficit (NIHSS score >20), aphasia, history of significant heart failure (NYHA >3), or dementia were not included into the study. Patients with transient ischemic attacks were included into the study only if they presented hemispheric symptoms. All of the patients were informed about the protocol and gave written consent to participate in the study. The
3 617 study was approved by a local Ethics Committee and was conducted according to the Helsinki Declaration for Human Research. Clinical assessment The neurological deficit was assessed with the National Institute of Health Stroke Scale (NIHSS) (19) on the day of admission. Functional disability was assessed using the Rankin and Barthel scales also on the day of admission. The functional outcome during a 2-year follow-up after the stroke or TIA was assessed with the same scales during a telephone interview with patients, caregiver, or family member. Risk factors for cardiovascular events such as increased body mass index (BMI), smoking, hypertension, diabetes mellitus, cardiac arrhythmias, and hypercholesterolemia were assessed in all patients on admission. Sleep-disordered breathing evaluation All patients included to the study underwent an 8-h nocturnal (between 10 p.m. to 6 a.m.) screening for SDB with a portable 8 channel recorder (Embletta, Medcare, Iceland). The examination took place within 7 days after the onset of stroke or TIA symptoms. The recorded variables were: nasal flow, abdominal and thoracic efforts, pulse oximetry, body position, and snoring. Breathing parameters were automatically analyzed with Somnologica Software (Medcare, Iceland) and were visually corrected by a researcher. The Apnea-Hypopnea Index (AHI) was estimated according to the American Academy of Sleep Medicine Task Force guidelines and definitions (19). The patients with stroke or TIA were stratified according to AHI into groups: without SDB (AHI 5) and with SDB (AHI >5). Statistical comparisons were done with a t-test or one-way ANOVA followed by Tukey s test after the normal distributions of data had been established. The rate of recurrence and case fatality were assessed with Fischer s exact tests. Results are shown as means ±SD The follow-up analysis We followed 72 patients after ischemic stroke or TIA for 24 months. The points of interest were the rate of recurrence of cerebrovascular events (transient ischemic attack or recurrent ischemic stroke), case fatality, and functional outcome. The rate of recurrence of TIA or stroke and case fatality were assessed from an analysis of the medical Solmed database system with subsequent phone interviews with the patient, caregiver, or family member. Functional outcome was analyzed with the Barthel and Rankin scales during similar phone interviews. RESULTS Ninety one patients (mean age 65.2 ± 10.3; 79 males 12 females, 69 patients with stroke and 22 patients with TIA), without previously diagnosed SDB, were included into the study. According to the AHI score, the patients were stratified into two groups: without SDB (AHI 5, 30 patients) and with SDB (AHI >5, 61 patients). The mean age and BMI of the patients with SDB did not differed statistically from those of the patients without SDB (66.9 ± 9.7 and 62.1 ± 9.7 years and 27.7 ± 4.1 and 25.1 ± 4.0 kg/m 2, respectively). The cardiovascular
4 618 risk factors for stroke were distributed similarly in both groups. Hypertension was present in 75.4% and 73.4% patients with and without SDB, respectively; P>0.05. Nicotinism was present in 65.5% and in 66.6% patients with and without SDB, respectively; P>0.05. There were no statistical differences between the respective groups of patient with and without SDB concerning the incidence of heart ischemic disease (40.9% vs. 43.3%), cardiac arrhythmias (26.2% vs. 23.3%), diabetes mellitus (18.0% vs. 18.5%), and hypercholesterolemia (72.3% vs. 76.6%) (P>0.05 for all). The clinical neurological status assessed with the NIH stroke scale was slightly, but not significantly, worse in the patients with SDB than in those without SDB (NIHSS 5.7 ± 2.2 and 4.4 ± 1.9 respectively; P>0.05) (Fig. 1). Sleep-disordered breathing (AHI >5) (20) was present in 61 (67.7%) patients with stroke or TIA. The mean AHI in patients with SDB was 20.8 ±15.8 compared with the 1.75 ± 1.4 in patients without SDB (P<0.05). Thirty seven patients with SDB (60.7%) had mild-to-moderate SDB (AHI <20) and 24 patients (39.3%) had severe SDB (AHI >20). In patients with SDB, apneas predominated and made up 57.2 ± 21.6% of all hypopneic/apneic events. Among the apneic events, the obstructive apneas were significantly more frequent (P<0.01) as they Fig. 1. A - Demographic data, B - respiratory and clinical parameters, C - risk factors. Abbreviations: BMI - Body Mass Index, SDB Sleep Disordered Breathing, AHI Apnea Hypopnea Index, NIH - National Institute of Health Stroke Scale.
5 619 Fig. 2. Percentage of patients with recurrent cardiovascular events among patients with and without sleep disordered breathing (SDB). made up 75.2 ± 12.6% of all apneic events. Central apneas in patients with stroke and TIA were responsible for 12.2 ± 9.6% of all apneic events. DISCUSSION Most of the papers published so far have focused on the issue of the sleepdisordered breathing as a risk factor for ischemic stroke. There are many convincing results from large cohort studies that sleep-disordered breathing, especially obstructive sleep apneas, are independent risk factors for stroke (4, 5, 7, 10, 12, 13, 15). It has also been demonstrated that the severity of sleep apneas contributes to the functional outcome after stroke and significantly increases the risk of death (21, 22). Less is known about the recurrence of the cerebrovascular event in patients with the history of stroke or TIA and SDB. The recent study from Germany shows that the incidence of sleep apnea is much more frequent in patients with recurring stroke than in those with the first ever stroke (23). These data are consistent with our results which clearly show that patients with ischemic stroke or TIA and sleep-disordered breathing have a higher risk of consecutive cerebrovascular event within the next 2 years than those with stroke and TIA but without SDB (Odds Ratio 1.52; 95% Confidence Interval ). Our patients with, or without SDB, did not differed with respect to age, BMI, or other cardiovascular risk factors. It is noteworthy that they did not have significantly increased BMI (mean BMI: 27.7 ± 4.1) and their initial NIH score was not statistically different between the patients with and without SDB and relatively low, (mean NIH value 5.7 ± 2.2). These data have important practical implications.
6 620 Firstly, since it is possible to effectively treat the sleep-disordered breathing, all patients with stroke and SDB should undergo non-invasive or invasive treatment of SDB. It would be advisable to refer all of them (despite mild or moderate SDB) to sleep research centers or pulmonologists. Secondly, it should be recommended to perform a routine sleep-apnea screening in all patients having suffered an ischemic stroke or transient ischemic attack. Although we did not find significant differences between patients with or without SDB in functional parameters after a 2-year follow-up, which may be caused by the strict inclusion criteria to the study, and relatively mild neurological deficit in majority of patients, we think that the patient after ischemic stroke or TIA with SDB should be under careful supervision of the neurologist, caregiver, and neurorehabilitant. Acknowledgments: The study was supported by MNiI grant number 2P05B Conflicts of interest: No conflicts of interest were declared with respect to this paper. REFERENCES 1. Cheyne J. A case of apoplexy in which the fleshy part of the heart is converted into fat. Dublin Hosp Rep 1818; 2: Stokes W. The Diseases of the Heart and the Aorta. Dublin Ireland, Hodges & Smith Burwell CD, Bickellman AG, Robin ED, Whaley RD. Extreme obesity associated with alveolar hypoventilation; a Pickwickian syndrome. Am J Med 1956; 21: Koskenvuo M, Kaprio J, Partinen M, Langinvainio H, Sarna S, Heikkila K. Snoring as a risk factor for hypertension and angina pectoris. Lancet 1985; 1: Partinen M, Palomaki H. Snoring and cerebral infarction. Lancet; 2: Palomaki H, Partinen M, Juvela S, Kaste M. Snoring as a risk factor for sleep-related brain infarction. Stroke 1991; 20: Roux F, D Ambrosio C, Mohsenin V. Sleep related cerebrovascular disorders and cardiovascular diseases. Am J Med 2000; 108: White DP. Sleep Apnea. Proceedings of the ATS, 2006; 3: Punjabi NM. The Epidemiology of Adult Obstructive Sleep Apnea, Proceedings of the ATS, 2008; 5: Hermann DM, Siccoli M, Kirov P, Gugger M, Bassetti CL. Central periodic breathing during sleep in acute ischemic stroke. Stroke 2007; 38: Culebras A. Cerebrovascular disease and sleep. Curr Neurol Neurosci Rep 2004; 4: Hermann DM, Basseti CL. Sleep-disordered breathing and stroke. Curr Opin Neurol 2003; 16: Neau JP, Paquaereau J, Meurice JC, Chavagnant JJ, Gil R. Stroke and sleep apnea: cause or consequence? Sleep Med Rev 2002; 6: Kesteloot H, Sans S, Kromhout D. Evolution of all-causes and cardiovascular mortality in the age-group years in Europe during the period A comparison with worldwide changes. Eur Heart J 2002; 23: Yaggi H, Mohsenin V. Sleep-disordered breathing and stroke. Clin Chest Med 2003; 24:
7 Hajat C, Dundas R, Stewart JA et al. Cerebrovascular risk factors and stroke subtypes: differences between ethnic groups. Stroke 2001; 32: Wierzbicka A, Rola R, Wichniak A, Richter P, Ryglewicz D, Jernajczyk W. The incidence of sleep apnea in patients with stroke or transient ischemic attack. J Physiol Pharmacol 2006; 57 Suppl 4: Rola R, Wierzbicka A, Wichniak A, Richter P, Ryglewicz D, Jernajczyk W. Sleep related breathing disorders in patients with ischemic stroke and transient ischemic attacks: respiratory and clinical correlations, J Physiol Pharmacol, 2007; 58 Suppl 5: Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 1999; 22: Brott T, Adams HP Jr, Olinger CP et al. Measurement of acute cerebral infarction: a clinical examination scale. Stroke 1989; 20: Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive Sleep Apnea as a Risk Factor for Stroke and Death N Engl J Med 2005; 353: Sahlin C, Sandberg O, Gustafson Y et al. Obstructive sleep apnea is a risk factor for death in patients with stroke: A 10-year follow-up. Arch Intern Med 2008; 168: Dziewas R, Humpert M, Hopmann B et al. Increased prevalence of sleep apnea in patients with recurring ischemic stroke compared with first stroke victims. J Neurol 2005; 252: Received: May 15, 2008 Accepted: August 7, 2008 Author s address: R. Rola, First Department of Neurology, Institute of Psychiatry and Neurology, Sobieskiego 9 St., Warsaw, Poland; phone: , fax: ; rafal.rola@wp.pl
SLEEP RELATED BREATHING DISORDERS IN PATIENTS WITH ISCHEMIC STROKE AND TRANSIENT ISCHEMIC ATTACKS: RESPIRATORY AND CLINICAL CORRELATIONS
JOURNAL OF PHYSIOLOGY AND PHARMACOLOGY 2007, 58, Suppl 5, 575 582 www.jpp.krakow.pl R. ROLA 1, A. WIERZBICKA 2, A. WICHNIAK 3, W. JERNAJCZYK 2, P. RICHTER 1, D. RYGLEWICZ 1 SLEEP RELATED BREATHING DISORDERS
More informationMario Kinsella MD FAASM 10/5/2016
Mario Kinsella MD FAASM 10/5/2016 Repetitive episodes of apnea or reduced airflow Due to upper airway obstruction during sleep Patients often obese Often have hypertension or DM 1 Obstructive apneas, hypopneas,
More informationSleep Apnea: Vascular and Metabolic Complications
Sleep Apnea: Vascular and Metabolic Complications Vahid Mohsenin, M.D. Professor of Medicine Yale University School of Medicine Director, Yale Center for Sleep Medicine Definitions Apnea: Cessation of
More informationIn the US, approximately 795,000 people have strokes and
Frequency of Sleep Apnea in Stroke and TIA Patients: A Meta-analysis Karin G. Johnson, M.D. 1 ; Douglas C. Johnson, M.D. 2 1 Baystate Medical Center, Springfield, MA; 2 Massachusetts General Hospital,
More informationIn-Patient Sleep Testing/Management Boaz Markewitz, MD
In-Patient Sleep Testing/Management Boaz Markewitz, MD Objectives: Discuss inpatient sleep programs and if they provide a benefit to patients and sleep centers Identify things needed to be considered when
More informationThe Sleep-Stroke Connection: An Under-recognized Entity. Simin Khavandgar MD UPMC Neurology Department
The Sleep-Stroke Connection: An Under-recognized Entity Simin Khavandgar MD UPMC Neurology Department Sleep Disordered Breathing (SDB) Obstructive Sleep Apnea (OSA): -Transient cessation of airflow, duration
More informationCircadian Variations Influential in Circulatory & Vascular Phenomena
SLEEP & STROKE 1 Circadian Variations Influential in Circulatory & Vascular Phenomena Endocrine secretions Thermo regulations Renal Functions Respiratory control Heart Rhythm Hematologic parameters Immune
More informationPost stroke sleep apnea hypopnea syndrome: a series of 12 consecutive stable stroke cases
European Review for Medical and Pharmacological Sciences Post stroke sleep apnea hypopnea syndrome: a series of 12 consecutive stable stroke cases M.L. SACCHETTI, M.T. DI MASCIO*, M. FIORELLI, D. TONI*,
More informationSleep and the Heart. Physiologic Changes in Cardiovascular Parameters during Sleep
Sleep and the Heart Rami N. Khayat, MD Professor of Internal Medicine Medical Director, Department of Respiratory Therapy Division of Pulmonary, Critical Care and Sleep Medicine The Ohio State University
More informationSleep and the Heart. Rami N. Khayat, MD
Sleep and the Heart Rami N. Khayat, MD Professor of Internal Medicine Medical Director, Department of Respiratory Therapy Division of Pulmonary, Critical Care and Sleep Medicine The Ohio State University
More informationGOALS. Obstructive Sleep Apnea and Cardiovascular Disease (OVERVIEW) FINANCIAL DISCLOSURE 2/1/2017
Obstructive Sleep Apnea and Cardiovascular Disease (OVERVIEW) 19th Annual Topics in Cardiovascular Care Steven Khov, DO, FAAP Pulmonary Associates of Lancaster, Ltd February 3, 2017 skhov2@lghealth.org
More informationSleep Disordered Breathing: Beware Snoring! Dr T A McDonagh Consultant Cardiologist Royal Brompton Hospital London. UK
Sleep Disordered Breathing: Beware Snoring! Dr T A McDonagh Consultant Cardiologist Royal Brompton Hospital London. UK Sleep Disordered Breathing in CHF Erratic breathing during sleep known for years e.g.
More information(To be filled by the treating physician)
CERTIFICATE OF MEDICAL NECESSITY TO BE ISSUED TO CGHS BENEFICIAREIS BEING PRESCRIBED BILEVEL CONTINUOUS POSITIVE AIRWAY PRESSURE (BI-LEVEL CPAP) / BI-LEVEL VENTILATORY SUPPORT SYSTEM Certification Type
More informationPortable Sleep Testing in Hospitalized Patients
1 Portable Sleep Testing in Hospitalized Patients Rami Khayat, MD Heart Failure AND Public Health 6 million Americans with heart failure (>2% population 20 million people with asymptomatic cardiac impairment
More informationCYCLICAL NOCTURNAL OXYGEN DESATURATION AND IMPACT ON ACTIVITIES OF DAILY LIVING IN ELDERLY PATIENTS
JOURNAL OF PHYSIOLOGY AND PHARMACOLOGY 2007, 58, Suppl 5, 185 191 www.jpp.krakow.pl H. FROHNHOFEN 1, H.C. HEUER 1, N. PFUNDNER 1, G. ORTH 2 CYCLICAL NOCTURNAL OXYGEN DESATURATION AND IMPACT ON ACTIVITIES
More informationChronic NIV in heart failure patients: ASV, NIV and CPAP
Chronic NIV in heart failure patients: ASV, NIV and CPAP João C. Winck, Marta Drummond, Miguel Gonçalves and Tiago Pinto Sleep disordered breathing (SDB), including OSA and central sleep apnoea (CSA),
More informationThe Effect of Sleep Disordered Breathing on Cardiovascular Disease
The Effect of Sleep Disordered Breathing on Cardiovascular Disease Juan G. Flores MD Pulmonary, Critical Care and Sleep Medicine Dupage Medical Group Director of Edward Sleep Lab Disclaimers or Conflicts
More informationThe most accurate predictors of arterial hypertension in patients with Obstructive Sleep Apnea Syndrome
The most accurate predictors of arterial hypertension in patients with Obstructive Sleep Apnea Syndrome Natsios Georgios University Hospital of Larissa, Greece Definitions Obstructive Sleep Apnea (OSA)
More informationHeart Failure and Sleep Disordered Breathing (SDB) Unhappy Bedfellows
Question Heart Failure and Sleep Disordered Breathing (SDB) Unhappy Bedfellows 1 ResMed 2012 07 2 ResMed 2012 07 Open Airway 3 ResMed 2012 07 Flow Limitation Snore 4 ResMed 2012 07 Apnoea 5 ResMed 2012
More informationΣύνδρομο σπνικής άπνοιας. Ποιός o ρόλος ηοσ ζηη γένεζη και ανηιμεηώπιζη ηων αρρσθμιών;
Σύνδρομο σπνικής άπνοιας. Ποιός o ρόλος ηοσ ζηη γένεζη και ανηιμεηώπιζη ηων αρρσθμιών; E.N. Σημανηηράκης MD, FESC Επίκ. Καθηγηηής Καρδιολογίας Πανεπιζηημιακό Νοζοκομείο Ηρακλείοσ Epidemiology 4% 2% 24%
More informationPolysomnography (PSG) (Sleep Studies), Sleep Center
Policy Number: 1036 Policy History Approve Date: 07/09/2015 Effective Date: 07/09/2015 Preauthorization All Plans Benefit plans vary in coverage and some plans may not provide coverage for certain service(s)
More informationSleep and Stroke. M.V. Padma Srivastava Department of Neurology All-India Institute of Medical Sciences, New Delhi ABSTRACT
Ann Natl Acad Med Sci (India), 49(3&4): 169-176, 2013 Sleep and Stroke M.V. Padma Srivastava Department of Neurology All-India Institute of Medical Sciences, New Delhi Circadian variations in conjunction
More informationEpidemiology and diagnosis of sleep apnea
Epidemiology and diagnosis of sleep apnea Dr Raphael Heinzer, MD MPH Center for Investigation and research in Sleep Lausanne University Hospital (CHUV) Switzerland Joint annual meeting SSC/SSCS-SSP 2016
More informationEmerging Nursing Roles in Collaborative Management of Sleep Disordered Breathing and Obstructive Sleep Apnoea
Emerging Nursing Roles in Collaborative Management of Sleep Disordered Breathing and Obstructive Sleep Apnoea Sigma Theta Tau International 28th International Nursing Research Congress 27-31 July 2017
More informationPOLICY All patients will be assessed for risk factors associated with OSA prior to any surgical procedures.
Revised Date: Page: 1 of 7 SCOPE All Pre-Admission Testing (PAT) and Same Day Surgery (SDS) nurses at HRMC. PURPOSE The purpose of this policy is to provide guidelines for identifying surgical patients
More informationUpdate on Sleep Apnea Diagnosis and Treatment
Update on Sleep Apnea Diagnosis and Treatment Damien Stevens MD Pulmonary/Critical Care/Sleep Medicine Medical Director KU Medical Center Sleep Laboratory Objectives Discuss physiology of sleep and obstructive
More informationPVDOMICS. Sleep Core. Cleveland Clinic Cleveland, Ohio
PVDOMICS Sleep Core Rawan Nawabit, Research Coordinator and Polysomnologist Joan Aylor, Research Coordinator Dr. Reena Mehra, Co-Investigator, Sleep Core Lead Cleveland Clinic Cleveland, Ohio 1 Obstructive
More informationThe Familial Occurrence of Obstructive Sleep Apnoea Syndrome (OSAS)
Global Journal of Respiratory Care, 2014, 1, 17-21 17 The Familial Occurrence of Obstructive Sleep Apnoea Syndrome (OSAS) Piotr Bielicki, Tadeusz Przybylowski, Ryszarda Chazan * Department of Internal
More informationNational Sleep Disorders Research Plan
Research Plan Home Foreword Preface Introduction Executive Summary Contents Contact Us National Sleep Disorders Research Plan Return to Table of Contents SECTION 5 - SLEEP DISORDERS SLEEP-DISORDERED BREATHING
More informationOSA and COPD: What happens when the two OVERLAP?
2011 ISRC Seminar 1 COPD OSA OSA and COPD: What happens when the two OVERLAP? Overlap Syndrome 1 OSA and COPD: What happens when the two OVERLAP? ResMed 10 JAN Global leaders in sleep and respiratory medicine
More informationAbout VirtuOx. Was marketed exclusively by Phillips Healthcare division, Respironics for 3 years
About VirtuOx VirtuOx, Inc. assists physicians and Durable Medical Equipment (DME)( companies diagnose respiratory diseases and qualify patients for home respiratory equipment under the guidelines of CMS
More informationWeb-Based Home Sleep Testing
Editorial Web-Based Home Sleep Testing Authors: Matthew Tarler, Ph.D., Sarah Weimer, Craig Frederick, Michael Papsidero M.D., Hani Kayyali Abstract: Study Objective: To assess the feasibility and accuracy
More informationSleep Apnea: Diagnosis & Treatment
Disclosure Sleep Apnea: Diagnosis & Treatment Lawrence J. Epstein, MD Sleep HealthCenters Harvard Medical School Chief Medical Officer for Sleep HealthCenters Sleep medicine specialty practice group Consultant
More informationHigh Risk OSA n = 5,359
Table S1 Prevalence of atrial fibrillation (AF) identified using different methods in participants with high and low risk obstructive sleep apnea (). High Risk n = 5,359 Low Risk n = 14,992 SR-AF (%) 467
More informationHabitual snoring as a risk factor for acute vascular disease
Eur Respir J, 1993, 6, 1357-1361 Printed in UK - all rights reserved Copyright ERS Journals L!d 1993 European Respiratory JoumaJs ISSN 0903-1936 Habitual snoring as a risk factor for acute vascular disease
More informationΚλινικό Φροντιστήριο Αναγνώριση και καταγραφή αναπνευστικών επεισοδίων Λυκούργος Κολιλέκας Επιμελητής A ΕΣΥ 7η Πνευμονολογική Κλινική ΝΝΘΑ Η ΣΩΤΗΡΙΑ
Κλινικό Φροντιστήριο Αναγνώριση και καταγραφή αναπνευστικών επεισοδίων Λυκούργος Κολιλέκας Επιμελητής A ΕΣΥ 7 η Πνευμονολογική Κλινική ΝΝΘΑ Η ΣΩΤΗΡΙΑ SCORING SLEEP -Rechtschaffen and Kales (1968) - AASM
More informationSleep and the Heart Reversing the Effects of Sleep Apnea to Better Manage Heart Disease
1 Sleep and the Heart Reversing the Effects of Sleep Apnea to Better Manage Heart Disease Rami Khayat, MD Professor of Internal Medicine Director, OSU Sleep Heart Program Medical Director, Department of
More informationDr Alireza Yarahmadi and Dr Arvind Perathur Mercy Medical Center - Winter Retreat Des Moines February 2012
Dr Alireza Yarahmadi and Dr Arvind Perathur Mercy Medical Center - Winter Retreat Des Moines February 2012 Why screen of OSA prior to surgery? What factors increase the risk? When due to anticipate problems?
More information1/27/2017 RECOGNITION AND MANAGEMENT OF OBSTRUCTIVE SLEEP APNEA: STRATEGIES TO PREVENT POST-OPERATIVE RESPIRATORY FAILURE DEFINITION PATHOPHYSIOLOGY
RECOGNITION AND MANAGEMENT OF OBSTRUCTIVE SLEEP APNEA: STRATEGIES TO PREVENT POST-OPERATIVE RESPIRATORY FAILURE Peggy Hollis MSN, RN, ACNS-BC March 9, 2017 DEFINITION Obstructive sleep apnea is a disorder
More informationZia H Shah MD FCCP. Director of Sleep Lab Our Lady Of Lourdes Hospital, Binghamton
Zia H Shah MD FCCP Director of Sleep Lab Our Lady Of Lourdes Hospital, Binghamton Obesity 70-80% of cases Alcohol use Hypognathism Marfan s syndrome Smoking ENT problems OSA and DM epidemics have
More informationWhat is SDB? Obstructive sleep apnea-hypopnea syndrome (OSAHS)
Have a Good Sleep? Estimated 70 million Americans have clinically significant sleep problems Chronic insomnias report decreased quality of life, memory and attention problems, decreased physical health
More informationSLEEP DISORDERED BREATHING The Clinical Conditions
SLEEP DISORDERED BREATHING The Clinical Conditions Robert G. Hooper, M.D. In the previous portion of this paper, the definitions of the respiratory events that are the hallmarks of problems with breathing
More informationCentral Sleep Apnoea during CPAP therapy First insights from a big data analysis. April 2018
Central Sleep Apnoea during CPAP therapy First insights from a big data analysis April 2018 Agenda Lexicon Introduction to Big Data The findings of the Trajectories of Emergent Central Sleep Apnea during
More informationSREE CHITRA TIRUNAL INSTITUTE FOR MEDICAL SCIENCES AND TECHNOLOGY
SREE CHITRA TIRUNAL INSTITUTE FOR MEDICAL SCIENCES AND TECHNOLOGY THIRUVANANTHAPURAM, KERALA STUDY OF THE PREVALENCE AND SEVERITY OF OBSTRUCTIVE SLEEP APNEA IN ACUTE ISCHEMIC STROKE AND ITS IMPACT ON RECOVERY
More informationCo-Morbidities Associated with OSA
Co-Morbidities Associated with OSA Dr VK Vijayan MD (Med), PhD (Med), DSc, FCCP, FICC, FAPSR, FAMS Advisor to Director General, ICMR Bhopal Memorial Hospital and Research Centre & National Institute for
More informationNew Government O2 Criteria and Expert Panel. Jennifer Despain, RPSGT, RST, AS
New Government O2 Criteria and Expert Panel Jennifer Despain, RPSGT, RST, AS Lead Sleep Technologist, Central Utah Clinic Sleep Disorders Center; Provo, Utah Objectives: Review new government O2 criteria
More informationObstructive Sleep Apnea
Obstructive Sleep Apnea by Barbara Phillips MD MSPH and Matthew T Naughton MD FRACP Epidemiology and risk factors 7 Clinical presentation 13 Medical complications 22 Diagnosis 40 Medical management 50
More informationIndex SLEEP MEDICINE CLINICS. Note: Page numbers of article titles are in boldface type.
549 SLEEP MEDICINE CLINICS Sleep Med Clin 1 (2007) 549 553 Note: Page numbers of article titles are in boldface type. A Abdominal motion, in assessment of sleep-related breathing disorders, 452 454 Adherence,
More informationObstructive sleep apnea (OSA) is the periodic reduction
Obstructive Sleep Apnea and Oxygen Therapy: A Systematic Review of the Literature and Meta-Analysis 1 Department of Anesthesiology, Toronto Western Hospital, University Health Network, University of Toronto,
More informationAn update on childhood sleep-disordered breathing
An update on childhood sleep-disordered breathing แพทย หญ งวนพร อน นตเสร ภาคว ชาก มารเวชศาสตร คณะแพทยศาสตร มหาว ทยาล ยสงขลานคร นทร Sleep-disordered breathing Primary snoring Upper airway resistance syndrome
More informationPEDIATRIC OBSTRUCTIVE SLEEP APNEA (OSA)
PEDIATRIC OBSTRUCTIVE SLEEP APNEA (OSA) DEFINITION OSA Inspiratory airflow is either partly (hypopnea) or completely (apnea) occluded during sleep. The combination of sleep-disordered breathing with daytime
More informationSleep Disordered Breathing
Sleep Disordered Breathing SDB SDB Is an Umbrella Term for Many Disorders characterized by a lack of drive to breathe Results n repetitive pauses in breathing with no effort Occurs for a minimum of 10
More informationAHA Sleep Apnea and Cardiovascular Disease. Slide Set
AHA 2008 Sleep Apnea and Cardiovascular Disease Slide Set Based on the AHA 2008 Scientific Statement Sleep Apnea and Cardiovascular Disease Virend K. Somers, MD, DPhil, FAHA, FACC Mayo Clinic and Mayo
More informationObstructive sleep apnoea How to identify?
Obstructive sleep apnoea How to identify? Walter McNicholas MD Newman Professor in Medicine, St. Vincent s University Hospital, University College Dublin, Ireland. Potential conflict of interest None Obstructive
More informationSleep Apnea & Stroke: A Dangerous Liaison. Devin Brown, M.D., M.S. Professor of Neurology Stroke Program University of Michigan
Sleep Apnea & Stroke: A Dangerous Liaison Devin Brown, M.D., M.S. Professor of Neurology Stroke Program University of Michigan Conflict of Interest Disclosures for Speakers x 1. I do not have any relationships
More informationPrevalence of Sleep Disordered Breathing in Congestive Heart Failure as Determined by ApneaLink, a Simplified Screening Device
Prevalence of Sleep Disordered Breathing in Congestive Heart Failure as Determined by ApneaLink, a Simplified Screening Device Susan R. Isakson, BS, 1 Jennifer Beede, BS, 1 Kevin Jiang, BS, 1 Nancy J.
More informationLocalizing lesion locations to predict extent of aphasia recovery. Abstract
Localizing lesion locations to predict extent of aphasia recovery Abstract Extensive research has related specific lesion locations to language impairment in aphasia. However, far less work has focused
More informationIntroducing the WatchPAT 200 # 1 Home Sleep Study Device
Introducing the WatchPAT 200 # 1 Home Sleep Study Device Top 10 Medical Innovation for 2010 Cleveland Clinic Fidelis Diagnostics & Itamar Medical Fidelis Diagnostics founded in 2004, is a privately-held
More informationObstructive sleep apnea (OSA) is a prevalent disease and has
Case Report Sleep Apnea: A Novel Risk Factor in Acute Stroke and Transient Ischemic Attack Obstructive sleep apnea (OSA) is a prevalent disease and has been increasingly recognized as an independent risk
More informationDECLARATION OF CONFLICT OF INTEREST
DECLARATION OF CONFLICT OF INTEREST Obstructive sleep apnoea How to identify? Walter McNicholas MD Newman Professor in Medicine, St. Vincent s University Hospital, University College Dublin, Ireland. Potential
More informationPolicy Specific Section: October 1, 2010 January 21, 2013
Medical Policy Bi-level Positive Airway Pressure (BPAP/NPPV) Type: Medical Necessity/Not Medical Necessity Policy Specific Section: Durable Medical Equipment Original Policy Date: Effective Date: October
More informationThe Impact of Smoking on Acute Ischemic Stroke
Smoking The Impact of Smoking on Acute Ischemic Stroke Wei-Chieh Weng, M.D. Department of Neurology, Chang-Gung Memorial Hospital, Kee-Lung, Taiwan Smoking related mortality Atherosclerotic vascular disease
More informationPolysomnographic Profile in a Sleep Laboratory in Kolkata : A Retrospective Analysis of 714 Cases
riginal Article Polysomnographic Profile in a Sleep Laboratory in Kolkata : A Retrospective Analysis of 714 Cases AG Ghoshal *, Supriya Sarkar **, DJ Roy +, RK Das +, Mita Ray + Abstract In this retrospective
More informationBasics of Polysomnography. Chitra Lal, MD, FCCP, FAASM Assistant professor of Medicine, Pulmonary, Critical Care and Sleep, MUSC, Charleston, SC
Basics of Polysomnography Chitra Lal, MD, FCCP, FAASM Assistant professor of Medicine, Pulmonary, Critical Care and Sleep, MUSC, Charleston, SC Basics of Polysomnography Continuous and simultaneous recording
More informationDear, Respectfully, United Sleep Centers SLEEP STUDY DATE: FEBUARY 26, 2015 AT OUR DOWNEY CENTER TIME: 10PM, PLEASE ARRIVE ON TIME
Sleep Study Instructions SLEEP STUDY DATE: FEBUARY 26, 2015 AT OUR DOWNEY CENTER TIME: 10PM, PLEASE ARRIVE ON TIME ADDRESS: 11411 BROOKSHIRE AVE SUITE 505 DOWNEY, CA Dear, Thank you for choosing us as
More informationCHANGING SHAPE OF SLEEP STUDIES
CHANGING SHAPE OF SLEEP STUDIES JAMES C. O BRIEN MD FCCP, FAASM MEDICAL DIRECTOR, PROHEALTH PHYSICIANS SLEEP CENTERS 10/19/2107 GOALS OF MY TALK-- Review the types of sleep studies Provide clinical information
More informationEdoardo Gronda UO cardiologia e Ricerca Dipartimento Cardiovascolare IRCCS MultiMedica
Convegno Pneumologia 2016 Milano 16-18 giugno 2016 Centro Congressi Palazzo delle Stelline Edoardo Gronda UO cardiologia e Ricerca Dipartimento Cardiovascolare IRCCS MultiMedica Central apnea 10 second
More informationObstructive Sleep Apnea
Obstructive Sleep Apnea Definition: Repetitive episodes of upper airway obstruction (complete or partial) that occur during sleep and are associated with arousals or desaturations +/or daytime sleepiness.
More informationThis is a cross-sectional analysis of the National Health and Nutrition Examination
SUPPLEMENTAL METHODS Study Design and Setting This is a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) data 2007-2008, 2009-2010, and 2011-2012. The NHANES is
More informationA 74-year-old man with severe ischemic cardiomyopathy and atrial fibrillation
1 A 74-year-old man with severe ischemic cardiomyopathy and atrial fibrillation The following 3 minute polysomnogram (PSG) tracing was recorded in a 74-year-old man with severe ischemic cardiomyopathy
More informationCauses and Consequences of Respiratory Centre Depression and Hypoventilation
Causes and Consequences of Respiratory Centre Depression and Hypoventilation Lou Irving Director Respiratory and Sleep Medicine, RMH louis.irving@mh.org.au Capacity of the Respiratory System At rest During
More informationJoel Reiter*, Bashar Zleik, Mihaela Bazalakova, Pankaj Mehta, Robert Joseph Thomas
Joel Reiter*, Bashar Zleik, Mihaela Bazalakova, Pankaj Mehta, Robert Joseph Thomas Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA *ומעבדת השינה הדסה עין כרם, ירושלים חיפפ ירושלים,
More informationApnea-Hypopnea- Index The new old biomarker for Sleep-Disordered Breathing. Alan S Maisel MD
Apnea-Hypopnea- Index The new old biomarker for Sleep-Disordered Breathing Alan S Maisel MD Triumvirate of Health-public awareness 1.8% Sleep Physical Fitness Nutrition 91.3% 99.9% Sleep is important to
More informationOBSTRUCTIVE SLEEP APNEA and WORK Treatment Update
OBSTRUCTIVE SLEEP APNEA and WORK Treatment Update David Claman, MD Professor of Medicine Director, UCSF Sleep Disorders Center 415-885-7886 Disclosures: None Chronic Sleep Deprivation (0 v 4 v 6 v 8 hrs)
More informationNovel pathophysiological concepts for the development and impact of sleep apnea in CHF.
Olaf Oldenburg Novel pathophysiological concepts for the development and impact of sleep apnea in CHF. Sleep apnea the need to synchronize the heart, the lung and the brain. Heart Failure 2011 Gothenburg,
More informationObstructive Sleep Apnea as a Risk Factor for Stroke and Death
The new england journal of medicine original article Obstructive Sleep Apnea as a Risk Factor for Stroke and Death H. Klar Yaggi, M.D., M.P.H., John Concato, M.D., M.P.H., Walter N. Kernan, M.D., Judith
More informationBiPAPS/TVAPSCPAPASV???? Lori Davis, B.Sc., R.C.P.T.(P), RPSGT
BiPAPS/TVAPSCPAPASV???? Lori Davis, B.Sc., R.C.P.T.(P), RPSGT Modes Continuous Positive Airway Pressure (CPAP): One set pressure which is the same on inspiration and expiration Auto-PAP (APAP) - Provides
More informationSimple diagnostic tools for the Screening of Sleep Apnea in subjects with high risk of cardiovascular disease
Cardiovascular diseases remain the number one cause of death worldwide Simple diagnostic tools for the Screening of Sleep Apnea in subjects with high risk of cardiovascular disease Shaoguang Huang MD Department
More information11/20/2015. Eighth Bi-Annual Pediatric Sleep Medicine Conference. November 12-15, 2015 Omni Amelia Island Plantation Resort Amelia Island, Florida
Eighth Bi-Annual Pediatric Sleep Medicine Conference November 12-15, 2015 Omni Amelia Island Plantation Resort Amelia Island, Florida Carol L. Rosen, MD Case Western Reserve University School of Medicine
More informationSupplementary Online Content
Supplementary Online Content Inohara T, Xian Y, Liang L, et al. Association of intracerebral hemorrhage among patients taking non vitamin K antagonist vs vitamin K antagonist oral anticoagulants with in-hospital
More informationObstructive sleep apnea as a risk factor for silent cerebral infarction
J Sleep Res. (2013) 22, 452 458 Sleep apnea and cerebral infarcts Obstructive sleep apnea as a risk factor for silent cerebral infarction EO RIN CHO 1, HYUN KIM 1,2, HYUNG SUK SEO 3, SOOYEON SUH 1, SEUNG
More informationSleep Apnea. Herbert A Berger, MD Pulmonary Division Department of Internal Medicine University of Iowa
Sleep Apnea Herbert A Berger, MD Pulmonary Division Department of Internal Medicine University of Iowa Disclosures No Relevant Financial Interests to Report Objectives Learn the history and physical examination
More informationIncreased Risk of Ischemic Stroke during Sleep in Apneic Patients
JCN Open Access pissn 1738-6586 / eissn 2005-5013 / J Clin Neurol 2018 ORIGINAL ARTICLE Increased Risk of Ischemic Stroke during Sleep in Apneic Patients Jin Soo Kim a Seongheon Kim a Seung Hwan Lee a
More informationSleep Diordered Breathing (Part 1)
Sleep Diordered Breathing (Part 1) History (for more topics & presentations, visit ) Obstructive sleep apnea - first described by Charles Dickens in 1836 in Papers of the Pickwick Club, Dickens depicted
More informationRisk Factors for Ischemic Stroke: Electrocardiographic Findings
Original Articles 232 Risk Factors for Ischemic Stroke: Electrocardiographic Findings Elley H.H. Chiu 1,2, Teng-Yeow Tan 1,3, Ku-Chou Chang 1,3, and Chia-Wei Liou 1,3 Abstract- Background: Standard 12-lead
More informationRecent epidemiological studies have revealed
1021 Snoring and the Risk of Ischemic Brain Infarction Heikki Palomaki, MD To determine if a history of snoring is a risk factor for brain infarction, I conducted a case-control study of risk factors for
More informationSleep and the Heart. Sleep Stages. Sleep and the Heart: non REM 8/31/2016
Sleep and the Heart Overview of sleep Hypertension Arrhythmias Ischemic events CHF Pulmonary Hypertension Cardiac Meds and Sleep Sleep Stages Non-REM sleep(75-80%) Stage 1(5%) Stage 2(50%) Stage 3-4*(15-20%)
More informationWRHA Surgery Program. Obstructive Sleep Apnea (OSA)
WRHA Surgery Program Obstructive Sleep Apnea (OSA) March 2010 Prepared by WRHA Surgery & Anesthesiology Programs Objectives 1. Define obstructive sleep apnea (OSA). 2. Purpose of the guidelines. 3. Identify
More informationMedical Affairs Policy
Medical Affairs Policy Service: Sleep Disorder Treatment: Positive Airway Pressure Devices and Oral Appliances (CPAP, BPAP, BiPAP, BiPAP ST, BiPAP with backup, BiPAP -Auto SV, VPAP, VPAP Adapt, VPAP adapt
More information<INSERT COUNTRY/SITE NAME> All Stroke Events
WHO STEPS STROKE INSTRUMENT For further guidance on All Stroke Events, see Section 5, page 5-15 All Stroke Events Patient Identification and Patient Characteristics (I 1) Stroke
More informationPre-op Clinical Triad - Pulmonary. Sammy Pedram, MD FCCP Assistant Professor of Medicine Pulmonary & Critical Care Medicine March 16, 2018
Pre-op Clinical Triad - Pulmonary Sammy Pedram, MD FCCP Assistant Professor of Medicine Pulmonary & Critical Care Medicine March 16, 2018 Disclosures none Case Mr. G is a 64 year-old man who presents to
More informationLipolysis and Metabolic Impairment in Community-Based Sample with Obstructive Sleep Apnea
Lipolysis and Metabolic Impairment in Community-Based Sample with Obstructive Sleep Apnea R. Nisha Aurora, MD Assistant Professor of Medicine Division of Pulmonary & Critical Care Medicine Group 4 Obstructive
More informationInternational Journal of Scientific & Engineering Research Volume 9, Issue 1, January ISSN
International Journal of Scientific & Engineering Research Volume 9, Issue 1, January-2018 342 The difference of sleep quality between 2-channel ambulatory monitor and diagnostic polysomnography Tengchin
More informationResearch Article Screening Sleep Disordered Breathing in Stroke Unit
Sleep Disorders, Article ID 317615, 7 pages http://dx.doi.org/10.1155/2014/317615 Research Article Screening Sleep Disordered Breathing in Stroke Unit Kirsi Väyrynen, 1,2 Kati Kortelainen, 2 Heikki Numminen,
More informationNon-contact Screening System with Two Microwave Radars in the Diagnosis of Sleep Apnea-Hypopnea Syndrome
Medinfo2013 Decision Support Systems and Technologies - II Non-contact Screening System with Two Microwave Radars in the Diagnosis of Sleep Apnea-Hypopnea Syndrome 21 August 2013 M. Kagawa 1, K. Ueki 1,
More informationΠανεπιστήμιο Θεσσαλίας Τμήμα Ιατρικής Εργαστήριο Βιομαθηματικών
Πανεπιστήμιο Θεσσαλίας Τμήμα Ιατρικής Εργαστήριο Βιομαθηματικών Πρόγραμμα Μεταπτυχιακών Σπουδών Μεθοδολογία Βιοϊατρικής Έρευνας, Βιοστατιστική και Κλινική Βιοπληροφορική Διπλωματική Εργασία Μαρία Τσιάτσιου
More informationSleep and Heart Health: Consequences of OSA
Sleep and Heart Health: Consequences of OSA Michelle Zetoony, DO, FCCP, FACOI Sleep Medicine Specialist Board Certified Pulmonary, Critical Care, Sleep and Internal Medicine 2014 Objectives Explain the
More informationNational Collaborating Centre for Chronic Conditions at the Royal College of Physicians
13. Surgery for acute stroke 13.2 Surgical referral for decompressive hemicraniectomy Reference Gupta R, Connolly ES, Mayer S et al. Hemicraniectomy for massive middle cerebral artery territory infarction:
More informationMedicare CPAP/BIPAP Coverage Criteria
Medicare CPAP/BIPAP Coverage Criteria For any item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable and necessary for the diagnosis or treatment
More informationSleep Studies: Attended Polysomnography and Portable Polysomnography Tests, Multiple Sleep Latency Testing and Maintenance of Wakefulness Testing
Portable Polysomnography Tests, Multiple Sleep Latency Testing and Maintenance of Wakefulness Testing MP9132 Covered Service: Yes when meets criteria below Prior Authorization Required: Yes as indicated
More information