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Sleep-disordered breathing: implications in cerebrovascular disease
1Yale Center for Sleep Medicine, Yale University School of Medicine, New Haven, CT., USA. vahid.mohsenin@yale.edu
Preventive Cardiology
|August 21, 2004
Summary
Sleep-disordered breathing (SDB) is strongly linked to stroke risk, independent of other factors. Screening stroke patients for SDB is recommended as it represents a modifiable risk factor for cerebrovascular events.
Area of Science:
- Neurology
- Sleep Medicine
- Cardiovascular Research
Background:
- Stroke and sleep-disordered breathing (SDB) are prevalent conditions associated with significant morbidity and mortality.
- Epidemiologic studies reveal a strong association between stroke and SDB, independent of established stroke risk factors.
Purpose of the Study:
- To review the scientific basis linking SDB and stroke.
- To propose SDB as a modifiable risk factor for stroke.
- To discuss the implications for clinical screening and management.
Main Methods:
- Review of existing epidemiologic studies and scientific literature.
- Analysis of the influence of sleep states and SDB on cerebral hemodynamics.
- Examination of pathogenetic mechanisms including hemodynamic, metabolic, and hematologic changes.
Main Results:
- SDB is associated with characteristic circadian rhythmicity in stroke occurrence.
- Pathogenetic mechanisms include decreased cerebral perfusion and increased coagulability during SDB.
- SDB may contribute to diurnal hypertension, and significantly increases stroke risk, even independently of hypertension.
Conclusions:
- SDB is a significant risk factor for stroke through hemodynamic and hematologic alterations.
- High prevalence of SDB in transient ischemic attack and stroke patients necessitates screening.
- Identifying and treating SDB may offer a modifiable strategy to reduce stroke risk.