Cerebrovascular diseases and sleep-disordered breathing
Luigi Ferini-Strambi1, Maria Livia Fantini
1Dept of Neurology, Sleep Disorders Center, Università Vita-Salute San Raffaele, Milan, Italy. ferinistrambi.luigi@hsr.it
Summary
Sleep-disordered breathing (SDB) likely causes strokes, not the other way around. Treating SDB may prevent future cerebrovascular events.
Area of Science:
- Neurology
- Sleep Medicine
- Cardiovascular Science
Background:
- Sleep-disordered breathing (SDB) is increasingly recognized as a significant factor in cerebrovascular disease.
- The relationship between SDB and stroke is complex, involving both acute and chronic pathophysiological mechanisms.
Purpose of the Study:
- To investigate the causal role of SDB in stroke development.
- To explore the pathophysiological links between SDB and cerebrovascular disease.
- To highlight the implications of SDB in stroke patients.
Main Methods:
- Analysis of apnea type (obstructive vs. central) in stroke patients.
- Comparison of SDB frequency in transient ischemic attack versus cerebral infarction.
- Assessment of excessive daytime sleepiness in stroke patients with and without SDB.
- Review of experimental and clinical studies on SDB and stroke pathophysiology.
Main Results:
- SDB, particularly obstructive sleep apnea, is more likely a cause than a consequence of stroke.
- SDB is associated with poor stroke outcomes.
- Mechanisms include altered cerebral hemodynamics, hematologic changes, cardiocirculatory dysfunction, and accelerated atherosclerosis in carotid arteries.
Conclusions:
- SDB plays a significant role in predisposing individuals to stroke.
- Screening for SDB is crucial in patients with a history of stroke or transient ischemic attack.
- Effective treatment of SDB can potentially reduce the risk of subsequent cerebrovascular events.
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