阻塞性睡眠呼吸暂停与脑卒中相关性的研究进展

doi:10.3969/j.issn.1006-9771.2019.07.008

Abstract

Abstract: Obstructive sleep apnea (OSA) may increase the risk of stroke, and patients with stroke are also prone to suffer OSA. Advanced age, high body mass index, male, hypertension and diabetes are risk factors for stoke in OSA patients, and severe sleep apnea may also be associated with poor functional outcomes of stroke. Potential pathophysiological mechanisms may include endothelial dysfunction, abnormal neuromodulation, metabolic abnormalities, change of cerebral hemodynamic and hypercoagulability. Continuous positive airway pressure (CPAP) is the standard treatment for patients with moderate to severe OSA, but it has not been proved that CPAP can reduce the risk of cardiovascular events including stroke.

Key words: obstructive sleep apnea, stroke, epidemiology, pathophysiology, review

CLC Number:

R743.3

CHEN Jing-mian, LI Zong-jun, LI Pei-lan, ZHANG Tong. Advance in Relationship between Obstructive Sleep Apnea and Stroke (review)[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2019, 25(7): 783-787.

References

1 LyonsO D, RyanC M. Sleep apnea and stroke [J]. Can J Cardiol, 2015, 31(7): 918-927.
2 DirnaglU, IadecolaC, MoskowitzM A. Pathobiology of ischaemic stroke: an integrated view [J]. Trends Neurosci, 1999, 22(9): 391-397.
3 BautersF, RietzschelE R, HertegonneK B, et al. The link between obstructive sleep apnea and cardiovascular disease [J]. Curr Atheroscler Rep, 2016, 18(1): 1.
4 ArztM, YoungT, FinnL, et al. Association of sleep-disordered breathing and the occurrence of stroke [J]. Am J Respir Crit Care Med, 2005, 172(11): 1447-1451.
5 BerryR B, RyalsS, WagnerM H. Use of chest wall EMG to classify hypopneas as obstructive or central [J]. J Clin Sleep Med, 2018, 14(5): 725-733.
6 BixlerE O, VgontzasA N, LinH M, et al. Prevalence of sleep-disordered breathing in women: effects of gender [J]. Am J Respir Crit Care Med, 2001, 163(3 Pt1): 608-613.
7 YoungT, PaltaM, DempseyJ, et al. The occurrence of sleep-disordered breathing among middle-aged adults [J]. N Engl J Med, 1993, 328(17): 1230-1235.
8 KushidaC A, EfronB, GuilleminaultC. A predictive morphometric model for the obstructive sleep apnea syndrome [J]. Ann Intern Med, 1997, 127(8 Pt1): 581-587.
9 PeppardP E, YoungT, PaltaM, et al. Longitudinal study of moderate weight change and sleep-disordered breathing [J]. JAMA, 2000, 284(23): 3015-3021.
10 赵显超,程金湘,雷革胜,等. 单中心8037例睡眠障碍患者的流行病学及临床特征分析[J]. 中华神经科杂志, 2017, 50(8): 579-584.
11 YaggiH K, ConcatoJ, KernanW N, et al. Obstructive sleep apnea as a risk factor for stroke and death [J]. N Engl J Med, 2005, 353(19): 2034-2041.
12 MunozR, Duran-CantollaJ, Martinez-VilaE, et al. Severe sleep apnea and risk of ischemic stroke in the elderly [J]. Stroke, 2006, 37(9): 2317-2321.
13 KokkarinenJ. Obstructive sleep apnea-hypopnea and incident stroke: the sleep heart health study [J]. Am J Respir Crit Care Med, 2011, 183(7): 950.
14 Campos-RodriguezF, Martinez-GarciaM A, Reyes-NunezN, et al. Role of sleep apnea and continuous positive airway pressure therapy in the incidence of stroke or coronary heart disease in women [J]. Am J Respir Crit Care Med, 2014, 189(12): 1544-1550.
15 PawarN H, O'RiordanJ A, MalikP, et al. Obstructive sleep apnea: an unusual cause of hemorrhagic stroke [J]. Cureus, 2017, 9(9): e1718.
16 BaroneD A, KriegerA C. Stroke and obstructive sleep apnea: a review [J]. Curr Atheroscler Rep, 2013, 15(7): 334.
17 DongR, DongZ, LiuH, et al. Prevalence, risk factors, outcomes, and treatment of obstructive sleep apnea in patients with cerebrovascular disease: a systematic review [J]. J Stroke Cerebrovasc Dis, 2018, 27(6): 1471-1480.
18 GuvenS F, TurkkaniM H, CiftciB, et al. The relationship between high-sensitivity C-reactive protein levels and the severity of obstructive sleep apnea. %A Guven SF [J]. Sleep Breath, 2012, 16 (1): 217-221.
19 LavieL. Oxidative stress in obstructive sleep apnea and intermittent hypoxia－revisited－the bad ugly and good: implications to the heart and brain [J]. Sleep Med Rev, 2015, 4(20): 27-45.
20 WinklewskiP J, FrydrychowskiA F. Cerebral blood flow, sympathetic nerve activity and stroke risk in obstructive sleep apnoea. Is there a direct link? [J]. Blood Press, 2013, 22(1): 27-33.
21 FletcherE C. Sympathetic over activity in the etiology of hypertension of obstructive sleep apnea [J]. Sleep, 2003, 26(1): 15-19.
22 LavieL. Obstructive sleep apnoea syndrome－an oxidative stress disorder [J]. Sleep Med Rev, 2003, 7(1): 35-51.
23 SomersV K, DykenM E, ClaryM P, et al. Sympathetic neural mechanisms in obstructive sleep apnea [J]. J Clin Invest, 1995, 96(4): 1897-1904.
24 WardS, RyanS, Mc NicholasW T, et al. Comparison of baroreflex sensitivity measures for assessing subjects with obstructive sleep apnea [J]. Conf Proc IEEE Eng Med Biol Soc, 2006, 1: 3572-3575.
25 SomersV K, WhiteD P, AminR, et al. Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing [J]. J Am Coll Cardiol, 2008, 52(8): 686-717.
26 SpiegelK, KnutsonK, LeproultR, et al. Sleep loss: a novel risk factor for insulin resistance and type 2 diabetes [J]. J Appl Physiol (1985), 2005, 99(5): 2008-2019.
27 MakinoS, HandaH, SuzukawaK, et al. Obstructive sleep apnoea syndrome, plasma adiponectin levels, and insulin resistance [J]. Clin Endocrinol (Oxf), 2006, 64(1): 12-19.
28 AlshehriM A, AlharthiS R, AlsuwatA A, et al. Clinical characteristics of type 2 diabetics who are at high risk for obstructive sleep apnea [J]. Med Arch, 2018, 72(4): 249-252.
29 PunjabiN M, PolotskyV Y. Disorders of glucose metabolism in sleep apnea [J]. J Appl Physiol (1985), 2005, 99(5): 1998-2007.
30 UrsavasA, IlcolY O, NalciN, et al. Ghrelin, leptin, adiponectin, and resistin levels in sleep apnea syndrome: role of obesity [J]. Ann Thorac Med, 2010, 5(3): 161-165.
31 MasseriniB, MorpurgoP S, DonadioF, et al. Reduced levels of adiponectin in sleep apnea syndrome [J]. J Endocrinol Invest, 2006, 29(8): 700-705.
32 VizzardiE, SciattiE, BonadeiI, et al. Obstructive sleep apnoea-hypopnoea and arrhythmias: new updates [J]. J Cardiovasc Med (Hagerstown), 2017, 18(7): 490-500.
33 ShitritD, PeledN, ShitritA B, et al. An association between oxygen desaturation and D-dimer in patients with obstructive sleep apnea syndrome [J]. Thromb Haemost, 2005, 94(3): 544-547.
34 HongS N, YunH C, YooJ H, et al. Association between hypercoagulability and severe obstructive sleep apnea [J]. JAMA Otolaryngol Head Neck Surg, 2017, 143(10): 996-1002.
35 ReillyD F, CurtisA M, ChengY, et al. Peripheral circadian clock rhythmicity is retained in the absence of adrenergic signaling [J]. Arterioscler Thromb Vasc Biol, 2008, 28(1): 121-126.
36 GamiA S, HowardD E, OlsonE J, et al. Day-night pattern of sudden death in obstructive sleep apnea [J]. N Engl J Med, 2005, 352(12): 1206-1214.
37 OgaT, ChinK, TabuchiA, et al. Effects of obstructive sleep apnea with intermittent hypoxia on platelet aggregability [J]. J Atheroscler Thromb, 2009, 16(6): 862-869.
38 PatelN, DonahueC, ShenoyA, et al. Obstructive sleep apnea and arrhythmia: a systemic review [J]. Int J Cardiol, 2017, 228: 967-970.
39 LombardiC, TobaldiniE, MontanoN, et al. Obstructive sleep apnea syndrome (OSAS) and cardiovascular system [J]. Med Lav, 2017, 108(4): 276-282.
40 ShiinaK, TomiyamaH, TakataY, et al. Concurrent presence of metabolic syndrome in obstructive sleep apnea syndrome exacerbates the cardiovascular risk: a sleep clinic cohort study [J]. Hypertens Res, 2006, 29(6): 433-441.
41 殷梅,朱榆红,张圣,等. 阻塞性睡眠呼吸暂停综合征致缺血性脑卒中的发病机制[J]. 中风与神经疾病杂志, 2013, 30(2): 171-172.
42 朱榆红,殷梅. 睡眠呼吸暂停低通气综合征致脑卒中的研究进展[J]. 内科急危重症杂志, 2013, 19(2): 69-72.
43 GamiA S, PressmanG, CaplesS M, et al. Association of atrial fibrillation and obstructive sleep apnea [J]. Circulation, 2004, 110(4): 364-367.
44 JavaheriS, ParkerT J, LimingJ D, et al. Sleep apnea in 81 ambulatory male patients with stable heart failure. Types and their prevalences, consequences, and presentations [J]. Circulation, 1998, 97(21): 2154-2159.
45 MehraR, BenjaminE J, ShaharE, et al. Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study [J]. Am J Respir Crit Care Med, 2006, 173(8): 910-916.
46 PoliM, PhilipP, TaillardJ, et al. Atrial fibrillation is a major cause of stroke in apneic patients: a prospective study [J]. Sleep Med, 2017, 2(30): 251-254.
47 QaseemA, HoltyJ E, OwensD K, et al. Management of obstructive sleep apnea in adults: a clinical practice guideline from the American College of Physicians [J]. Ann Intern Med, 2013, 159(7): 471-483.
48 AbuzaidA S, Al AshryH S, ElbadawiA, et al. Meta-analysis of cardiovascular outcomes with continuous positive airway pressure therapy in patients with obstructive sleep apnea [J]. Am J Cardiol, 2017, 120(4): 693-699.
49 YuJ, ZhouZ, McEvoyR D, et al. Association of positive airway pressure with cardiovascular events and death in adults with sleep apnea: a systematic review and meta-analysis [J]. JAMA, 2017, 318(2): 156-166.
50 da Silva PaulitschF, ZhangL. Continuous positive airway pressure for adults with obstructive sleep apnea and cardiovascular disease: a meta-analysis of randomized trials [J]. Sleep Med, 2019, 54: 28-34.
51 SandbergO, FranklinK A, BuchtG, et al. Nasal continuous positive airway pressure in stroke patients with sleep apnoea: a randomized treatment study [J]. Eur Respir J, 2001, 18(4): 630-634.
52 RyanC M, BayleyM, GreenR, et al. Influence of continuous positive airway pressure on outcomes of rehabilitation in stroke patients with obstructive sleep apnea [J]. Stroke, 2011, 42(4): 1062-1067.
53 AaronsonJ A, HofmanW F, van BennekomC A, et al. Effects of continuous positive airway pressure on cognitive and functional outcome of stroke patients with obstructive sleep apnea: a randomized controlled trial [J]. J Clin Sleep Med, 2016, 12(4): 533-541.
54 BravataD M, ConcatoJ, FriedT, et al. Continuous positive airway pressure: evaluation of a novel therapy for patients with acute ischemic stroke [J]. Sleep, 2011, 34(9): 1271-1277.

[1]	SHAO Weiting, LEI Jianghua. Effect of response interruption and redirection as a behavioral intervention on vocal stereotypy in children with autism spectrum disorder: a scoping review [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 10-20.
[2]	WANG Hangyu, GE Keke, FAN Yonghong, DU Lilu, ZOU Min, FENG Lei. Effect of active music therapy on cognitive function for older adults with cognitive impairment: a systematic review based on ICD-11 and ICF [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 36-43.
[3]	WEN Jianing, JIN Qiuyan, ZHANG Qi, LI Jie, SI Qi. Effect of cognitively engaging physical activity on developing executive function of children and adolescents: a systematic review based on ICF [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 44-53.
[4]	GE Keke, FAN Yonghong, WANG Hangyu, DU Lilu, LI Changjiang, ZOU Min. Health benefit of mindfulness intervention for older adults with insomnia disorders: a systematic review [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 54-60.
[5]	LIN Na, GAO Hanlu, LU Huiping, CHEN Yanqing, ZHENG Junfan, CHEN Shurong. Effect of virtual reality on upper limb function after stroke: a study of diffusion tensor imaging [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 61-67.
[6]	WANG Haoyi, SHI Yawei, LU Jun, XU Guangxu. Impact of subjective vertical perception impairment on function in stroke patients: a retrospective study [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 68-73.
[7]	CHEN Junwen, CHEN Qian, CHEN Cheng, LI Shuyue, LIU Lingling, WU Cunshu, GONG Xiang, LU Jun, XU Guangxu. Effect of modified Baduanjin exercise on cardiopulmonary function, motor function and activities of daily living for stroke patients [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 74-80.
[8]	HU Yonglin, MA Ying, DOU Chao, LU Anmin, JIANG Xiaoge, SONG Xinjian, XIAO Yuhua. Effect of neural mobilization based on shoulder control training on shoulder pain and upper limb function in stroke patients with hemiplegia [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 81-86.
[9]	ZHANG Jingya, ZOU Min, SUN Hongwei, SUN Changlong, ZHU Juntong. Effect of psychological intervention on anxiety or depression in children and adolescents with hearing impairment: a systematic review [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(9): 1004-1011.
[10]	WANG Junyu, YANG Yong, YUAN Xun, XIE Ting, ZHUANG Jie. Effect of high-intensity interval training on executive function for healthy children and adolescents: a systematic review [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(9): 1012-1020.
[11]	WEI Xiaowei, YANG Jian, WEI Chunyan. Psychological and behavioral benefits of adapted yoga exercise for children with autism spectrum disorder in special education schools: a systematic review [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(9): 1021-1028.
[12]	YANG Yaru, YANG Jian. School-based physical activity-related health services and their health benefits within the World Health Organization health-promoting school framework: a systematic review of systematic reviews [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(9): 1040-1047.
[13]	WANG He, HAN Liang, KAN Mengfan, YU Shaohong. Efficacy of electrical stimulation on shoulder-hand syndrome after stroke: a systematic review and meta-analysis [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(9): 1048-1056.
[14]	SHI Jiawei, LI Lingyu, YANG Haojie, WANG Qinlu, ZOU Haiou. Effect of preoperative prerehabilitation training on total knee arthroplasty: a systematic review of systematic reviews [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(9): 1057-1064.
[15]	SUN Tengfang, REN Mengting, YANG Lin, WANG Yaoting, WANG Hongyu, YAN Xingzhou. Effect of hyperbaric oxygen therapy combined with repetitive peripheral magnetic stimulation on ankle motor function and balance of stroke patients [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 875-881.

Advance in Relationship between Obstructive Sleep Apnea and Stroke (review)

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 15

Metrics

Comments

Recommended 0