Protective Effects of Obstructive Sleep Apnea on Outcomes After Subarachnoid Hemorrhage: A Nationwide Analysis

Neurosurgery ◽  
2020 ◽  
Vol 87 (5) ◽  
pp. 1008-1015
Author(s):  
Christian Kaculini ◽  
David J Wallace ◽  
Audrey E Haywood ◽  
Joel Michalek ◽  
Justin Mascitelli ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Subarachnoid Hemorrhage ◽  
Sleep Apnea ◽  
Tobacco Use ◽  
Univariate Analysis ◽  
Protective Effects ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Poor Outcomes ◽  
The Impact

Abstract BACKGROUND Obstructive sleep apnea (OSA) is typically associated with an increased risk of cardiovascular and cerebrovascular disease. Recent studies, however, have suggested that hypercapnia and chronic intermittent hypoxia may potentially provide protection against ischemic events like stroke. OBJECTIVE To evaluate the impact of OSA with presentation, hospital course, and treatment outcomes of patients with subarachnoid hemorrhage (SAH). METHODS Data for patients with SAH between the years 2011 and 2015 were extracted from the Nationwide Inpatient Sample (NIS) and stratified based on diagnosis codes for OSA. Univariate analysis was used to assess the prevalence of comorbidities in OSA patients diagnosed with SAH and several covariates, including patient demographics, aneurysmal treatment, in-hospital morality rate, length of stay, and costs. Multivariate logistic regression models analyzed the relationship between several comorbidities, including OSA, tobacco use, and hypertension, and poor outcomes after SAH. RESULTS Data from 49 265 SAH patients were used in this study, of which 2408 (4.9%) also had a concomitant OSA diagnosis. Patients with OSA compared to all other SAH patients had a significantly lower in-hospital mortality rate, as well as statistically significant lower odds of vasospasm, stroke, and poor outcomes. Additionally, hypercholesterolemia, obesity, and tobacco use disorder were also associated with more favorable outcomes. CONCLUSION SAH patients with OSA are significantly less likely to have a poor outcome when compared to non-OSA patients, despite having an increased risk of several comorbidities.

The Impact of Obstructive Sleep Apnea on Balance, Gait, and Falls Risk: A Narrative Review of the Literature

2020 ◽  
Vol 75 (12) ◽  
pp. 2450-2460 ◽  
Author(s):  
David Stevens ◽  
Brianna Jackson ◽  
Jayne Carberry ◽  
James McLoughlin ◽  
Chris Barr ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Disturbances ◽  
Large Scale ◽  
Falls Risk ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Risk Of Falls ◽  
Osa Treatment ◽  
The Impact

Abstract Falls-related hospitalization and injury rates are steadily increasing globally due to a growth in the aging population, and the associated health problems that increase risk of falls. One such associated health problem is sleep disturbances and disorders. Recent cohort studies have shown that subjectively reported poor quality sleep is associated with an increased risk of falls. Obstructive sleep apnea (OSA) is a common sleep disorder characterized by the repetitive reductions, or cessation, of airflow. Some studies have shown that OSA impairs posture/balance and gait with nocturnal hypoxemia the likely main cause. Emerging evidence suggests that treating OSA by continuous positive airway pressure (CPAP) can improve gait, but no studies to date have examined the effect of CPAP on posture/balance. The overall control of balance relies on a complex interaction between several physiological functions including vestibular, muscle, visual, and cognitive functions. We postulate that OSA impacts balance by affecting these different systems to various degrees, with the nocturnal hypoxic burden likely playing an important role. Importantly, these impairments in balance/posture and possible falls risk may be alleviated by OSA treatment. Larger mechanistic studies are needed to properly elucidate how OSA affects falls risk and future large-scale randomized control trials are needed to determine the effectiveness of OSA treatment in reducing the risk of falls.

scholarly journals The Effect of the Severity of Obstructive Sleep Apnea on Leukocyte Telomere Length, 25 Hydroxy Vitamin D, and Parathyroid Hormonal Concentrations in Asian Indians

2021 ◽  
Vol 12 ◽  
Author(s):  
Surya Prakash Bhatt ◽  
Randeep Guleria ◽  
Naval K. Vikram
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Telomere Length ◽  
Body Fat ◽  
Asian Indians ◽  
Univariate Analysis ◽  
Apnea Hypopnea Index ◽  
Leukocyte Telomere Length ◽  
Obstructive Sleep ◽  
Increased Risk

Background: Obstructive sleep apnea (OSA) is a common disorder in which breathing repeatedly stops during sleep. Leukocyte telomere length (LTL) and OSA are linked with an increased risk of oxidative stress and inflammation. The possible link between LTL and OSA in Asian Indians has not been evaluated. Thus, the present study aims to compare the link between LTL and OSA in Asian Indians.Methods: In this study, 300 subjects (120 obese with OSA, 110 obese without OSA, and 70 non-obese without OSA) were included after overnight polysomnography and a fasting blood sample. Clinical, anthropometry, metabolic markers, insulin, 25-hydroxyvitamin D [25(OH) D], and parathyroid hormones (PTH) levels were investigated. LTL was investigated by a QPCR. Univariate and stepwise multivariate linear regression analyses adjusting for age, gender, BMI, and % body fat were conducted while treating LTL as a dependent variable in relation to AHI and other covariates.Results: Obese subjects with OSA had significantly decreased 25(OH)D and increased PTH levels. The mean telomere length (T/S) ratio was significantly shorter in patients with OSA. The adjusted correlation analysis showed that shortening of telomere length correlated with increasing age, apnea-hypopnea index (AHI), oxygen desaturation index, and RDI. Univariate analysis showed that LTL revealed a trend toward a negative correlation with a mean age (β + SE, −0.015 + 0.0006; p = 0.01) and positive correlation with AHI [β +slandered error (SE), 0.042 + 0.017; p = 0.008]. In the multiple regression analysis, LTL was positively associated with AHI (β + SE, 0.281 + 0.04; p = 0.001) after adjusting for age, sex, BMI, and % body fat. Even when adjusted for confounding factors, 25(OH)D, and PTH levels, LTL still was related to AHI (β + SE, 0.446 + 0.02; p = 0.05).Conclusion: Our study indicates the presence of an association between LTL and OSA and a significant impact of OSA severity and telomeres shortening in Asian Indians.

scholarly journals Impact of obstructive sleep apnea on cerebral blood flow

2019 ◽  
Vol 73 ◽  
pp. 65-75
Author(s):  
Katarzyna Postrzech-Adamczyk ◽  
Artur Nahorecki ◽  
Paweł Łyszczak ◽  
Robert Skomro ◽  
Andrzej Szuba
Keyword(s):  
Risk Factors ◽  
Blood Flow ◽  
Obstructive Sleep Apnea ◽  
Cerebral Blood Flow ◽  
Sleep Apnea ◽  
The Body ◽  
Early Screening ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
The Impact

Aim: Obstructive sleep apnea (OSA) is a common disorder with growing incidence. Major risk factors for OSA are obesity, aging, gender and menopause. As life expectancy lengthens and the obesity epidemic is ongoing, we can assume that OSA will affect an increasing part of the population. Pathological consequences of this disease include an increased risk of arterial hypertension, coronary artery disease, arrhythmia, heart failure as well as cerebrovascular diseases, such as stroke, transient ischemic attack and cognitive dysfunction. The cerebrovascular system differs significantly from other vessels in the body. Brain oxygen demands constitute about 20% of the total oxygen consumed by the body. Conclusions: OSA significantly affects the cerebral blood flow both during sleep and daily activities. This can have serious health consequences and makes the brain more vulnerable to ischemia. In this review we describe the impact of OSA on cerebral circulation during both sleep and wakefulness and we also outline the pathophysiology of these changes. Results: In patients with other risk factors for cerebral ischemia, early screening and treatment for OSA should be introduced.

Childhood Obstructive Sleep Apnea, What a Surgeon Should Know. Part 1: Interpreting the Polysomnography Study; Part 2: Diagnosis and Management

FACE ◽  
2021 ◽  
pp. 273250162110580
Author(s):  
Erica Lauren Smearman ◽  
Joseph Williams
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Study ◽  
Diagnosis And Management ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Study Evaluation ◽  
Level 1 ◽  
The Impact ◽  
Pierre Robin

Obstructive sleep apnea (OSA) and disordered breathing can be common in early development with certain conditions placing children at increased risk for OSA, such as micrognathia and the Pierre Robin sequence, craniosynostosis, and tonsillar hypertrophy. A Level 1 Sleep Study evaluation is recommended in all children with suspected sleep apnea. Part 1 of this review provides a discussion of the polysomnography study and interpretation. Part 2 focuses on diagnosis and management, emphasizing conditions that are amendable to surgical intervention and the impact of intervention on post-operative sleep study outcomes.

Aerodynamics Analysis of the Impact of Nasal Surgery on Patients with Obstructive Sleep Apnea and Nasal Obstruction

ORL ◽  
2021 ◽  
pp. 1-8
Author(s):  
Lifeng Li ◽  
Demin Han ◽  
Hongrui Zang ◽  
Nyall R. London
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Nasal Obstruction ◽  
Upper Airway ◽  
Apnea Hypopnea Index ◽  
Nasal Surgery ◽  
Subjective Sleep Quality ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
The Impact

<b><i>Objective:</i></b> The purpose of this study was to evaluate the effects of nasal surgery on airflow characteristics in patients with obstructive sleep apnea (OSA) by comparing the alterations of airflow characteristics within the nasal and palatopharyngeal cavities. <b><i>Methods:</i></b> Thirty patients with OSA and nasal obstruction who underwent nasal surgery were enrolled. A pre- and postoperative 3-dimensional model was constructed, and alterations of airflow characteristics were assessed using the method of computational fluid dynamics. The other subjective and objective clinical indices were also assessed. <b><i>Results:</i></b> By comparison with the preoperative value, all postoperative subjective symptoms statistically improved (<i>p</i> &#x3c; 0.05), while the Apnea-Hypopnea Index (AHI) changed little (<i>p</i> = 0.492); the postoperative airflow velocity and pressure in both nasal and palatopharyngeal cavities, nasal and palatopharyngeal pressure differences, and total upper airway resistance statistically decreased (all <i>p</i> &#x3c; 0.01). A significant difference was derived for correlation between the alteration of simulation metrics with subjective improvements (<i>p</i> &#x3c; 0.05), except with the AHI (<i>p</i> &#x3e; 0.05). <b><i>Conclusion:</i></b> Nasal surgery can decrease the total resistance of the upper airway and increase the nasal airflow volume and subjective sleep quality in patients with OSA and nasal obstruction. The altered airflow characteristics might contribute to the postoperative reduction of pharyngeal collapse in a subset of OSA patients.

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