Sleep disordered breathing and stroke
Upload time：2017-02-23 Browse：
Author: Peking Union Medical College Hospital Hao Honglin
Sleep disordered breathing (SDB) and sleep wake disorder (SWD) are common in stroke patients, with a prevalence rate of 43-70%, while the prevalence in the general population is 4-24%. Recent studies have suggested that sleep disordered breathing and sleep wake disorders are both risk factors for stroke and the consequences of stroke, which may affect the recovery, outcome and recurrence of stroke. Stroke after sleep apnea obstructive sleep apnea (OSA), or central apnea (CSA) or both, of which OSA OSA is more common, sleep when the upper airway stenosis or mechanical collapse leading to respiratory airflow disruption, while CSA is breathing in pivot drive due to a lack of. Sleep disordered breathing can be characterized by snoring, hypoxia, apnea, frequent awakenings, asthma, asphyxia, and so on.
Pleural pressure increases, atrial remodeling, conduction abnormalities, and even lead to atrial fibrillation OSA night repeated hypoxia hypoxic, oxidative stress activates the sympathetic nerve and the renin angiotensin aldosterone system caused by hypertension and increased plasma fibrinogen level and platelet aggregation increased, resulting in a hypercoagulable state. OSA mediated inflammation aggravates atherosclerosis and hypertension.
OSA can cause chronic hypoxia and hypercapnia, together with high blood pressure, together lead to systemic vascular and cerebral vascular reconstruction, damage to the brain. When hypoxia and hypercapnia, cerebral blood flow from low perfusion to high perfusion area, further aggravated the OSA stroke patients with secondary nerve damage. On the contrary, CSA after stroke is due to brain damage leading to insufficient respiratory muscle afferent signal. The reaction of medulla on blood CO2 levels are low, and the autonomy of the neural network to the hypoxia sensitive, can control breath, but due to bilateral hemispheric cerebral infarction is damaged.
Because of the high risk of sleep disordered breathing in stroke patients, it is recommended that patients with stroke be evaluated for sleep. There is evidence that effective treatment for patients with OSA after stroke can improve the prognosis and reduce the recurrence of stroke. Application of CPAP in the treatment of obstructive sleep apnea. Central sleep apnea can be considered with oxygen therapy, BiPAP, and matched servo ventilation (ASV).
Sleep apnea increases the risk of stroke in the general population, and affects the recovery of short-term or long-term stroke. The current level of awareness supports the diagnosis and treatment of sleep disordered breathing and sleep wake disorders after stroke.
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