Risk Factors May Differ In Stroke Population
Several risk factors for OSA have been identified.
Obesity is one of the strongest risk factors, with increasing body mass index associated with increased OSA prevalence.,, However, obesity appears to be a less significant risk factor in patients who have had a stroke than in the general population. In the 2010 meta-analysis of OSA after stroke, the average BMI was only 26.4 kg/m2 , and increasing BMI was not associated with increasing AHI.
Male sex and advanced age are also OSA risk factors., They remain significant in patients after a stroke about 65% of poststroke patients who have OSA are men, and the older the patient, the more likely the AHI is greater than 10.
Ethnicity and genetics may also play important roles in OSA risk, with roughly 25% of OSA prevalence estimated to have a genetic basis., Some risk factors for OSA such as craniofacial shape, upper airway anatomy, upper airway muscle dysfunction, increased respiratory chemosensitivity, and poor arousal threshold during sleep are likely determined by genetics and ethnicity., Compared with people of European origin, Asians have a similar prevalence of OSA, but at a much lower average BMI, suggesting that other factors are significant. Possible genetically determined anatomic risk factors have not been specifically studied in the poststroke population, but it can be assumed they remain relevant.
How To Treat Sleep Problems
Treatments for insomnia may include prescription sedatives or changes in your bedroom or nighttime activities. Continuous positive airway pressure or CPAP is one of the most common and effective treatments for sleep-related breathing disorders like sleep apnea. A CPAP machine delivers short bursts of compressed air to prevent airway obstruction and help you get a better nights sleep. There are other ways to control sleep-related breathing disorders. A special mouthpiece can be made to help minimize your symptoms. Mouthpieces prevent teeth-clenching and prevent the tongue from interfering with breathing. In some cases, upper airway surgery can result in a wider airway and relieve sleep problems. Some medications may also help.
Sleep-wake cycle disorders can be treated in a variety of ways. Talk with your healthcare team. Bright light therapy may help. The treatment is typically administered in the morning and may last about 30 minutes.
Melatonin is a hormone taken at night. It acts like a sedative and can help induce sleep. Sleep-wake cycle disorders are not usually permanent.
How Can Treating Sleep Apnea Help Me Prevent A Stroke
Untreated sleep apnea is a dangerous and sometimes fatal condition. Treating the cause of your sleep apnea as well as your symptoms can help you get not only a better nights sleep it could also save your life.
Obstructive sleep apnea is known as a modifiable risk factor for stroke. This means that it is possible to take steps to treat sleep apnea for future stroke prevention. Even treating sleep apnea after a stroke seems to reduce the possibility of another stroke.
Treating sleep apnea starts with lifestyle changes related to this condition. One of the first steps is to manage excess weight. Add exercise and change your diet to include more fruits, vegetables, whole grains, and lean proteins. These are great ways to reduce the risks of sleep apnea complications related to obesity. Obesity is a major risk factor for stroke, too, so lowering your body-mass index can help treat both conditions.
Other common treatments for sleep apnea help increase oxygen levels and lower blood pressure, also reducing your risk of stroke. Continuous positive airway pressure machines and dental devices for sleep apnea are two options for nighttime treatment of sleep apnea. The CPAP machine holds your airway open with pressurized air. Dental devices position your lower jaw to keep oxygen flowing freely all night long.
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Sleeplessness And Various Other Related Issues
Sleeping disorders is a state of insomnia where the individual has problem sleeping. Some people with sleeping disorders only have trouble resting at night, however others have troubles throughout the day.
Lung illness is a condition that affects the lungs as well as breathing. There are several kinds of pulmonary illness, consisting of persistent obstructive pulmonary condition , additionally known as emphysema, asthma, bronchitis, pneumonia, lung cancer, and consumption. The signs and symptoms may differ relying on what sort of pulmonary disease it is.
Phenotyping Sdb In Stroke Patients To Inform Novel Treatment Strategies
There are several nonanatomical contributors to SDB, being a low-respiratory arousal threshold, abnormal chemoreflex response to differing carbon dioxide levels, and low activation of the main upper-airway dilator muscle, the genioglossus . This knowledge has allowed for the development of emerging tailored treatments for those that have these nonanatomical contributors to SDB. Low arousal threshold can be treated by the use of sedative , abnormal chemoreflex has been treated by supplementary oxygen , and low activation of the upper-airway dilator muscles can be improved by targeted oral exercises . Importantly, these SDB phenotypes can be identified from diagnostic PSG studies however, the characterization of these phenotypes has not been performed in post-stroke SDB patients.
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Isnt Sleep Apnea Just A Fancy Name For Snoring
Not at all. Snoring is that annoying sound that occurs when air passes relaxed tissues in your throat as you sleep. Sleep apnea is a disorder in which a persons breathing repeatedly starts and stops during sleep. Not everyone who snores has sleep apnea, but many who have sleep apnea do snore regularly and loudly. One in five adults suffers from at least mild sleep apnea it afflicts more men than women. The most common type is obstructive sleep apnea , in which weight on the upper chest and neck contributes to blocking the flow of air. A less-common type, central sleep apnea , occurs when the brain fails to send regular signals to the diaphragm to contract and expand. CSA has been associated with brain stem stroke.
Can You Have A Stroke In Your Sleep
Strokes during sleep are especially challenging because of the time-sensitive nature of stroke treatment. Our treatment options are often more limited in these situations, as many of these patients have irreversible brain damage before arriving to the hospital, Dr. Rose said.
Not only is sleep apnea a risk factor for stroke, untreated sleep apnea is associated with poor outcomes after stroke. Stroke is the second-leading cause of death worldwide.
The rate of sleep apnea is much higher in patients who have experienced a stroke, compared with the general population. Both stroke survivors and health care providers should be aware of this risk, and screening for symptoms of sleep apnea should be considered in any patient who has had a stroke, Dr. Rose said.
Lifestyle changes like losing weight and quitting smoking can help with milder cases of sleep apnea. Moderate or severe sleep apnea can be treated with a continuous positive airway pressure machine. The CPAP machine keeps your airway passages open. This prevents snoring and apnea.
Consistent use of CPAP is effective at treating sleep apnea and has been shown to reduce stroke risk factors. Adherence to nightly usage can be challenging for some patients, especially initially as they are acclimating to this change in their sleeping habits. I encourage patients who are having trouble with using their CPAP to speak with their doctor to ensure their equipment fits and functions correctly, Dr. Rose said.
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The Stages Of Sleep Apnea Including Exactly How It Impacts The Body And Life Of A Person
Sleep apnea is a problem where breathing stops for periods throughout the night. It can be brought on by many things, such as weight gain, chronic snoring, or alcohol consumption.
The procedure of sleep apnea is broken into 4 stages: Obstructive Sleep Apnea , Central Sleep Apnea , Mixed Sleep Apnea , and Complex Sleep Apnea . Each stage has its own collection of difficulties that an individual will certainly deal with.
Obstructive sleep apnea is one of the most typical kind of sleep apnea and the only type that can be corrected with surgery. In this type, sufferers have issues taking a breath due to a blockage in their airway, which usually takes place when they are resting in the evening. The feeling of not breathing well enough deeply affects the quality of sleep, bring about dazzling desires that frequently include chatting, eating, or running. Can Sleep Apnea Machine Cause Dry Mouth VitalSleep
Night Symptoms May Include:
- Waking up during the night and gasping for breath
- Shortness of breath
Sleep disorders following stroke may be treated in a variety of ways, including:
- Losing weight
- Use of a specially designed dental appliance design to open airways during the night
- Avoiding sleeping on your back
- Using a continuous positive airway pressure machine to open your airways
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Prevalence And Pathophysiology Of Sdb Post Stroke
The most common form of SDB is obstructive sleep apnea , which is the reduction or cessation of airflow during sleep as a consequence of upper-airway collapse. Another form of SDB is central sleep apnea , which is also characterized by cessation of respiration but as a consequence of loss in central respiratory drive and effort, rather than physical upper-airway collapse .
The gold-standard diagnosis for SDB is performed by overnight laboratory polysomnography , comprising electroencephalography and respiratory measures . PSG, however, can be cumbersome and time-consuming, making it impractical in some clinical settings such as post-stroke . As such, the vast majority of studies examining SDB and stroke use respiratory polygraphy, which is a limited channel sleep study measuring respiratory parameters without EEG. There is good agreement between the limited channel studies compared with gold-standard PSG suggesting that the prevalence estimates for SDB post stroke are reasonable.
Defining And Quantifying Osa
OSA is the most common type of sleep-disordered breathing., It involves repeated narrowing or complete collapse of the upper airway despite ongoing respiratory effort., Apneic episodes are terminated by arousals from hypoxemia or efforts to breathe. In contrast, central sleep apnea is characterized by a patent airway but lack of airflow due to absent respiratory effort.
In OSA, the number of episodes of apnea and hypopnea are added together and divided by hours of sleep to calculate the apnea-hypopnea index . OSA is diagnosed by either of the following,:
AHI of 5 or higher, with clinical symptoms related to OSA
AHI of 15 or higher, regardless of symptoms. The AHI also defines OSA severity, as follows:
Mild: AHI 5 to 15
Moderate: AHI 15 to 30
Severe: AHI greater than 30.
Diagnostic criteria have varied over time, an important consideration when reviewing the literature.
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What Is Sleep Apnea Can Sleep Apnea Machine Cause Dry Mouth
Sleep apnea is a disorder in which an individuals breathing is interrupted during sleep. It can result in daytime drowsiness and also is frequently related to excessive weight, high blood pressure, and diabetes mellitus.
Sleep apnea happens when the muscular tissues of the throat collapse and block the air passage, making it hard for you to take a breath or even swallow. One of the most usual kind of this condition is obstructive sleep apnea, which impacts about six out of 10 adults.
The seriousness of your signs and symptoms can differ with exactly how often and significantly your air passage comes to be blocked during sleep. Mild obstructive sleep apnea might not interrupt your nighttime breathing sufficient to trigger significant daytime problems like extreme daytime sleepiness. Can Sleep Apnea Machine Cause Dry Mouth
Sleep Apnea Is A Risk Factor For Acute Ischemic Stroke
Two prospective cohort studies revealed a 2- to 4.5- fold independent risk for a first-ever ischemic stroke in patients with sleep apnea compared to those without,4-5 suggesting that sleep apnea constitutes a pre-existing condition rather than a consequence of acute ischemic brain damage. Moreover, the cumulative risk of suffering a recurrent ischemic stroke may grow notably in stroke victims who have co-existing sleep apnea.6,7 Yet it still remains a matter of debate whether the deleterious effects of sleep apnea are independent of other comorbidities often existing in those who have suffered a stroke, such as hypertension, atherosclerotic disease or atrial fibrillation.
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Is There A Benefit In Screening For Af In Patients With Osa
The association between OSA and increased risk for AF has been established in previous studies. OSA is an independent risk factor for stroke, and AF is likely to play a role in the development of stroke in patients with OSA. AF is usually diagnosed after symptoms related to arrhythmia, such as palpitations, usually due to rapid ventricular response. About 18% of strokes caused by AF occur in patients in which the AF is a new diagnosis, discovered upon the evaluation for stroke etiology. Evidence for screening unselected asymptomatic patients for AF is weak. The known association between OSA and AF brings to mind the question of screening patients with high-risk conditions like OSA, for silent AF. The Screening Study for Undiagnosed AF included 75 male subjects of age 55 and with 2 AF risk factors coronary disease, heart failure, hypertension, DM, and sleep apnea . Subjects were screened for arrhythmia in an outpatient setting for 2weeks using a Zio wearable patch-based device. Thirty-three percent had sleep apnea . An AF episode was defined as the presence of 30s of continuous AF during monitoring. AF was detected in four subjects .
Sleep Apnea And Other Cardiovascular Issues
It is clear that sleep apnea and stroke are related to sleep apnea and cardiovascular issues, and that both can be fatal. As with all complicated studies of the brain, more research can help truly answer these questions. Whats clear is that people with sleep apnea are three times more likely to prematurely die of any cause than those without sleep apnea.
We know all this through research studies and evidence. In reality, though, many people are walking around with undiagnosed sleep apnea. Indeed, some people are misdiagnosed with depression and anxiety or ADHD instead of sleep apnea. Undiagnosed and untreated sleep apnea can cause sudden death from stroke or cardiovascular illness.
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Link Between Breathing And Stroke
MRI brain imaging studies suggest about 20% to 25% of people over age 60 have had a silent stroke, according to Harvard Medical School neurologist Steven Greenberg, MD, PhD. They have been linked to memory loss in some people, he says.
The study offers “good evidence linking” sleep apnea to silent stroke, Greenberg tells WebMD. But this is just an observation of an association between the two that needs further study, he says.
Greenberg moderated a news briefing to discuss the findings at the American Stroke Association’s International Stroke Conference.
The study is small and preliminary. But it poses a number of questions that deserve further research, says Harvard neurologist Lee Schwamm, MD.
“I think what we can say is that breathing problems are more common in stroke patients than suspected,” he tells WebMD.
“But is abnormal breathing during sleep a long-term problem in these patients? Or will it go away? And is abnormal breathing a risk factor that leads to stroke? Or is it a consequence of stroke?” Schwamm asks.
Kepplinger plans further study. In the meantime, she says, all stroke patients should be screened for sleep apnea.
These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the “peer review” process, in which outside experts scrutinize the data prior to publication in a medical journal.
Benefits Of Getting Proper A Sleep
Proper rest is vital to our health in more ways than one. When the brain is rejuvenated with quality sleep, we function better during the day in terms of moods, memory recall, concentration, etc. In addition, every moment counts for children who require constant supervision during waking hours like infants & toddlers!
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The Relationship Between Osa And Af
The pathophysiologic mechanisms of the association between AF and OSA are complex and likely multifactorial. Controversy over this association and its directionality exists, because of the high incidence of cardiovascular comorbidities in patients with OSA and AF. Patients with OSA have a higher incidence of AF than the general population.
Most of the evidence suggests a strong association between OSA and AF. Animal studies have shown autonomic nervous system imbalances brought on by hypoxia as well as hypercapnia may precipitate electrical changes in atria that predispose to AF . Studies in rats have shown that fluctuations in intrathoracic pressure resulted in cardiac structural remodeling with increased left atrial dilatation and increased fibrosis .
What Causes Cheyne Stokes Breathing
The causes of Cheyne-Stokes breathing are not entirely known, but it is associated with damage to the part of the brain that controls breathing. This is usually due to a stroke, sometimes caused by bleeding in the brain or ischemia . It may also affect people who have seizures, infections in the brain, or nervous system disorders such as Parkinson's disease.
Cheyne stokes can also occur without any other neurological problems. There are two main reasons why this happens: heart failure and sleep apnea...
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Sa May Reduce Your Brains Ability To Regulate Blood Flow
Another possible explanation of the link between S.A. and stroke is that sleep apnea may damage your brains ability to control blood flow to itself. Normally, your brain is able to regulate blood flow to help meet its own needs, in spite of other factors like high blood pressure. This is known as cerebral autoregulation. However, S.A. can reduce blood flow to the brain and increase brain blood pressure, which over time may damage the cerebral autoregulation process. Essentially, your brain may not be able to prevent damage to itself after years of untreated S.A. This may also increase your risk for stroke.