Sleep‐Disordered Breathing in Acute Ischemic Stroke: A Mechanistic Link to Peripheral Endothelial Dysfunction
BackgroundSleep‐disordered breathing (SDB) after acute ischemic stroke is frequent and may be linked to stroke‐induced autonomic imbalance. In the present study, the interaction between SDB and peripheral endothelial dysfunction (ED) was investigated in patients with acute ischemic stroke and at 1‐y...
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2017-09-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.117.006010 |
| _version_ | 1811328991917768704 |
|---|---|
| author | Nadja Scherbakov Anja Sandek Nicole Ebner Miroslava Valentova Alexander Heinrich Nave Ewa A. Jankowska Jörg C. Schefold Stephan von Haehling Stefan D. Anker Ingo Fietze Jochen B. Fiebach Karl Georg Haeusler Wolfram Doehner |
| author_facet | Nadja Scherbakov Anja Sandek Nicole Ebner Miroslava Valentova Alexander Heinrich Nave Ewa A. Jankowska Jörg C. Schefold Stephan von Haehling Stefan D. Anker Ingo Fietze Jochen B. Fiebach Karl Georg Haeusler Wolfram Doehner |
| author_sort | Nadja Scherbakov |
| collection | DOAJ |
| description | BackgroundSleep‐disordered breathing (SDB) after acute ischemic stroke is frequent and may be linked to stroke‐induced autonomic imbalance. In the present study, the interaction between SDB and peripheral endothelial dysfunction (ED) was investigated in patients with acute ischemic stroke and at 1‐year follow‐up. Methods and ResultsSDB was assessed by transthoracic impedance records in 101 patients with acute ischemic stroke (mean age, 69 years; 61% men; median National Institutes of Health Stroke Scale, 4) while being on the stroke unit. SDB was defined by apnea‐hypopnea index ≥5 episodes per hour. Peripheral endothelial function was assessed using peripheral arterial tonometry (EndoPAT‐2000). ED was defined by reactive hyperemia index ≤1.8. Forty‐one stroke patients underwent 1‐year follow‐up (390±24 days) after stroke. SDB was observed in 57% patients with acute ischemic stroke. Compared with patients without SDB, ED was more prevalent in patients with SDB (32% versus 64%; P<0.01). After adjustment for multiple confounders, presence of SDB remained independently associated with ED (odds ratio, 3.1; [95% confidence interval, 1.2–7.9]; P<0.05). After 1 year, the prevalence of SDB decreased from 59% to 15% (P<0.001). Interestingly, peripheral endothelial function improved in stroke patients with normalized SDB, compared with patients with persisting SDB (P<0.05). ConclusionsSDB was present in more than half of all patients with acute ischemic stroke and was independently associated with peripheral ED. Normalized ED in patients with normalized breathing pattern 1 year after stroke suggests a mechanistic link between SDB and ED. Clinical Trial RegistrationURL: https://drks-neu.uniklinik-freiburg.de. Unique identifier: DRKS00000514. |
| first_indexed | 2024-04-13T15:35:55Z |
| format | Article |
| id | doaj.art-d636bef74bc74da5ad96c1643b35c098 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T15:35:55Z |
| publishDate | 2017-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-d636bef74bc74da5ad96c1643b35c0982022-12-22T02:41:16ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802017-09-016910.1161/JAHA.117.006010Sleep‐Disordered Breathing in Acute Ischemic Stroke: A Mechanistic Link to Peripheral Endothelial DysfunctionNadja Scherbakov0Anja Sandek1Nicole Ebner2Miroslava Valentova3Alexander Heinrich Nave4Ewa A. Jankowska5Jörg C. Schefold6Stephan von Haehling7Stefan D. Anker8Ingo Fietze9Jochen B. Fiebach10Karl Georg Haeusler11Wolfram Doehner12Center for Stroke Research Berlin (CSB), Charité–Universitätsmedizin Berlin, Berlin, GermanyInnovative Clinical Trials, Department of Cardiology and Pneumology, University Medicine Goettingen (UMG), Goettingen, GermanyInnovative Clinical Trials, Department of Cardiology and Pneumology, University Medicine Goettingen (UMG), Goettingen, GermanyInnovative Clinical Trials, Department of Cardiology and Pneumology, University Medicine Goettingen (UMG), Goettingen, GermanyCenter for Stroke Research Berlin (CSB), Charité–Universitätsmedizin Berlin, Berlin, GermanyDepartment of Heart Diseases, Wroclaw Medical University, Wroclaw, PolandDepartment of Intensive Care Medicine, Inselspital, University Hospital of Bern, SwitzerlandInnovative Clinical Trials, Department of Cardiology and Pneumology, University Medicine Goettingen (UMG), Goettingen, GermanyInnovative Clinical Trials, Department of Cardiology and Pneumology, University Medicine Goettingen (UMG), Goettingen, GermanyInterdisciplinary Center of Sleep Medicine, Charité–Universitätsmedizin Berlin, Berlin, GermanyCenter for Stroke Research Berlin (CSB), Charité–Universitätsmedizin Berlin, Berlin, GermanyCenter for Stroke Research Berlin (CSB), Charité–Universitätsmedizin Berlin, Berlin, GermanyCenter for Stroke Research Berlin (CSB), Charité–Universitätsmedizin Berlin, Berlin, GermanyBackgroundSleep‐disordered breathing (SDB) after acute ischemic stroke is frequent and may be linked to stroke‐induced autonomic imbalance. In the present study, the interaction between SDB and peripheral endothelial dysfunction (ED) was investigated in patients with acute ischemic stroke and at 1‐year follow‐up. Methods and ResultsSDB was assessed by transthoracic impedance records in 101 patients with acute ischemic stroke (mean age, 69 years; 61% men; median National Institutes of Health Stroke Scale, 4) while being on the stroke unit. SDB was defined by apnea‐hypopnea index ≥5 episodes per hour. Peripheral endothelial function was assessed using peripheral arterial tonometry (EndoPAT‐2000). ED was defined by reactive hyperemia index ≤1.8. Forty‐one stroke patients underwent 1‐year follow‐up (390±24 days) after stroke. SDB was observed in 57% patients with acute ischemic stroke. Compared with patients without SDB, ED was more prevalent in patients with SDB (32% versus 64%; P<0.01). After adjustment for multiple confounders, presence of SDB remained independently associated with ED (odds ratio, 3.1; [95% confidence interval, 1.2–7.9]; P<0.05). After 1 year, the prevalence of SDB decreased from 59% to 15% (P<0.001). Interestingly, peripheral endothelial function improved in stroke patients with normalized SDB, compared with patients with persisting SDB (P<0.05). ConclusionsSDB was present in more than half of all patients with acute ischemic stroke and was independently associated with peripheral ED. Normalized ED in patients with normalized breathing pattern 1 year after stroke suggests a mechanistic link between SDB and ED. Clinical Trial RegistrationURL: https://drks-neu.uniklinik-freiburg.de. Unique identifier: DRKS00000514.https://www.ahajournals.org/doi/10.1161/JAHA.117.006010clinical trialendothelial dysfunctionsleep disorderssympathetic nervous system |
| spellingShingle | Nadja Scherbakov Anja Sandek Nicole Ebner Miroslava Valentova Alexander Heinrich Nave Ewa A. Jankowska Jörg C. Schefold Stephan von Haehling Stefan D. Anker Ingo Fietze Jochen B. Fiebach Karl Georg Haeusler Wolfram Doehner Sleep‐Disordered Breathing in Acute Ischemic Stroke: A Mechanistic Link to Peripheral Endothelial Dysfunction Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease clinical trial endothelial dysfunction sleep disorders sympathetic nervous system |
| title | Sleep‐Disordered Breathing in Acute Ischemic Stroke: A Mechanistic Link to Peripheral Endothelial Dysfunction |
| title_full | Sleep‐Disordered Breathing in Acute Ischemic Stroke: A Mechanistic Link to Peripheral Endothelial Dysfunction |
| title_fullStr | Sleep‐Disordered Breathing in Acute Ischemic Stroke: A Mechanistic Link to Peripheral Endothelial Dysfunction |
| title_full_unstemmed | Sleep‐Disordered Breathing in Acute Ischemic Stroke: A Mechanistic Link to Peripheral Endothelial Dysfunction |
| title_short | Sleep‐Disordered Breathing in Acute Ischemic Stroke: A Mechanistic Link to Peripheral Endothelial Dysfunction |
| title_sort | sleep disordered breathing in acute ischemic stroke a mechanistic link to peripheral endothelial dysfunction |
| topic | clinical trial endothelial dysfunction sleep disorders sympathetic nervous system |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.117.006010 |
| work_keys_str_mv | AT nadjascherbakov sleepdisorderedbreathinginacuteischemicstrokeamechanisticlinktoperipheralendothelialdysfunction AT anjasandek sleepdisorderedbreathinginacuteischemicstrokeamechanisticlinktoperipheralendothelialdysfunction AT nicoleebner sleepdisorderedbreathinginacuteischemicstrokeamechanisticlinktoperipheralendothelialdysfunction AT miroslavavalentova sleepdisorderedbreathinginacuteischemicstrokeamechanisticlinktoperipheralendothelialdysfunction AT alexanderheinrichnave sleepdisorderedbreathinginacuteischemicstrokeamechanisticlinktoperipheralendothelialdysfunction AT ewaajankowska sleepdisorderedbreathinginacuteischemicstrokeamechanisticlinktoperipheralendothelialdysfunction AT jorgcschefold sleepdisorderedbreathinginacuteischemicstrokeamechanisticlinktoperipheralendothelialdysfunction AT stephanvonhaehling sleepdisorderedbreathinginacuteischemicstrokeamechanisticlinktoperipheralendothelialdysfunction AT stefandanker sleepdisorderedbreathinginacuteischemicstrokeamechanisticlinktoperipheralendothelialdysfunction AT ingofietze sleepdisorderedbreathinginacuteischemicstrokeamechanisticlinktoperipheralendothelialdysfunction AT jochenbfiebach sleepdisorderedbreathinginacuteischemicstrokeamechanisticlinktoperipheralendothelialdysfunction AT karlgeorghaeusler sleepdisorderedbreathinginacuteischemicstrokeamechanisticlinktoperipheralendothelialdysfunction AT wolframdoehner sleepdisorderedbreathinginacuteischemicstrokeamechanisticlinktoperipheralendothelialdysfunction |