| Central sleep apnea indicates autonomic dysfunction in asymptomatic carotid stenosis: a potential marker of cerebrovascular and cardiovascular risk. | |
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MedLine Citation:
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PMID: 20337190 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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STUDY OBJECTIVES: Arteriosclerosis related stenosis in the carotid bulb causes autonomic imbalance, likely due to carotid chemoreceptor and baroreceptor dysfunction. The latter are associated with increased cerebrovascular and cardiovascular mortality. Chemoreceptor and baroreceptor dysfunction is also involved in the origin of central sleep apnea syndrome (CSA) in different clinical entities. We hypothesized that CSA is associated with stenosis of the internal carotid artery (ICA). The mechanism of this association is an autonomic imbalance induced by stenosis-mediated chemoreceptor and baroreceptor dysfunction. DESIGN: Cross-sectional prospective study. SETTING: University-based tertiary referral sleep clinic and research center. PATIENTS: Fifty-nine patients with various degrees of asymptomatic extracranial ICA (elCA) (n = 49) and intracranial ICA (ilCA) stenosis (n = 10) were investigated. INTERVENTIONS: Polysomnography to detect CSA and analysis of spontaneous heart rate variability (HRV) to detect autonomic imbalance. MEASUREMENTS AND RESULTS: CSA occurred in 39% of the patients with elCA stenosis but was absent in patients with ilCA stenosis. CSA was present in patients with severe elCA stenosis of > or = 70% on one side. Independent predictors for CSA were severity of stenosis, asymmetric distribution of stenosis between both elCA and autonomic imbalance, namely a decrease of parasympathetic tone. The specific constellation of HRV-parameters indicated increased chemoreceptor sensitivity and impaired baroreflex sensitivity. CONCLUSIONS: CSA indicates autonomic dysfunction in patients with asymptomatic elCA stenosis. Detection of CSA may help to identify asymptomatic patients with an increased risk of cerebrovascular or cardiovascular events who particularly benefit from carotid revascularization. |
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Authors:
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Sven Rupprecht; Dirk Hoyer; Georg Hagemann; Otto W Witte; Matthias Schwab |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Sleep Volume: 33 ISSN: 0161-8105 ISO Abbreviation: Sleep Publication Date: 2010 Mar |
Date Detail:
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Created Date: 2010-03-26 Completed Date: 2010-04-16 Revised Date: 2011-05-17 |
Medline Journal Info:
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Nlm Unique ID: 7809084 Medline TA: Sleep Country: United States |
Other Details:
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Languages: eng Pagination: 327-33 Citation Subset: IM |
Affiliation:
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Department of Neurology, Friedrich Schiller University, Jena, Germany. Sven.Rupprecht@med.uni-jena.de |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Autonomic Nervous System Diseases / diagnosis*, physiopathology* Baroreflex / physiology Carotid Artery, External / physiopathology Carotid Artery, Internal / physiopathology Carotid Stenosis / diagnosis, physiopathology* Cerebral Infarction / diagnosis*, physiopathology* Female Heart Rate / physiology Humans Male Myocardial Infarction / diagnosis*, physiopathology* Polysomnography Risk Sleep Apnea, Central / diagnosis*, physiopathology* Young Adult |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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