Document Detail


Central sleep apnea indicates autonomic dysfunction in asymptomatic carotid stenosis: a potential marker of cerebrovascular and cardiovascular risk.
MedLine Citation:
PMID:  20337190     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Sven Rupprecht; Dirk Hoyer; Georg Hagemann; Otto W Witte; Matthias Schwab
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Sleep     Volume:  33     ISSN:  0161-8105     ISO Abbreviation:  Sleep     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-26     Completed Date:  2010-04-16     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  7809084     Medline TA:  Sleep     Country:  United States    
Other Details:
Languages:  eng     Pagination:  327-33     Citation Subset:  IM    
Affiliation:
Department of Neurology, Friedrich Schiller University, Jena, Germany. Sven.Rupprecht@med.uni-jena.de
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MeSH Terms
Descriptor/Qualifier:
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
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