Osas related organ system complications neurologic and ophthalmologic
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TTD 13. Annual Congress, 5-9 May 2010 Lütfi Kırdar Uluslararası Kongre ve Sergi Sarayı- İstanbul. OSAS Related Organ System Complications Neurologic and ophthalmologic. D oç .D r .S adık ARDIÇ S B Dışkapı Yıldırım Beyazit E ğitim ve Araştırma H ast, G öğüs Hastalıkları K liniği

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OSAS Related Organ System Complications Neurologic and ophthalmologic

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Osas related organ system complications neurologic and ophthalmologic

TTD 13. Annual Congress,

5-9 May 2010

Lütfi Kırdar Uluslararası Kongre ve Sergi Sarayı- İstanbul

OSAS Related Organ SystemComplicationsNeurologicandophthalmologic

Doç.Dr.Sadık ARDIÇ

SB Dışkapı Yıldırım Beyazit Eğitim ve Araştırma Hast, GöğüsHastalıkları Kliniği

Uyku Hastalıkları Merkezi


Osas related organ system complications neurologic and ophthalmologic

CEHALET


Osas neurologic and ophthalmologic diseases

OSAS,Neurologic, andOphthalmologicDiseases

  • NeurologicComplications

  • CognitiveFunctionImpairment

  • Stroke,

  • CerebrovascularDisease,

  • ExecessiveDaytimeSleepness.

  • OphthalmologicComplications

  • Glaucoma,

  • Nonarteriticanteriorischemicopticneuropathy,

  • Visualfielddefects,

  • Papilledema,

  • Centralserouschorioretinopathy,

  • Floppyeyelidsyndrome.


Ouas da n ropsikiyatrik sonu lar

OUAS da Nöropsikiyatrik Sonuçlar

  • Morningheadache

  • Sleepfragmentionanddeprivation

  • İnsomnia

  • ExcessiveDaytimeSleepness,

  • Fatigiue

  • Badworkingperformance,

  • Mooddisorders,

  • CognitiveFunctionsİmpairment

  • CerebrovascularDisease,

  • Stroke


Working memory

Working Memory


E xecutive functions

Executivefunctions

  • Executivefunctionsarecognitive control processes that include;

  • Flexibility in problem solving,

  • Planning,

  • Response inhibition,

  • Allocationof attention,

  • Maintenance and manipulation of informationover time,

  • Self-regulation of goal-directed behavior

  • Fuster JM. Executive frontal functions. Exp Brain Res 133: 66–70, 2000.

  • Elliott R. Executive functions and their disorders. Br Med Bull 65: 49–59,2003..


Osas related organ system complications neurologic and ophthalmologic

BeebeD.W.,Gozal D. J. Sleep Res.2002;11, 1-16


Osas related organ system complications neurologic and ophthalmologic

Jet Lag

Shift Work

DSPS

ASPS

İrreguar

sleep-wake

Patern

Narcolepsy

Focal leison

Klein-Levin

Prader-Willi

Miyotonik Distrofi

Ensefalit

İMSS Hypersomnia

Serebral Palsy

Head İnjury

Serebral Radyoterapy

Methabolic Disorders

Endocrine Disorders

Neurologic Disorders

Systhemic

Disorders

Circadien

rythim

Disorders

Excessive Daytime Sleepness

Sleep

Fragmentation

Drugs

Light

OUAS

UARS

PLMS

Drugs

Pshyiatric

Disorders

Sleep deprivation

Şizofreni

Seasonal

Affective Disorders

Social factors

Circadien rythim Disorders

Drugs


Working memory1

Working Memory


Cognitive functions in osas

Cognitive Functions in OSAS

  • Workingmemoryspeed in OSDB was significantly slower than in healthy subjects,

  • A group average map showed absence of dorsolateral prefrontalactivation, regardless of nocturnal hypoxia.

  • ThomasR.J., et all.Functional imaging of working memory in obstructivesleep-disorderedbreathing.J ApplPhysiol 2005; 98:2226-2234.


Cognitive functions in osas1

Cognitive Functions in OSAS

  • After treatment, resolutionof subjective sleepiness,

  • Contrasted with no significant change inbehavioral performance,

  • Persistent lack of prefrontal activation,

  • Partial recovery of posterior parietal activation.

  • ThomasR.J., et all.Functional imaging of working memory in obstructivesleep-disorderedbreathing.J ApplPhysiol 2005; 98:2226-2234.


Cognitive functions in osas2

Cognitive Functions in OSAS

  • These findings suggestthat working memory may be impaired in OSDB,

  • Thisimpairment is associated with disproportionate impairment of functionin the dorsolateral prefrontal cortex.

  • Nocturnal hypoxia may notbe a necessary determinant of cognitive dysfunction,

  • Sleep fragmentationmay be sufficient.

  • ThomasR.J., et all.Functional imaging of working memory in obstructivesleep-disorderedbreathing.J ApplPhysiol 2005; 98:2226-2234.


Osas related organ system complications neurologic and ophthalmologic

OSAS da Histogram

(Pre and Post CPAP)

Sleep fragmentation

In OSAS, pre CPAP Histogram

In OSAS, post CPAP Histogram


Cognitive functions in osas3

Cognitive Functions in OSAS

  • There may be dissociations betweenrespiratory vs. cortical recovery and objective vs.subjective recovery.

  • Hypofrontality may provide a plausible biological mechanism for aclinical overlap with disorders of mood and attention.

  • ThomasR.J., et all.Functional imaging of working memory in obstructive sleep-disordered breathing.J Appl Physiol 2005; 98:2226-2234.


Cognitive functions in osas4

Cognitive Functions in OSAS

  • Theydemonstrateabsentdorsolaterallateralprefrontalactivationin OSDB patients performing a working memory taskregardless of the presence of nocturnal hypoxia.

  • After positiveairway pressure therapy, there was a complete subjectiveclinical recovery but activation remained impaired.

  • ThomasR.J., et all.Functional imaging of working memory in obstructivesleep-disorderedbreathing.J ApplPhysiol 2005; 98:2226-2234.


Cognitive functions in sleep d eprivation

Cognitive Functions in SleepDeprivation

  • After sleep deprivation, subjects demonstrate impaired executive control,such as ;

  • Increased rate of forgetting,

  • Slow responses tosimple mathematical calculations,

  • False responses during avigilance task .

  • It is thus possible that impaired workingmemory is animportant abnormality in pathological sleepystates including obstructive sleep-disordered breathing (OSDB) or narcolepsy.

  • Van Dongen HP, et all.Sleep 26: 117–126, 2003.


Sleep fragmentation in osas

Sleep Fragmentation in OSAS

  • Experimentalauditorysleepfragmentation, which can be induced by using ,

  • Anauditory stimulus to disrupt sleep,

  • Sleepiness,

  • Impairs mood,

  • Decreasesmental flexibility,

  • Decreases sustained attention,

  • Martin SE, et all.The effect ofsleep fragmentation on daytime function. Am J RespirCrit Care Med 153: 1328–1332, 1996.


Cognitive function and behavior of children with adenotonsillar hypertrophy

Cognitive Function and Behavior of Children With Adenotonsillar Hypertrophy.

  • Childrenwithadenotonsillarhypertrophy who are suspected of having OSDB, nightly

  • snoring, higher AHI values,

  • High sleep efficiencies,

  • Short sleep latencies (in the sleep laboratory)

  • Predictimpaired cognitive performance, especially with;generalverbal, abstract reasoning, and verbal memory tasks.

  • Thedegree of impairment of intellectual function in particularwas profound

  • Suratt P.M.etall. Suspected of Having Obstructive Sleep-Disordered BreathingCognitive Function and Behavior of Children With AdenotonsillarHypertrophy. Pediatrics 2007;119;320-329


Cognitive function of preschoolers children

Cognitive Function of PreschoolersChildren

  • Thesleep-disorderedbreathingmay be associatedwithimpairedexecutivefunction in preschoolers,

  • Itsstrongestimpact on theinhibitiondimension,

  • Furtheremphasizingtheimportance of earlyinterventionforsleep-disorderedbreathing in thisearlyage.


Sdb and cognition in older women

SDB and Cognition in older women

  • SDB is an important risk factor for cognitive impairment in older women,

  • Especially those with the APOE epsilon4 allele.

  • Mechanisms linking these disorders need to be identified.

  • Spira AP.et all SDB and cognition in older women. J Am Geriatr Soc. 2008;56(1):45-50.


Cognitive dysfunction and osa in children

Cognitive dysfunction, and OSA in Children

  • APOE epsilon4 allele is morefrequent in childrenwithobstructivesleepapnea,

  • Particularly in thosewhodevelopneurocognitivedeficits,

  • Suggestingthatthe APOE epsilon4 allele is associatedwith not onlyincreasedodds of havingsleep-disorderedbreathing,

  • But alsowith an increased risk forneurocognitivedysfunction.

  • Gozal D. et all.APOE epsilon 4 allele, cognitivedysfunction, andobstructivesleepapnea in children. Neurology. 2007 Jul 17;69(3):243-9


Truck drivers in hypersomnolence

Truck Drivers in Hypersomnolence

  • Three hundred male truck drivers were studied.

  • The mean daily sleep duration was 5.6+/-1.3 h, and poor quality of sleep was found in 46.3% of the individuals.

  • Hypersomnolence was found in 46% of the drivers and was associated with younger age, snoring, and working >10 h without rest.

  • A positive correlation between hypersomnolence and previous accidents was detected (p=0.005).


Cognitive dysfunction and osa in children1

Cognitive Dysfunction and OSA in Children

  • Childrenscheduledforadenotonsillectomyoftenhavemild-to-moderate SDB andsignificantneurobehavioralmorbidity, includinghyperactivity, inattention, attention-deficit/hyperactivitydisorder, andexcessivedaytimesleepiness, all of whichtendtoimproveby 1 yearaftersurgery.

  • However, thelack of bettercorrespondencebetween SDB measuresandneurobehavioraloutcomessuggeststheneedforbettermeasuresorimprovedunderstanding of underlyingcausalmechanisms.

    Chervin RD, et all.Sleep-disorderedbreathing, behavior, andcognition in childrenbeforeandafteradenotonsillectomy. Pediatrics. 2006 Apr;117(4):e769-78.


Cognitive dysfunction and osa in children2

Cognitive Dysfunction and OSA in Children

  • On theneuropsychologyassessmentbattery (NEPSY), childrenwith SDB scoredsignificantlylowerthanthecontrolgroup on ,

  • Theattention/executivefunction domain and

  • Twosubtestswithinthat domain,

  • Onemeasuringvisualattention ,

  • Theotherexecutivefunction.

  • Inaddition, childrenwith SDB scoredsignificantlylowerthanthecontrols on onesubtestfromthe NEPSY language domain: PhonologicalProcessing.

  • O'BrienLM, etall .Neurobehavioralcorrelates of sleep-disorderedbreathing in children.J SleepRes. 2004 Jun;13(2):165-72.


Cognitive dysfunction and osa in children3

Cognitive Dysfunction and OSA in Children

  • (devam)

  • Childrenwith SDB weresignificantlysleepierthancontrols.

  • Furthermore, total arousalindexwasnegativelycorrelatedwithneurocognitiveabilities,

  • Suggestinga role forsleepfragmentation in pediatric SDB-inducedcognitivedysfunction

  • O'Brien LM, etall .Neurobehavioralcorrelates of sleep-disorderedbreathing in children.J SleepRes. 2004 ;13(2):165-72.


Cognitive changes and sleep disordered breathing in elderly

Cognitive changes and sleep disordered breathing in elderly

  • Decliningcognitivefunction in olderpersonswithmildtomoderate SDB is relatedtotheamount of respiratorydisturbancesoccurring at night,

  • Suggestthattheeffect of SDB on cognitivedecline is unrelatedtoraceandmeasuredhypoxemia.

  • Thelargenumber of community-dwellingelderlywithmildtomoderate SDB mayaccrueconsiderablebenefits (bothcognitivelyandmedically) fromthetreatment of SDB,

  • iftheyare not markedlyhypoxemic.

  • Cohen-Zion M. et all.Cognitivechangesandsleepdisorderedbreathing in elderly: differences in race. J PsychosomRes. 2004 ;56(5):549-53.


Effect of cpap treatment on cognitive function in osas

Effect of CPAP Treatment on Cognitive Function in OSAS

  • It is concludedthat in patientswith severe OSA, CPAP treatmentresults in a significantearlyimprovement in cognitivefunction but not in emotionalstatus.

  • Borak J, et all.Effects of CPAP treatment on psychologicalstatus in patientswith severe obstructivesleepapnoea. J SleepRes. 1996;5(2):123-7


In osas cognitive functions

In OSAS Cognitive Functions

  • OUAS lılar, normal bireylerle karşılaştırıldığında,hareketi (motor fonksiyon) başlatma ve bitirmede daha yavaş kalmakta.

  • İnhibituvar motor kontrol eksekutif bir fonksiyondur, oksihemoglobin desaturasyonuna bağlı gelişir.

  • P. Sagaspe et al. Inhibitory motor control in apneic and insomniac patients.J.Sleep Res.2007;16 :381–387


In osas cognitive functions1

In OSAS Cognitive Functions

  • Motor inhibisyon fonksiyonu, bozulduğunda bireyde trafik yada iş kazası yapma riski artar.

  • OUAS olan bireylerin kaza yapma risklerini artıran faktörlerden biriside bu fonksiyonun bozuk olmasıdır.

  • P. Sagaspe et al. Inhibitory motor control in apneic and insomniac patients.J.Sleep Res.2007;16 :381–387


Osas cpap treatment and cognitive functions

OSAS ,CPAP treatment and Cognitive Functions

  • CPAP treatmenteffect on cognitivefunctions;

  • Afterlongterm CPAP treatment, attention,visiuallearningand motor skillsimprove,

  • But anyimprovmentwas not seenexecutivefunctions.

  • Ferini-StrambiL. et all. Cognitive dysfunction in patients with obstructive sleep apnea (OSA): partial reversibility after continuous positive airway pressure (CPAP)Brain Research Bulletin, 2003; 61 : 87-92


In osas brain structural changes

In OSAS, Brain Structural Changes

  • In OSAS, disease especially effects WM.

  • Lymbic system, pons, frontal, temporal and parietal cortexs and cerebellum(in and out neural patway)

  • Macey et al.Brain Structure in OSA— Sleep, 2008;31(7):967-977


In osas brain structural changes1

In OSAS, Brain Structural Changes

  • In OSAS,neurobehavioral and pshycologic impairments belong to neural fiber destructions.

  • Hypoxia, oxidative stress, choronic inflammation, small vessel disease and local ischemia play role this structural changes

  • Macey et al.Brain Structure in OSA— Sleep, 2008;31(7):967-977


Osas related organ system complications neurologic and ophthalmologic

CPons: caudal pons; MCP: middle cerebellar peduncle; CST: corticospinal tract.


In osas brain structural changes2

In OSAS, Brain Structural Changes

  • This pathologies would not be improved by conventional treatment methods and could be permenant.

  • Because of then,in OSAS,treatment modalities have to be preventive treatment options.

  • Macey et al.Brain Structure in OSA— Sleep, 2008;31(7):967-977


O s a s c ogniti ve function and brain

OSAS, Cognitive functionandBrain

Figure 2. Significant hypometabolism (P < 0.005 uncorrected for multiple comparisonsfor voxels and P-corrected <0.05 forclusters) in the apneic group compared withcontrols, as shown by superimposition ontoaxial slices of the customized template (righthemisphere corresponds to the right side of figure).

K. Yaouhi et al.Cognitive and brain imaging study of OSA patients.J. Sleep Res. 2009;18, 36–48


O s a s c ogniti ve function and brain1

OSAS, Cognitive FunctionandBrain

  • In elderly OSAS patients, cognitive impairments are shown very early.

  • In young patients have severe OSAS,that they compansate, cognitive impairment is not happened.

  • Alchanatis et al., 2008


O s a s c ogniti ve function and brain2

OSAS, Cognitive FunctionandBrain

  • There is very important amount regional gray matter loss in OSAS patients.

  • Frontal ,temporo–parieto–occipital cortex, thalamus, basal ganglions and cerebellar region

  • Hypometabolism restrict more than GM density changes.

  • These evidence prefrontal cortex, precuneus, parieto–occipital cotex and cingulate gyrus (mid and posterior regions) are seen.

K. Yaouhi et al.Cognitive and brain imaging study of OSA patients.J. Sleep Res. 2009;18, 36–48


Osas related organ system complications neurologic and ophthalmologic

(a) Regional gray matter loss in OSAS patients. (b) Task-related activation in OSAS patients.

1 = left anterior cingulate cortex, 2 = posterior lateral parietal cortex, 3 = inferior temporal gyrus, 4 = parahippocampal gyrus, 5 = right quadrangular lobule, 6 = left hippocam-6 = left hippocam-pus, 7 = dorsolateral prefrontal cortex, 8 = inferior/middle frontal, 9 = thalamus, 10 = cingulate gyrus, 11 = cerebellum.*BOLD Blood oxygen level dependent

Desseilles et al. Functional Brain Imaging in Sleep Disorders.Sleep 2008;31(6):777-794.


Sleep and c erebral blood flow

Sleepand Cerebral blood flow

  • Sleep-related breathing disorders are strongly

    associated with increased risk of stroke independent ofknown risk factors. .

  • The mechanisms underlying this increasedrisk of stroke are multifactorial and include reductionin cerebral blood flow, altered cerebral autoregulation, andincreased platelet aggregation and plasma fibrinogen level.

  • Mohsenin V. Stroke and Sleep Apnea,Stroke 2001;32;1271-1278


Sleep and c erebral blood flow1

Sleepand Cerebral blood flow

  • Doppler USG,133Xe inhalation, Single-photon emission CT;have shown

  • 5% to 28% reduction in cerebral blood flow during non–rapideye movement (Non-REM) sleep,

  • 4% to 41% increase in REMsleep,

  • Compared with wakefulness in normal persons.

  • Mohsenin V. Stroke and Sleep Apnea,Stroke 2001;32;1271-1278


Sleep and c erebral blood flow2

Sleepand Cerebral blood flow

  • Changes in cerebral blood flow parallel changes in the brainmetabolic rate and oxygenconsumption in both non-REMand REM sleep.

  • Madsen PL.ActaNeurol Scand Suppl. 1993;148:3–27.

  • These changes in cerebral blood flow areindependent of extracerebral hemodynamic factors

  • Lenzi P, et all.Cerebralbloodflowregulationin REM sleep: a model for flow-metabolism coupling. Arch ItalBiol. 1999;137:165–179.


Sleep and c erebral blood flow3

Sleep and Cerebral blood flow

  • Several cross-sectional studies have demonstrated an agerelatedreduction in regional cerebral blood flow in the rangeof 20% to 24% in normal aging individuals.

  • This reduction in regional blood flow has been attributed toage-related brain atrophy and increased cerebral vascular resistance secondary to cerebral arteriosclerosis.

  • Naritomi H, Arch Neurol.1979;36:410–416.

  • Melamed E,Stroke. 1980;11:31–35.


Stroke transiet ischemic attack and osas

Stroke, Transiet Ischemic Attack and OSAS

  • In a larger study of 128 patients with transient ischemicattack and stroke, Bassetti and Aldrich25 found obstructive sleepapnea in 62.5% of the patients compared with 12.5% in thenormal control group.

  • They observed a high frequency ofobstructive sleep apnea disorder in patients with transient ischemicattack, suggesting preexisting obstructive sleep apnea disorderbefore cerebrovascular events rather than as a consequenceof it.

  • This latter observation strongly supports the role of sleep apnea as an independent risk factor for cerebrovascular accident

  • Bassetti C, Aldrich MS. Sleep apnea in acute cerebrovascular diseases: final report on 128 patients. Sleep 1999; 22: 217-223.


Stroke transiet ischemic attack and osas1

Stroke, Transiet Ischemic Attack and OSAS

  • Taken together, the combination ofcerebral hypoperfusion and hypercoagulability in sleep apneadisorder is possibly the mainpathophysiological mechanismfor increased risk of stroke in this population.

  • The mechanisms underlying this increasedrisk of stroke are multifactorial and include reductionin cerebral blood flow, altered cerebral autoregulation, andincreased platelet aggregation and plasma fibrinogen level.

  • Mohsenin V. Stroke and Sleep Apnea, Stroke 2001;32;1271-1278


Osas related organ system complications neurologic and ophthalmologic

Valham F.et all.Circulation 2008;118;955-960;


Osas related organ system complications neurologic and ophthalmologic

Table 3. Predictors of Stroke

Unadjusted HR (95% CI) P Adjusted HR (95% CI)* P

Apnea-hypopnea index < 5 1 1

Apnea-hypopnea index ≥5 3.92 (1.90–8.11) 0.001 2.89 (1.37–6.09) 0.005

Age, y 1.07 (1.02–1.12) 0.006 1.07 (1.02–1.13) 0.010

Body mass index, kg/m2 1.05 (0.97–1.13) 0.2471.04 (0.96–1.14) 0.340

Male gender 2.18 (1.05–4.50) 0.036 2.90 (1.27–6.58) 0.011

Left ventricular function

Good 1 1

Fair 2.41 (1.30–4.47) 0.005 2.00 (1.04–3.83) 0.038

Poor 4.86 (1.86–12.7) 0.001 6.65 (2.37–18.7) 0.001

Coronary artery intervention 1.30 (0.61–2.79) 0.496 0.76 (0.33–1.77) 0.525

Diabetes mellitus 2.90 (1.55–5.42) 0.001 1.86 (0.94–3.71) 0.076

Hypertension 1.95 (1.10–3.45) 0.023 1.88 (1.01–3.51) 0.047

Previous stroke/TIA 1.72 (0.53–5.54)0.364 1.40 (0.40–4.87)0.602

Atrial fibrillation 2.11 (0.51–8.68) 0.303 2.19 (0.48–10.1) 0.314

Current smoking 0.84 (0.41–1.74) 0.639 1.25 (0.57–2.70) 0.578

TIA indicates transient ischemic attack.

*Adjusted for apnea-hypopnea index 5, age, body mass index, gender, left ventricular function,

coronary artery intervention, diabetes mellitus, hypertension, previous stroke/TIA, atrial fibrillation, and current smoking Valham F. et all.Circulation 2008;118;955-960;


Osas r isk of s troke or d eath

OSAS, Risk of Stroke or Death

  • The obstructive sleep apnea syndrome significantly increases the risk of stroke or

    death from any cause,

  • The increase is independent of other risk factors, including hypertension.

  • Yaggi H.K et all. N Engl J Med 2005;353:2034-41.


Osas related organ system complications neurologic and ophthalmologic

OSAS, Risk of Stroke or Death

Yaggi H.K et all. N Engl J Med 2005;353:2034-41.


Osas related organ system complications neurologic and ophthalmologic

OSAS, Risk of Stroke or Death

Yaggi H.K et all. N Engl J Med 2005;353:2034-41.


Osas and stroke

OSAS and Stroke

  • Sabah inme oluşmasında yatkınlık sağlayan alta yatan mekanizma, sabah uyanıldığında serebral damarların vasomotor reaktivite yetmezliğidir.

  • Çok parçalanmış uyku ve karbondioksit retensiyonun fazlalığı, sabah hiperkapnik vasomotor yanıtın bozulmasına neden olur.

  • Qureshi AI, Winter WC, Bliwise DL. Sleep fragmentation and morning cerebrovasomotor reactivity to hypercapnia.AM J RESPIR CRIT CARE MED 1999;160:1244–1247.


Osas and stroke1

OSAS and Stroke

  • Parçalanmış uykunun, karbondioksit retansiyonuna göre iki kat daha fazla olumsuz etkiye sahip olduğu gösterilmiştir.

  • Sonuçda, uyku kaybı ve uyku parçalanması , hiperkapnik ventilatuvar cevabın baskılanması ile birliktedir.

  • Qureshi AI, Winter WC, Bliwise DL. Sleep fragmentation and morning cerebrovasomotor reactivity to hypercapnia.AM J RESPIR CRIT CARE MED 1999;160:1244–1247.


Osas and stroke2

OSAS and Stroke

  • Death after Stroke attack, ıf there is SDB which is bad prognostic factor

  • Parra O. ,Eur Respir J 2004; 24: 267–272.

  • Stroke is important risk factor for OSAS patient with coronary artery disease

  • Valham F et all.Circulation 2008;118;955-960;

  • CSA and stroke is frequent. This releated to hypocapni and left ventricular systemic function impairment.

  • Nopmaneejumruslers, Kaneko, Hajek, et al.: Cheyne-Stokes Respiration in Stroke.Am J Respir Crit Care Med 2005; 171:1048–1052


Sleep disorders and stroke

Sleep Disorders and Stroke

  • SDB and Sleep-wake disorders affect the outcome ofstroke.

  • It can be realized to choose treatment options

  • Herman DM, Bassetti CL.Sleep-related breathing and sleep-wake disturbances in ischemic stroke. Neurology. 2009 Oct 20;73(16):1313-22.


Osas related organ system complications neurologic and ophthalmologic

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Sdb and stroke

SDB and Stroke

  • In atients with Moderate and Severe SDB, National Institute of Health Stroke Scala(NIHSS) Score,is higher than Mild SDB .

  • Severe SDB increase, ischemic stroke ve transiet iscemic attack frequencies.

  • After ischemic stroke,it affects the outcome of diseases .

  • Rola R.Sleep related breathing disorders in patients with ischemic stroke and transient ischemic attacks: respiratory and clinical correlations. J Physiol Pharmacol. 2007 Nov;58 Suppl 5(Pt 2):575-82.


Osas related organ system complications neurologic and ophthalmologic

Rola R. J Physiol Pharmacol. 2007;58(Suppl 5)575-82


Osas related organ system complications neurologic and ophthalmologic

Rola R. J Physiol Pharmacol. 2007;58 Suppl 5575-82.


Osas and stroke3

OSAS and Stroke

  • OSAS AHI>15, CSAS AHI>15

  • All patients were followed up prospectivelyfor a mean (SD) of 10.0 (0.6) years, with death asthe primary outcome; no one was lost to follow-up.

  • Of 132 enrolled patients, 116 had died at followup.

  • Patients with stroke and obstructive sleepapnea have an increased risk of early death.

  • Central sleepapnea was not related to early death among the present patients.

  • Sahlin C .et all. OSA is a risk factor for death in patients with stroke; Arch Intern Med.2008;168(3):297-301


In osas ophthalmologic complications

In OSAS Ophthalmologic Complications

  • OphthalmologicComplications

  • Glaucoma,

  • Nonarteriticanteriorischemicopticneuropathy,

  • Visualfielddefects,

  • Papilledema,

  • Centralserouschorioretinopathy,

  • Floppyeyelidsyndrome.

  • Dhillon et all. Sleep-disorderedbreathingandeffects on ocular health.Can J Ophthalmol. 2007;42:238-43,

  • NietoEnriquez J. et all.[Ocular disease in sleepapneasyndrome] MedClin (Barc). 2009 Oct 24;133(15):594-8.


In osas ophthalmologic complications1

In OSAS Ophthalmologic Complications

  • The sleep apnoea syndrome is correlated with a proportional decrease in the RNFL.

  • Decreased ocular perfusion related to hypoxia and vasospasm associated with OSAS .

  • OSAS may cause RNFL thinning, which may precede clinically detectable glaucoma.

  • Kargi SH,et all Retinal nerve fibre layer measurements are reduced in patients with obstructive sleep apnoea syndrome. Eye (Lond). 2005 ;19 :575-9.


In osas ophthalmologic complications2

In OSAS Ophthalmologic Complications

  • SDB and concomitant ophthalmologic complications is very important to awerness and prevent ophthalmologic health

  • Dhillon S.et all.Sleep-disordered breathing and effects on ocular health.Can.J Ophthalmol.2007;42:238-43


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