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Thalamic connectivity in patients with sleep-disordered breathing (SDB) after stroke
Get PDFBackground : Thalamus-cortical connections are essential for normal sleep1. Stroke can alter this circuit affecting also breathing during sleep2.
Aim: To compare the functional connectivity of ventral-postero-lateral thalamic nucleous (VPL-TN) in stroke patients affected by SDB (S-SDB) as respect to stroke cases not affected (S) and to healthy controls (HC).
Methods: stroke patients were submitted to clinical, neuroradiological and full nocturnal polysomnography (PSG) monitoring. Conventional and functional MR exams during resting state (rs-fMRI) were performed in a single session (3 Tesla Siemens-Verio) in 12 stroke patients and in 11 HCs. Statistical analysis of rs-fMRI connectivity was performed using the FMRIB software package. A seed analysis approach was performed using VPL-TN as region of interest. Significant difference in rs-fMRI connectivity among the groups (S-SDB, S, HC) was set at p < 0.05.
Results: six stroke patients out of 12 had a SDB. No differences were found between S and S-SDB groups as to risk profile and PSG data (Tab.1). rs-fMRI connectivity analysis indicated that precuneus (PreCu) and brainstem (BS) were significantly more connected with VPL-TN in S-SDB as respect to HC. When comparing S-SDB to S patients, a further significantly higher connectivity with anterior cingulate cortex (ACC) was revealed (Fig. 1-2).
Conclusions: A higher connectivity between VPL-TN and regions involved also in modulating chemosensitivity (ACC and BS)3, 4 or alertness (PreCu)5 was observed during wake in S-SDB as respect to S patients. These preliminary data support the hypothesis that stroke may cause an SDB as the consequence of an altered sleep-wake circuitBackground : Thalamus-cortical connections are essential for normal sleep1. Stroke can alter this circuit affecting also breathing during sleep2.
Aim: To compare the functional connectivity of ventral-postero-lateral thalamic nucleous (VPL-TN) in stroke patients affected by SDB (S-SDB) as respect to stroke cases not affected (S) and to healthy controls (HC).
Methods: stroke patients were submitted to clinical, neuroradiological and full nocturnal polysomnography (PSG) monitoring. Conventional and functional MR exams during resting state (rs-fMRI) were performed in a single session (3 Tesla Siemens-Verio) in 12 stroke patients and in 11 HCs. Statistical analysis of rs-fMRI connectivity was performed using the FMRIB software package. A seed analysis approach was performed using VPL-TN as region of interest. Significant difference in rs-fMRI connectivity among the groups (S-SDB, S, HC) was set at p < 0.05.
Results: six stroke patients out of 12 had a SDB. No differences were found between S and S-SDB groups as to risk profile and PSG data (Tab.1). rs-fMRI connectivity analysis indicated that precuneus (PreCu) and brainstem (BS) were significantly more connected with VPL-TN in S-SDB as respect to HC. When comparing S-SDB to S patients, a further significantly higher connectivity with anterior cingulate cortex (ACC) was revealed (Fig. 1-2).
Conclusions: A higher connectivity between VPL-TN and regions involved also in modulating chemosensitivity (ACC and BS)3, 4 or alertness (PreCu)5 was observed during wake in S-SDB as respect to S patients. These preliminary data support the hypothesis that stroke may cause an SDB as the consequence of an altered sleep-wake circui
Types of stroke recurrence in patients with ischemic stroke: a substudy from the PRoFESS trial.
No full textBackground Risk profiles for stroke recurrence are poorly characterized.
Aims We determined the variation in the risk and type of recurrent stroke among index ischemic stroke subtypes, and whether index stroke subtype and conventional stroke risk factors were predictors of stroke recurrence.
Methods Patients enrolled in the Prevention Regimen for Effectively Avoiding Second Strokes trial were included in this study.
Results In 1794 patients' recurrent stroke subtypes were the same as the index stroke in: 48 center dot 3% of patients with large artery atherothrombosis stroke; 50% of patients with cardioembolic stroke; 48 center dot 7% of patients with small artery occlusion stroke; 8 center dot 1% of patients with stroke of other etiology, and 45 center dot 3% of patients with undetermined etiology stroke. Patients with cardioembolic stroke, who were unwilling or unable to take oral anticoagulants, had the greatest risk of stroke recurrence. Predictors of stroke recurrence in multivariable analysis were: older age and previous stroke among large artery atherothrombosis strokes; older age, male sex, previous stroke, previous transient ischemic attack, hypertension, diabetes, and tobacco use among small artery occlusion strokes; older age among cardioembolic strokes; atrial fibrillation and anti-diabetic medications among other etiology strokes; older age, previous stroke and atrial fibrillation among undetermined etiology strokes. Predictors of brain hemorrhage as recurrent stroke were index small artery occlusion stroke, older age, previous stroke, and antiplatelet treatment with aspirin plus extended-release dipyridamole.
Conclusions Risk predictors for stroke recurrence and for brain hemorrhage differ by index ischemic stroke subtype, information that is important when initiating secondary prevention therapy
Post stroke sleep apnea hypopnea syndrome: a series of 12 consecutive stable stroke cases
No full textOBJECTIVES: Sleep Disordered Breathing (SDB) is a negative prognostic factor for stroke patients. In order to reveal: (1) the frequency of Sleep Apnea-Hypopnea Syndrome (SANS) in the stable phase of the illness; (2) the type of SAHS, either obstructive (OSAHS) or central (CSAHS); (3) the possible association between SAHS and daily sleepiness, cardiac arrhythmias, stroke/TIA recurrence and location of the brain lesion, an observational study is on-going at Sapienza- University of Rome. We report here the results of cases included in the feasibility study. PATIENTS AND METHODS: clinical evaluations, brain images and polisomnographic study were performed at discharge and after 4 and 9 months of stroke. RESULTS: Eleven out of the 12 patients included (91.6%) had an Apnea/Hypopnea Index-AM >= 5. In 5 cases, the majority of total respiratory events were purely central in origin. In 3 of these 5 cases, a concomitant obstruction of the upper airways was revealed; the 2 remaining had risk factors for OSAHS (smoke, hypertension, BMI > 25). A significant association was found between central apnea/hypopnea events and cardiac arrhythmias (p value 0.017). CONCLUSIONS: These findings confirm the high prevalence of SDB, either obstructive or/and central, even in the stable phase of the illness, which - in those patients who had accumulated risk factors for OSAHS - result in Complex-sleep apnea/hypopnea syndrome (CompSAHS). As patients with CompSAHS are left with very disrupted breathing on continuous positive airway pressure, in order to select cases with stable stroke who benefit from continuos-positive airway pressure (C-PAP) treatment, further and more detailed clinical studies are needed to better distinguish CompSAHS from mixed SAHS
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