Top

Published in:

01-07-2013 | Cardiovascular Disease and Stroke (D Leifer and JE Safdieh, Section Editors)

Stroke and Obstructive Sleep Apnea: A Review

Authors: Daniel A. Barone, Ana C. Krieger

Published in: Current Atherosclerosis Reports | Issue 7/2013

Abstract

Obstructive sleep apnea (OSA) has been found to be an independent risk factor for stroke in large epidemiological studies. The mechanisms underlying this relationship have been investigated over the past 2–3 decades, with a particular focus on identifying pathophysiological pathways and risk modification strategies. Despite the advancements made, the specific understanding of the implicated mechanisms is still limited. This brief review focuses on presenting some of the epidemiological evidence of the linkage between OSA and stroke, discussing mechanistic pathways and the potential effect of OSA treatment in modulating the risk for stroke in these patients. Future directions for research in this field are also discussed.

Guilleminault C, Tilkian A, Dement WC. The sleep apnea syndromes. Annu Rev Med. 1976;27:465–84.PubMedCrossRef

Sullivan CE, Issa FG. Pathophysiological mechanisms in obstructive sleep apnea. Sleep. 1980;3(3–4):235–46.PubMed

Fusetti M, Fioretti AB, Valenti M, Masedu F, Lauriello M, Pagliarella M. Cardiovascular and metabolic comorbidities in patients with obstructive sleep apnoea syndrome. Acta Otorhinolaryngol Ital. 2012;32(5):320–5.PubMed

Bixler EO, Vgontzas AN, Lin HM, Ten Have T, Rein J, Vela-Bueno A, et al. Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med. 2001;163(3 Pt 1):608–13.PubMedCrossRef

Sacco S, Peverini F, Bastianello S, De Leo G, Marini C, Carolei A. Severe oxygen desaturation in obstructive sleep-apnea syndrome as a possible cause of ischemic stroke. Eur Neurol. 2005;53(2):86–7.PubMedCrossRef

•• Loke YK, Brown JW, Kwok CS, Niruban A, Myint PK. Association of obstructive sleep apnea with risk of serious cardiovascular events: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2012;5(5):720–8. The authors present data from a meta-analysis of nine relevant prospective studies evaluating stroke and cardiovascular disease in sleep apnea. Their analysis demonstrated an overall odds ratio for incident stroke of 2.24 (1.57, 3.19 CI) among patients with sleep apnea. The risk was increased with worse severity of disease, as measured by the AHI.PubMedCrossRef

Godoy J, Mellado P, Tapia J, Santin J. Obstructive sleep apnea as an independent stroke risk factor: possible mechanisms. Curr Mol Med. 2009;9(2):203–9.PubMedCrossRef

Somers VK, Dyken ME, Clary MP, Abboud FM. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest. 1995;96(4):1897–904.PubMedCrossRef

Patil SP, Schneider H, Schwartz AR, Smith PL. Adult obstructive sleep apnea: pathophysiology and diagnosis. Chest. 2007;132(1):325–37.PubMedCrossRef

10.

Hudgel DW. Mechanisms of obstructive sleep apnea. Chest. 1992;101(2):541–9.PubMedCrossRef

11.

Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353(19):2034–41.PubMedCrossRef

12.

Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Nieto FJ, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001;163(1):19–25.PubMedCrossRef

13.

Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA. 2000;283(14):1829–36.PubMedCrossRef

14.

Arzt M, Young T, Finn L, Skatrud JB, Bradley TD. Association of sleep-disordered breathing and the occurrence of stroke. Am J Respir Crit Care Med. 2005;172(11):1447–51.PubMedCrossRef

15.

Martinez-Garcia MA, Galiano-Blancart R, Roman-Sanchez P, Soler-Cataluna JJ, Cabero-Salt L, Salcedo-Maiques E. Continuous positive airway pressure treatment in sleep apnea prevents new vascular events after ischemic stroke. Chest. 2005;128(4):2123–9.PubMedCrossRef

16.

Fletcher EC. Cardiovascular effects of continuous positive airway pressure in obstructive sleep apnea. Sleep. 2000;15(23):S154–157.

17.

Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005;365(9464):1046–53.PubMed

18.

Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328(17):1230–5.PubMedCrossRef

19.

Iber C. ea: The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. 2007.

20.

Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, et al. Executive summary: heart disease and stroke statistics—2013 update: a report from the american heart association. Circulation. 2012;127(1):143–52.CrossRef

21.

Kushida CA, Efron B, Guilleminault C. A predictive morphometric model for the obstructive sleep apnea syndrome. Ann Intern Med. 1997;127(8 Pt 1):581–7.PubMedCrossRef

22.

Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284(23):3015–21.PubMedCrossRef

23.

Ferguson KAOT, Lowe AA, Ryan C, Fleetham JA. The Relationship Between Obesity And Craniofacial Structure In Obstructive Sleep Apnea. Chest. 1995;108(102):375–81.PubMedCrossRef

24.

Foster GD, Sanders MH, Millman R, Zammit G, Borradaile KE, Newman AB, et al. Obstructive sleep apnea among obese patients with type 2 diabetes. Diabetes Care. 2009;32(6):1017–9.PubMedCrossRef

25.

• Rice TB, Foster GD, Sanders MH, Unruh M, Reboussin D, Kuna ST, et al. The relationship between obstructive sleep apnea and self-reported stroke or coronary heart disease in overweight and obese adults with type 2 diabetes mellitus. Sleep. 2012;35(9):1293–8. This article reports data in 305 overweight or obese participants with type 2 diabetes evaluated by full polysomnography to determine the presence and severity of sleep apnea as part of an evaluation of the association of cardiovascular disease and stroke in this population. The study revealed that sleep apnea was associated with an increased odds ratio for stroke of 2.57 (1.03, 6.42 CI) after adjusting for confounding variables.PubMed

26.

Silverberg DS, Oksenberg A, Iaina A. Sleep-related breathing disorders as a major cause of essential hypertension: fact or fiction? Curr Opin Nephrol Hypertens. 1998;7(4):353–7.PubMedCrossRef

27.

Fletcher EC, DeBehnke RD, Lovoi MS, Gorin AB. Undiagnosed sleep apnea in patients with essential hypertension. Ann Intern Med. 1985;103(2):190–5.PubMedCrossRef

28.

Kales A, Bixler EO, Cadieux RJ, Schneck DW, Shaw 3rd LC, Locke TW, et al. Sleep apnoea in a hypertensive population. Lancet. 1984;2(8410):1005–8.PubMedCrossRef

29.

Lavie P, Ben-Yosef R, Rubin AE. Prevalence of sleep apnea syndrome among patients with essential hypertension. Am Heart J. 1984;108(2):373–6.PubMedCrossRef

30.

Williams AJ, Houston D, Finberg S, Lam C, Kinney JL, Santiago S. Sleep apnea syndrome and essential hypertension. Am J Cardiol. 1985;55(8):1019–22.PubMedCrossRef

31.

Somers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A, et al. Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing. J Am Coll Cardiol. 2008;52(8):686–717.PubMedCrossRef

32.

•• Redline S, Yenokyan G, Gottlieb DJ, Shahar E, O'Connor GT, Resnick HE, et al. Obstructive sleep apnea-hypopnea and incident stroke: the sleep heart health study. Am J Respir Crit Care Med. 2010;18(2):269–77. The authors present the results of one of the largest epidemiological studies in sleep apnea, the Sleep Heart Health Study. A total of 5,422 subjects with full overnight polysomnography were prospectively followed for a period of 8.7 years. In men, an increased odds ratio for stroke was seen in association with an AHI above 20 events /h, at 2.86 (1.1, 7.4 CI). An incremental risk for stroke was seen in men for each unit of increase in AHI. In women, stroke risk was elevated in association with an AHI above 25.CrossRef

33.

Society AT. Indications and standards for use of nasal continuous positive airway pressure (CPAP) in sleep apnea syndromes: American Thoracic Society: official statement adopted March 1994. Am J Respir Crit Care Med. 1994;150:1738–45.CrossRef

34.

Schulz R, Olschewski H, Grimminger F, Seeger W. Prevalence of stroke and transitory ischemic attacks in obstructive sleep apnea: a retrospective analysis of 187 consecutive patients. Pneumologie. 2000;54(12):575–9.PubMedCrossRef

35.

Nachtmann A, Stang A, Wang YM, Wondzinski E, Thilmann AF. Association of obstructive sleep apnea and stenotic artery disease in ischemic stroke patients. Atherosclerosis. 2003;169(2):301–7.PubMedCrossRef

36.

Valham F, Mooe T, Rabben T, Stenlund H, Wiklund U, Franklin KA. Increased risk of stroke in patients with coronary artery disease and sleep apnea: a 10-year follow-up. Circulation. 2008;118(9):955–60.PubMedCrossRef

37.

Romaniak A. Stepien A: [Sleep disorders as a risk factors for stroke]. Neurol Neurochir Pol. 2001;35(5):821–7.PubMed

38.

Ahn SH, Kim JH, Kim DU, Choo IS, Lee HJ, Kim HW. Interaction between Sleep-Disordered Breathing and Acute Ischemic Stroke. J Clin Neurol. 2013;9(1):9–13.PubMedCrossRef

39.

Medical Expenditure Panel Survey (MEPS) of the Agency for Healthcare Research and Quality (AHRQ). 2008.

40.

Levy P, Tamisier R, Launois S. Pepin JL: [Surviving sleep: when the heart and brain are damaged by apnea]. Bull Acad Natl Med. 2011;195(7):1611–28.PubMed

41.

Mohsenin V. Sleep-related breathing disorders and risk of stroke. Stroke. 2001;32(6):1271–8.PubMedCrossRef

42.

Shamsuzzaman AS, Gersh BJ, Somers VK. Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA. 2003;290(14):1906–14.PubMedCrossRef

43.

Netzer N, Werner P, Jochums I, Lehmann M, Strohl KP. Blood flow of the middle cerebral artery with sleep-disordered breathing: correlation with obstructive hypopneas. Stroke. 1998;29(1):87–93.PubMedCrossRef

44.

Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342(19):1378–84.PubMedCrossRef

45.

Lavie P, Herer P, Hoffstein V. Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study. BMJ. 2000;320(7233):479–82.PubMedCrossRef

46.

Davies CW, Crosby JH, Mullins RL, Barbour C, Davies RJ, Stradling JR. Case-control study of 24 hour ambulatory blood pressure in patients with obstructive sleep apnoea and normal matched control subjects. Thorax. 2000;55(9):736–40.PubMedCrossRef

47.

Tolle FA, Judy WV, Yu PL, Markand ON. Reduced stroke volume related to pleural pressure in obstructive sleep apnea. J Appl Physiol. 1983;55(6):1718–24.PubMed

48.

Yumino D, Kasai T, Kimmerly D, Amirthalingam V, Floras JS, Bradley TD. Differing effects of obstructive and central sleep apneas on stroke volume in patients with heart failure. Am J Respir Crit Care Med. 2013;187(4):433–8.PubMedCrossRef

49.

Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, et al. Heart disease and stroke statistics—2011 update: a report from the American Heart Association. Circulation. 2011;123(4):e18–e209.PubMedCrossRef

50.

Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22(8):983–8.PubMedCrossRef

51.

Lin HJ, Wolf PA, Kelly-Hayes M, Beiser AS, Kase CS, Benjamin EJ, et al. Stroke severity in atrial fibrillation. The Framingham Study. Stroke. 1996;27(10):1760–4.PubMedCrossRef

52.

Marini C, De Santis F, Sacco S, Russo T, Olivieri L, Totaro R, et al. Contribution of atrial fibrillation to incidence and outcome of ischemic stroke: results from a population-based study. Stroke. 2005;36(6):1115–9.PubMedCrossRef

53.

Rossi VA, Stradling JR, Kohler M. Effects of obstructive sleep apnoea on heart rhythm. Eur Respir J. 2012;2012:20.

54.

Ferro JM, Massaro AR, Mas JL. Aetiological diagnosis of ischaemic stroke in young adults. Lancet Neurol. 2010;9(11):1085–96.PubMedCrossRef

55.

• Ciccone A, Proserpio P, Roccatagliata DV, Nichelatti M, Gigli GL, Parati G, et al. Wake-up stroke and TIA due to paradoxical embolism during long obstructive sleep apnoeas: a cross-sectional study. Thorax. 2013;68(1):97–104. This article evaluates the potential for paradoxical embolism as an etiology for stroke in OSA. The authors present a prospective evaluation of 335 patients with acute stroke or TIA, in which 21 % had evidence of prolonged apneic episodes and right-to-left shunt. The adjusted odds ratio for stroke or TIA upon waking was elevated in this subset at 1.91 (1.08, 3.38 CI).PubMedCrossRef

56.

Beelke M, Angeli S, Del Sette M, De Carli F, Canovaro P, Nobili L, et al. Obstructive sleep apnea can be provocative for right-to-left shunting through a patent foramen ovale. Sleep. 2002;25(8):856–62.PubMed

57.

Lau EM, Yee BJ, Grunstein RR, Celermajer DS. Patent foramen ovale and obstructive sleep apnea: a new association? Sleep Med Rev. 2010;14(6):391–5.PubMedCrossRef

58.

Shiina K, Tomiyama H, Takata Y, Usui Y, Asano K, Hirayama Y, et al. Concurrent presence of metabolic syndrome in obstructive sleep apnea syndrome exacerbates the cardiovascular risk: a sleep clinic cohort study. Hypertens Res. 2006;29(6):433–41.PubMedCrossRef

59.

Lavie L. Obstructive sleep apnoea syndrome—an oxidative stress disorder. Sleep Med Rev. 2003;7(1):35–51.PubMedCrossRef

60.

Ip MS, Lam B, Chan LY, Zheng L, Tsang KW, Fung PC, et al. Circulating nitric oxide is suppressed in obstructive sleep apnea and is reversed by nasal continuous positive airway pressure. Am J Respir Crit Care Med. 2000;162(6):2166–71.PubMedCrossRef

61.

Drager LF, Bortolotto LA, Lorenzi MC, Figueiredo AC, Krieger EM, Lorenzi-Filho G. Early signs of atherosclerosis in obstructive sleep apnea. Am J Respir Crit Care Med. 2005;172(5):613–8.PubMedCrossRef

62.

Von Kanel R, Loredo JS, Ancoli-Israel S, Mills PJ, Natarajan L, Dimsdale JE. Association between polysomnographic measures of disrupted sleep and prothrombotic factors. Chest. 2007;131(3):733–9.CrossRef

63.

Dumitrascu R, Tiede H, Rosengarten B. Schulz R: [Obstructive sleep apnea and stroke]. Pneumologie. 2012;66(8):476–9.PubMedCrossRef

64.

Urbano F, Roux F, Schindler J, Mohsenin V. Impaired cerebral autoregulation in obstructive sleep apnea. J Appl Physiol. 2008;105(6):1852–7.PubMedCrossRef

65.

Nasr N, Traon AP, Czosnyka M, Tiberge M, Schmidt E, Larrue V. Cerebral autoregulation in patients with obstructive sleep apnea syndrome during wakefulness. Eur J Neurol. 2009;16(3):386–91.PubMedCrossRef

66.

Fletcher EC. Sympathetic over activity in the etiology of hypertension of obstructive sleep apnea. Sleep. 2003;26(1):15–9.PubMed

67.

Fletcher EC. Cardiovascular disease associated with obstructive sleep apnea. Monaldi Arch Chest Dis. 2003;59(3):254–61.PubMed

68.

Ward S, Ryan S, Mc Nicholas WT, Heneghan C. Comparison of baroreflex sensitivity measures for assessing subjects with obstructive sleep apnea. Conf Proc IEEE Eng Med Biol Soc. 2006;1:3572–5.PubMed

69.

Kasasbeh E, Chi DS, Krishnaswamy G. Inflammatory aspects of sleep apnea and their cardiovascular consequences. South Med J. 2006;99(1):58–67.PubMedCrossRef

70.

Lavie L. Sleep-disordered breathing and cerebrovascular disease: a mechanistic approach. Neurol Clin. 2005;23(4):1059–75.PubMedCrossRef

71.

Ryan S, Taylor CT, McNicholas WT. Selective activation of inflammatory pathways by intermittent hypoxia in obstructive sleep apnea syndrome. Circulation. 2005;112(17):2660–7.PubMedCrossRef

72.

Lavie L, Dyugovskaya L, Lavie P. Sleep-apnea-related intermittent hypoxia and atherogenesis: adhesion molecules and monocytes/endothelial cells interactions. Atherosclerosis. 2005;183(1):183–4. Epub 2005 Aug 1.; 2005.PubMedCrossRef

73.

Spiegel K, Knutson K, Leproult R, Tasali E, Van Cauter E. Sleep loss: a novel risk factor for insulin resistance and Type 2 diabetes. J Appl Physiol. 2005;99(5):2008–19.PubMedCrossRef

74.

Makino S, Handa H, Suzukawa K, Fujiwara M, Nakamura M, Muraoka S, et al. Obstructive sleep apnoea syndrome, plasma adiponectin levels, and insulin resistance. Clin Endocrinol. 2006;64(1):12–9.CrossRef

75.

Ip MS, Lam B, Ng MM, Lam WK, Tsang KW, Lam KS. Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med. 2002;165(5):670–6.PubMedCrossRef

76.

Punjabi NM, Polotsky VY. Disorders of glucose metabolism in sleep apnea. J Appl Physiol. 2005;99(5):1998–2007.PubMedCrossRef

77.

Punjabi NM, Shahar E, Redline S, Gottlieb DJ, Givelber R, Resnick HE. Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study. Am J Epidemiol. 2004;160(6):521–30.PubMedCrossRef

78.

Masserini B, Morpurgo PS, Donadio F, Baldessari C, Bossi R, Beck-Peccoz P, et al. Reduced levels of adiponectin in sleep apnea syndrome. J Endocrinol Invest. 2006;29(8):700–5.PubMed

79.

Ursavas A, Ilcol YO, Nalci N, Karadag M, Ege E. Ghrelin, leptin, adiponectin, and resistin levels in sleep apnea syndrome: Role of obesity. Ann Thorac Med. 2010;5(3):161–5.PubMedCrossRef

80.

Shepard Jr JW. Hypertension, cardiac arrhythmias, myocardial infarction, and stroke in relation to obstructive sleep apnea. Clin Chest Med. 1992;13(3):437–58.PubMed

81.

Reilly DF, Westgate EJ, FitzGerald GA. Peripheral circadian clocks in the vasculature. Arterioscler Thromb Vasc Biol. 2007;27(8):1694–705.PubMedCrossRef

82.

Tofler GH, Brezinski D, Schafer AI, Czeisler CA, Rutherford JD, Willich SN, et al. Concurrent morning increase in platelet aggregability and the risk of myocardial infarction and sudden cardiac death. N Engl J Med. 1987;316(24):1514–8.PubMedCrossRef

83.

Gami AS, Howard DE, Olson EJ, Somers VK. Day-night pattern of sudden death in obstructive sleep apnea. N Engl J Med. 2005;352(12):1206–14.PubMedCrossRef

84.

Guilleminault C, Connolly SJ, Winkle RA. Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome. Am J Cardiol. 1983;52(5):490–4.PubMedCrossRef

85.

Shepard Jr JW, Garrison MW, Grither DA, Dolan GF. Relationship of ventricular ectopy to oxyhemoglobin desaturation in patients with obstructive sleep apnea. Chest. 1985;88(3):335–40.PubMedCrossRef

86.

Zwillich C, Devlin T, White D, Douglas N, Weil J, Martin R. Bradycardia during sleep apnea. Characteristics and mechanism. J Clin Invest. 1982;69(6):1286–92.PubMedCrossRef

87.

Koehler U, Fus E, Grimm W, Pankow W, Schafer H, Stammnitz A, et al. Heart block in patients with obstructive sleep apnoea: pathogenetic factors and effects of treatment. Eur Respir J. 1998;11(2):434–9.PubMedCrossRef

88.

Somers VK. Sleep—a new cardiovascular frontier. N Engl J Med. 2005;353(19):2070–3.PubMedCrossRef

89.

Yokoe T, Minoguchi K, Matsuo H, Oda N, Minoguchi H, Yoshino G, et al. Elevated levels of C-reactive protein and interleukin-6 in patients with obstructive sleep apnea syndrome are decreased by nasal continuous positive airway pressure. Circulation. 2003;107(8):1129–34.PubMedCrossRef

90.

Harsch IA, Schahin SP, Bruckner K, Radespiel-Troger M, Fuchs FS, Hahn EG, et al. The effect of continuous positive airway pressure treatment on insulin sensitivity in patients with obstructive sleep apnoea syndrome and type 2 diabetes. Respiration. 2004;71(3):252–9.PubMedCrossRef

91.

Harbison J, O'Reilly P, McNicholas WT. Cardiac rhythm disturbances in the obstructive sleep apnea syndrome: effects of nasal continuous positive airway pressure therapy. Chest. 2000;118(3):591–5.PubMedCrossRef

92.

Pressman MR, Schetman WR, Figueroa WG, Van Uitert B, Caplan HJ, Peterson DD. Transient ischemic attacks and minor stroke during sleep. Relationship to obstructive sleep apnea syndrome. Stroke. 1995;26(12):2361–5.PubMedCrossRef

93.

Tikare SK, Chaudhary BA, Bandisode MS. Hypertension and stroke in a young man with obstructive sleep apnea syndrome. Postgrad Med. 1985;78(7):59–60.PubMed

94.

Disler P, Hansford A, Skelton J, Wright P, Kerr J, O'Reilly J, et al. Diagnosis and treatment of obstructive sleep apnea in a stroke rehabilitation unit: a feasibility study. Am J Phys Med Rehabil. 2002;81(8):622–5.PubMedCrossRef

95.

Parra-Ordaz O. The importance of treatment for breathing disorders during sleep in stroke patients. Rev Neurol. 2005;1(41):S35–37.

96.

Martinez-Garcia MA, Soler-Cataluna JJ, Ejarque-Martinez L, Soriano Y, Roman-Sanchez P, Illa FB, et al. Continuous positive airway pressure treatment reduces mortality in patients with ischemic stroke and obstructive sleep apnea: a 5-year follow-up study. Am J Respir Crit Care Med. 2009;180(1):36–41.PubMedCrossRef

97.

Ryan CM, Bayley M, Green R, Murray BJ, Bradley TD. Influence of continuous positive airway pressure on outcomes of rehabilitation in stroke patients with obstructive sleep apnea. Stroke. 2011;42(4):1062–7.PubMedCrossRef

98.

Tomfohr LM, Hemmen T, Natarajan L, Ancoli-Israel S, Loredo JS, Heaton RK, et al. Continuous positive airway pressure for treatment of obstructive sleep apnea in stroke survivors: what do we really know? Stroke. 2012;43(11):3118–23.PubMedCrossRef

99.

Padma A, Ramakrishnan N, Narayanan V. Management of obstructive sleep apnea: A dental perspective. Indian J Dent Res. 2007;18(4):201–9.PubMedCrossRef

100.

Li KK. Sleep apnea surgery: putting it all together. Oral Maxillofac Surg Clin North Am. 2009;21(4):421–3.PubMedCrossRef

Title: Stroke and Obstructive Sleep Apnea: A Review
Authors: Daniel A. Barone
Ana C. Krieger
Publication date: 01-07-2013
Publisher: Springer US
Published in: Current Atherosclerosis Reports / Issue 7/2013
Print ISSN: 1523-3804
Electronic ISSN: 1534-6242
DOI: https://doi.org/10.1007/s11883-013-0334-8

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits

Illustration of figure on mountain summit/© Orapun / Stock.adobe.com, STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 7/2013

Mineralocorticoid Receptors in Vascular Disease: Connecting Molecular Pathways to Clinical Implications

Prenotification and Other Factors Involved in Rapid tPA Administration

Use of Perfusion Imaging and Other Imaging Techniques to Assess Risks/Benefits of Acute Stroke Interventions

C-Peptide and Its Career from Innocent Bystander to Active Player in Diabetic Atherogenesis

Spinal Dural Arteriovenous Fistulas: A Review

Management of the Stroke Patient with Patent Foramen Ovale: New Insights and Persistent Questions in the Wake of Recent Randomized Trials

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage