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sleep apnea, brainstem stroke

Stephanie M Stahl, H Klar Yaggi, Stanley Taylor, Li Qin, Cristina S Ivan, Charles Austin, Jared Ferguson, Radu Radulescu, Lauren Tobias, Jason Sico, Carlos A Vaz Fragoso, Linda S Williams, Rachel Lampert, Edward J Miech, Marianne S Matthias, John Kapoor, Dawn M Bravata
BACKGROUND: The literature about the relationship between obstructive sleep apnea (OSA) and stroke location is conflicting with some studies finding an association and others demonstrating no relationship. Among acute ischemic stroke patients, we sought to examine the relationship between stroke location and the prevalence of OSA; OSA severity based on apnea-hypopnea index (AHI), arousal frequency, and measure of hypoxia; and number of central and obstructive respiratory events. METHODS: Data were obtained from patients who participated in a randomized controlled trial (NCT01446913) that evaluated the effectiveness of a strategy of diagnosing and treating OSA among patients with acute ischemic stroke and transient ischemic attack...
October 2015: Sleep Medicine
Devin L Brown, Mollie McDermott, Ashkan Mowla, Lindsey De Lott, Lewis B Morgenstern, Kevin A Kerber, Garnett Hegeman, Melinda A Smith, Nelda M Garcia, Ronald D Chervin, Lynda D Lisabeth
BACKGROUND: Association between cerebral infarction site and poststroke sleep-disordered breathing (SDB) has important implications for SDB screening and the pathophysiology of poststroke SDB. Within a large, population-based study, we assessed whether brainstem infarction location is associated with SDB presence and severity. METHODS: Cross-sectional study was conducted on ischemic stroke patients in the Brain Attack Surveillance in Corpus Christi (BASIC) project...
August 2014: Sleep Medicine
Josef G Heckmann, Stefan Ernst
Central alveolar hypoventilation (CAH) syndrome is a clinical condition that is characterized by the loss of automatic breathing, particularly during sleep. Most forms in adults are caused by brainstem ischemia, mass, infection, demyelinating disease, or anoxic-ischemic damage. We present a case of a fatal symptomatic acquired CAH syndrome caused by megadolichobasilar artery. A 62-year-old man with pre-existing vascular dementia suffered an acute posterior stroke. During stroke care, long episodes of hypopnea and apnea were observed which responded well to verbal reminders...
February 2014: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Michael Mendoza, Julius Gene Latorre
Ondine's curse is an eponym that refers to central alveolar apnea/hypopnea observed among patients with acquired or congenital brainstem disorders. This condition results in loss of automatic and/or voluntary respiration with characteristic polysomnographic finding of impaired ventilator responses to hypercapnia and sleep apnea, which are more pronounced during non-REM sleep, less in REM sleep, and least during wakefulness.
January 8, 2013: Neurology
Giorgio Silvestrelli, Alessia Lanari, Andrea Droghetti
Breathing is a primal homeostatic neural process, regulating levels of oxygen and carbon dioxide in blood and tissues, which are crucial for life. Rhythmic respiratory movements must occur continuously throughout life and originate from neural activity generated by specially organized macro- and microcircuits in the brainstem. In the respiratory network there is a spatial and dynamic hierarchy of interacting circuits, each of which controls different aspects of respiratory rhythm generation and pattern formation, which can be revealed as the network is progressively reduced...
2012: Frontiers of Neurology and Neuroscience
Martín A Nogués, Eduardo Benarroch
BACKGROUND: Control of ventilation depends on a brainstem neuronal network that controls activity of the motor neurons innervating the respiratory muscles. This network includes the pontine respiratory group and the dorsal and ventral respiratory groups in the medulla. Neurologic disorders affecting these areas or the respiratory motor unit may lead to abnormal breathing. REVIEW SUMMARY: The brainstem respiratory network contains neurons critical for respiratory rhythmogenesis; this network receives inputs from peripheral and central chemoreceptors sensitive to levels of carbon dioxide (PaCO2) and oxygen (PaO2) and from forebrain structures that control respiration as part of integrated behaviors such as speech or exercise...
September 2008: Neurologist
István Bernáth, Patrick McNamara, Nóra Szternák, Zoltán Szakács, Péter Köves, Attila Terray-Horváth, Zsuzsanna Vida
OBJECTIVE: To test the hypothesis that blood hyperviscosity could account for the controversial results observed during electrophysiological evaluation of the brain stem in sleep apnea syndrome. METHODS: This was a prospective study of a sample of patients with sleep apnea who were participating in a stroke prevention evaluation. Participants were 610 male patients with obstructive sleep apnea, aged 30-55 years, without large vessel disease on Magnetic Resonance Angiography and neck Doppler sonography, and an infratentorial lesion on head magnetic resonance imaging...
March 2009: Sleep Medicine
Dong Wang, Bo Zhang, Jin Shi, Bo Peng, Yi Liu, Zai-wen Fan, Ying Liu, He Gao, Shu-guo Ji
OBJECTIVE: To investigate nocturnal sleep breathing disturbance in patients with ischemic cerebral stroke. METHODS: Forty-one patients with cerebral infarction undertook all-night screening of sleep breathing. The clinical features between cerebral infarction concomitant with mild and severe sleep breathing disturbance were compared, and the effects of different infarcted sites and sizes, the infarction history and symptoms on the breathing disorders were analyzed...
September 2005: Chinese Journal of Tuberculosis and Respiratory Diseases
A Parenti, V Macchi, R Snenghi, A Porzionato, T Scaravilli, S D Ferrara, R De Caro
Central sleep apnoea (CSA) is a breathing disorder characterized by repetitive central apnoeas with hypoxia interrupted by hyperventilation phases. In the literature, there are reports of CSA caused by brainstem infarcts. We report two patients (38 and 53 years old) with longstanding history of central sleep apnoea who died during sleep. In both cases the autopsy revealed acute bilateral hypoxic lesions at the level of the solitary tract nuclei. In one case, symmetrical selective neuronal necrosis was found in the dorsal part of the solitary tract nuclei...
September 2005: Clinical Neuropathology
Claudio L Bassetti
More than 50% of stroke patients have sleep-disordered breathing (SDB), mostly in the form of obstructive sleep apnea (OSA). SDB represents both a risk factor and a consequence of stroke. The presence of SDB has been linked with poorer long-term outcome and increased long-term stroke mortality. Continuous positive airway presure is the treatment of choice for OSA. Oxygen and other forms of ventilation may be helpful in other (e.g., central) forms of SDB. SDB can improve spontaneously after stroke. About 20 to 40% of stroke patients have sleep-wake disorders (SWD), mostly in form of insomnia, excessive daytime sleepiness/fatigue, or hypersomnia (increased sleep needs)...
March 2005: Seminars in Neurology
Pedro Schestatsky, Luis Nelson Teixeira Fernandes
UNLABELLED: We report and discuss the case of a 55-year old man who presented a history of stroke as well as chronic obstructive pulmonary disease. When admitted into the emergency room, he was diagnosed with a vertebro-basilar syndrome. A brain MRI showed a hyperintense area in the lower right brainstem laterally within the medulla, which corresponds to the area of the pathways descending from the autonomic breathing control center. During hospitalization, the patient had several episodes of prolonged apnea, mainly when asleep, having often to be "reminded" to breath...
June 2004: Arquivos de Neuro-psiquiatria
Martín A Nogués, Aquiles J Roncoroni, Eduardo Benarroch
Control of ventilation depends on a brainstem neuronal network that controls activity of the motor neurons innervating the respiratory muscles. This network includes the pontine respiratory group and the dorsal and ventral respiratory groups in the medulla, which contain neurons that fire primarily during inspiration, post-inspiration, or expiration. The ventral respiratory group includes the pre-Bötzinger complex, which contains neurokinin-1 receptor immunoreactive neurons critical for respiratory rhythmogenesis...
December 2002: Clinical Autonomic Research: Official Journal of the Clinical Autonomic Research Society
Jean Philippe Neau, Joël Paquereau, Jean Claude Meurice, Jean Jacques Chavagnat, Roger Gil
The relationships between obstructive sleep apnoea syndrome (OSAS) and stroke are still under discussion, but increasing evidence demonstrates that the OSAS is an independent risk factor for stroke. However, in rare cases, OSAS could be a consequence of strokes, especially if located in the brainstem. Many recent studies have found a 70 to 95% frequency of OSAS (defined by an apnoea/hypopnoea index >10) in patients with acute stroke. Age, body mass index, diabetes, and severity of stroke have been identified as independent predictors of stroke...
December 2002: Sleep Medicine Reviews
Z Tomori, V Donic, R Benacka, M Kuchta, S Koval, J Jakus
Four basic control mechanisms of breathing (brainstem respiratory centre, peripheral and central chemoreceptors, intero- and exteroceptive reflexes and suprapontine influences), as well as their sleep-related disorders are analysed. A decrease in central chemoreceptor sensitivity to CO2 and an increase in upper airway resistance during sleep result in hypoventilation and mild hypoxaemia already in physiological conditions. Compensatory increase in ventilatory effort with synchronous inhibition of pharyngeal dilators during sleep reduces the upper airway lumen manifesting with snoring, upper airway resistance syndrome, and OSA...
2002: Sborník Lékar̆ský
M Nakajima, K Katsura, Y Hashimoto, T Terasaki, M Uchino
A 49-year-old woman with 6 months history of body weight loss, muscle weakness, and dysarthria, was found with respiratory arrest and resuscitated in the morning of January 1999. An MRI brain scan revealed diffuse swelling and T2/FLAIR high signal intensity with mild Gadolinium enhancement in the lower pons and medulla oblongata. Although the histological diagnosis could not be obtained, glioma (astrocytoma) was suspected. In the morning of July 3rd she presented sweating and cyanosis. Her arterial oxygen saturation was 18%...
August 2000: Rinshō Shinkeigaku, Clinical Neurology
L R Pinto, A B Silva, S Tufik
Rapid eye movements that occur during paradoxical sleep are generated from the brainstem and are modulated by cerebral hemispheres. In an attempt to establish the participation of cerebral hemispheres on rapid eye movements, we carried out a quantitative study of eye movements density in patients bearing hemispheres vascular lesions. The polysomnographic recordings of 24 patients were compared to those of 24 healthy volunteers. Density of rapid eye movements was defined as the percentage of eye movements during the respective time of paradoxical sleep...
June 2000: Arquivos de Neuro-psiquiatria
S Kotterba, K Rasche
Patients with obstructive sleep apnea syndrome (OSAS) present upper airway obstruction during sleep which can be documented by electromyography. The cause of weakness in oropharyngeal muscles is still unknown. Lesions of pons and medulla oblongata have to be expected. Brainstem auditory evoked potentials (BAEP) may indicate pathological changes in these regions. Several studies described normal BAEP in OSAS-patients. Moderate forms of OSAS as well as central sleep apnea syndromes were investigated, however...
December 1996: Pneumologie
V Mohsenin, R Valor
Sleep pattern and breathing in humans are altered following cerebrovascular accidents involving the brainstem. Sleep apnea is a well-established complication of stroke involving the brainstem. On the other hand, the effect of cerebral stroke on sleep and breathing has not been well defined. The diffuse cerebral symptoms such as cognitive deficits, depression or fatigue, after hemispheric stroke mimic those present in patients with sleep apnea. To define the breathing pattern in patients with stroke involving cerebral hemispheres without brainstem lesion and without the prior history of sleep-disordered breathing, we studied 10 patients within 1 year of their stroke...
January 1995: Archives of Physical Medicine and Rehabilitation
J J Askenasy, I Goldhammer
Medullary disorders can be associated with a sleep apnea syndrome. The present patient developed a sleep apnea syndrome with approximately 25 episodes of apnea or hypopnea during each hour of sleep following a lateral medullary infarction. The presence of predisposing factors and involvement of respiratory centers in the area of the medullary lesion may determine the appearance of sleep apnea with brainstem infarction. Investigation of breathing during sleep may be helpful in such cases.
May 1988: Stroke; a Journal of Cerebral Circulation
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