Article

Central periodic breathing during sleep in 74 patients with acute ischemic stroke - Neurogenic and cardiogenic factors

Dept. of Neurology, University Hospital of Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland.
Journal of Neurology (Impact Factor: 3.84). 12/2008; 255(11):1687-92. DOI: 10.1007/s00415-008-0981-9
Source: PubMed

ABSTRACT The aims of our study were 1) to better characterize central periodic breathing during sleep (CPBS) and its clinical relevance in acute stroke, 2) to better define the role of brain damage in its pathogenesis.
We included 74 consecutive patients admitted within 96 hours after stroke onset. Stroke severity at admission, stroke outcome at discharge and stroke topography were assessed. ECG and transesophageal echocardiography were performed. Nocturnal breathing was assessed with an ambulatory device the first night after admission. CPBS severity was represented as absolute time and percentage of recording time.
Age was 63 +/- 13 (25-82), 49 (66 %) were male. Thirty (41 %) patients showed CPBS during >or= 10 % and 7 (9 %) during >or= 50 % of recording time. CPBS severity was associated with age (p = 0.017), stroke severity (p = 0.008), ECG abnormalities (p = 0.005) and lower left ventricular ejection fraction (p < 0.0001). CPBS severity was higher in patients with extensive hemispheric strokes (n = 6, p < 0.0001), and lower in patients with partial strokes involving the left insula (n = 5, p < 0.0001) and the mesencephalon (n = 5, p = 0.002).
CPBS is frequent in acute ischemic stroke and is associated with older age, stroke severity/extension, and lower left ventricular function. The lower occurrence of CPBS in left insular and mesencephalic stroke suggests a major role of distinct brain areas in the modulation of respiratory phenomena accompanying acute stroke.

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    • "Our finding of an association between frontal- and brainstem lesions and increasing length of CSR episodes is suggestive of disturbance or even more a damage of WM projections in frontal-brainstem pathways leading to central breathing dysregulation. These findings are supported by a study using functional MRI [64] and recent studies in stroke patients reporting patients with ischemic lesions in frontal areas to be particular affected by CSA-CSR [65]. "
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    ABSTRACT: The exact underlying pathomechanism of central sleep apnea with Cheyne-Stokes respiration (CSA-CSR) is still unclear. Recent studies have demonstrated an association between cerebral white matter changes and CSA. A dysfunction of central respiratory control centers in the brainstem was suggested by some authors. Novel MR-imaging analysis tools now allow far more subtle assessment of microstructural cerebral changes. The aim of this study was to investigate whether and what severity of subtle structural cerebral changes could lead to CSA-CSR, and whether there is a specific pattern of neurodegenerative changes that cause CSR. Therefore, we examined patients with Fabry disease (FD), an inherited, lysosomal storage disease. White matter lesions are early and frequent findings in FD. Thus, FD can serve as a "model disease" of cerebral microangiopathy to study in more detail the impact of cerebral lesions on central sleep apnea. Genetically proven FD patients (n = 23) and age-matched healthy controls (n = 44) underwent a cardio-respiratory polysomnography and brain MRI at 3.0 Tesla. We applied different MR-imaging techniques, ranging from semiquantitative measurement of white matter lesion (WML) volumes and automated calculation of brain tissue volumes to VBM of gray matter and voxel-based diffusion tensor imaging (DTI) analysis. In 5 of 23 Fabry patients (22%) CSA-CSR was detected. Voxel-based DTI analysis revealed widespread structural changes in FD patients when compared to the healthy controls. When calculated as a separate group, DTI changes of CSA-CSR patients were most prominent in the brainstem. Voxel-based regression analysis revealed a significant association between CSR severity and microstructural DTI changes within the brainstem. Subtle microstructural changes in the brainstem might be a neuroanatomical correlate of CSA-CSR in patients at risk of WML. DTI is more sensitive and specific than conventional structural MRI and other advanced MR analyses tools in demonstrating these abnormalities.
    PLoS ONE 04/2013; 8(4):e60304. DOI:10.1371/journal.pone.0060304 · 3.23 Impact Factor
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    • "We performed our sleep study at 6.3±2.2 days after stroke onset using a simplified portable protocol that exclude TIA patients. We chose 17 articles reporting the prevalence of SDB,2-5,7-17,19-21 in which the sleep measurements were made within 24, 48, or 72 hours, within 1 or 2 weeks, and around 1 or 3 months after stroke onset. These can be grouped into hyperacute (≤3 days), acute (1-2 weeks), and subacute (1-3 months) periods, whose mean prevalence rates of SDB were 59% (range 51-71%), 57% (50-67%), and 59% (44-71%), respectively. "
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    • "In a previous study carried out in a nonselected sample of patients with cerebral infarction, Parra et al. [11] reported the presence of Cheyne-Stokes respiration in 26% of patients, a percentage higher than 6% of observed in the study of Bassetti and Aldrichet [12]. To date, Cheyne-Stokes respiration in stroke patients has been related to a worse prognosis probably because this abnormal breathing pattern is found in more extensive cerebral lesions and is also more common in hemorrhagic strokes than in ischemic infarctions [11] [13]. "
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