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Is there a causal relationship between obstructive sleep apnea and the pathophysiology of intracranial aneurysm?

Besteht ein kausaler Zusammenhang zwischen obstruktiver Schlafapnoe und der Pathophysiologie intrakanieller Aneurysmen?

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Abstract

Rupture of an intracranial aneurysm (IA) leads to a rare subtype of intracranial bleeding, i. e., subarachnoid hemorrhage (SAH). However, SAH is associated with high long-term morbidity and mortality. Risk factors for the development and rupture of IA include modifiable factors, i. e., smoking and arterial hypertension. Symptoms of obstructive sleep apnea (OSA) are commonly reported following the rupture of an IA. The purpose of this review is to summarize the currently available evidence on the prevalence and effect of OSA in patients with IA. With an exploratory intent, we further identified potential mechanisms by which OSA might promote the development, growth, and rupture of IA.

Zusammenfassung

Die Ruptur eines intrakraniellen Aneurysmas (IA) kann zu einem seltenen Subtyp einer intrakraniellen Blutung, d. h. zu einer Subarachnoidalblutung (SAB), führen. Dabei geht eine SAB mit einer hohen Langzeitmorbidität und -mortalität einher. Zu den Risikofaktoren für die Entstehung und Ruptur eines IA gehören modifizierbare Faktoren wie Rauchen und arterielle Hypertonie. Häufig wird nach der Ruptur eines IA über Symptome einer obstruktiven Schlafapnoe (OSA) berichtet. Ziel der vorliegenden Übersichtsarbeit ist es, eine Zusammenfassung der derzeit verfügbaren Evidenz zur Prävalenz und zu den Auswirkungen einer OSA bei Patienten mit IA zu geben. Um dies näher zu untersuchen, ermittelten die Autoren potenzielle Mechanismen, durch welche eine OSA die Entstehung, das Wachstum und die Ruptur eines IA begünstigen könnte.

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References

  1. White DP, Younes MK (2012) Obstructive sleep apnea. Compr Physiol. https://doi.org/10.1002/cphy.c110064

    Article  Google Scholar 

  2. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. https://doi.org/10.1056/NEJM199304293281704

    Article  Google Scholar 

  3. Young T, Hutton R, Finn L, Badr S, Palta M (1996) The gender bias in sleep apnea diagnosis: are women missed because they have different symptoms? Arch Intern Med. https://doi.org/10.1001/archinte.156.21.2445

    Article  Google Scholar 

  4. Heinzer R, Vat S, Marques-Vidal P et al (2015) Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. https://doi.org/10.1016/S2213-2600(15)00043-0

    Article  Google Scholar 

  5. Jordan AS, McSharry DG, Malhotra A (2014) Adult obstructive sleep apnoea. Lancet. https://doi.org/10.1016/S0140-6736(13)60734-5

    Article  Google Scholar 

  6. Gottlieb DJ, Yenokyan G, Newman AB et al (2010) Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation. https://doi.org/10.1161/CIRCULATIONAHA.109.901801

    Article  Google Scholar 

  7. Marin JM, Carrizo SJ, Vicente E, Agusti AGN (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: An observational study. Lancet. https://doi.org/10.1016/S0140-6736(05)74229-X

    Article  Google Scholar 

  8. Redline S, Yenokyan G, Gottlieb DJ et al (2010) Obstructive sleep apnea-hypopnea and incident stroke: the sleep heart health study. Am J Respir Crit Care Med. https://doi.org/10.1164/rccm.200911-1746OC

    Article  Google Scholar 

  9. Punjabi NM, Caffo BS, Goodwin JL et al (2009) Sleep-disordered breathing and mortality: a prospective cohort study. Plos Med. https://doi.org/10.1371/journal.pmed.1000132

    Article  Google Scholar 

  10. Gaisl T, Bratton DJ, Kohler M (2015) The impact of obstructive sleep apnoea on the aorta. Eur Respir J. https://doi.org/10.1183/09031936.00029315

    Article  Google Scholar 

  11. Anderson C, Hankey G, Jamrozik K, Dunbabin D (2000) Epidemiology of aneurysmal subarachnoid hemorrhage in Australia and New Zealand: Incidence and case fatality from the Australasian Cooperative Research on Subarachnoid Hemorrhage Study (ACROSS). Stroke. https://doi.org/10.1161/01.STR.31.8.1843

    Article  Google Scholar 

  12. van Gijn J, Kerr RS, Rinkel GJ (2007) Subarachnoid haemorrhage. Lancet. https://doi.org/10.1016/S0140-6736(07)60153-6

    Article  Google Scholar 

  13. Macdonald RL, Schweizer TA (2017) Spontaneous subarachnoid haemorrhage. Lancet. https://doi.org/10.1016/S0140-6736(16)30668-7

    Article  Google Scholar 

  14. Sacco S, Totaro R, Toni D, Marini C, Cerone D, Carolei A (2009) Incidence, case-fatalities and 10-year survival of subarachnoid hemorrhage in a population-based registry. Eur Neurol. https://doi.org/10.1159/000226617

    Article  Google Scholar 

  15. Shamseer L, Moher D, Clarke M et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (prisma-p) 2015: Elaboration and explanation. BMJ. https://doi.org/10.1136/bmj.g7647

    Article  Google Scholar 

  16. Haley MD, Henderson DBH, Nowell M, Adams WM, Whitfield PC (2017) Giant vertebrobasilar aneurysm: a rare cause of central sleep apnoea. Br J Neurosurg 2017. https://doi.org/10.1080/02688697.2017.1378800

    Article  Google Scholar 

  17. Tanaka K, Kanamaru H, Morikawa A, Kawaguchi K (2016) Central Hypoventilation syndrome complicated with lateral medullary infarction after Endovascular treatment of the vertebral artery dissecting aneurysm: a case report. NMC Case Rep J. https://doi.org/10.2176/nmccrj.cr.2016-0067

    Article  Google Scholar 

  18. Morrone E, Pistarini C, Cazzulani B, Rossi M, Prpa A, Fanfulla F (2016) Sleep apnea after posterior cerebral artery aneurysm rupture and elevated intracranial pressure: a Chiari-like syndrome. Sleep Med. https://doi.org/10.1016/j.sleep.2016.01.003

    Article  Google Scholar 

  19. Chernyshev OY, Bir SC, Maiti TK et al (2017) Changing paradigm in the management of elderly patients with intracranial aneurysms: an institutional review. J Clin Neurosci. https://doi.org/10.1016/j.jocn.2017.05.015

    Article  Google Scholar 

  20. Bir SC, Nanda A, Cuellar H et al (2017) Coexistence of obstructive sleep apnea worsens the overall outcome of intracranial aneurysm: a pioneer study. J Neurosurg. https://doi.org/10.3171/2016.10.JNS162316

    Article  Google Scholar 

  21. Bir SC, Nanda A, Cuellar H, Liendo C, Minagar A, Chernyshev OY (2017) Ruptured cerebral aneurysm and obstructive sleep apnea: is any link there? Sleep 40(suppl 1):A379. https://doi.org/10.1093/sleepj/zsx050.1017

    Article  Google Scholar 

  22. Alaqeel AM, Almasri SH, Alotaibi NM et al (2013) Prevalence of symptoms and risk of sleep apnea in patients with ruptured cerebral aneurysm. Neurosciences (Riyadh) 18(3):249–251

    Google Scholar 

  23. Chernyshev OY, Bir SC, Maiti TK et al (2017) The relationship between obstructive sleep apnea and ruptured Intracranial aneurysms. J Clin Sleep Med pii: jc-17-00061 [Epub ahead of print]

  24. Schuiling WJ, Rinkel GJ, Walchenbach R, de Weerd AW (2005) Disorders of sleep and wake in patients after subarachnoid hemorrhage. Stroke. https://doi.org/10.1161/01.STR.0000154862.33213.73

    Article  Google Scholar 

  25. Jung T, Ryoo J, Cho H, Jang M, Lee J, Kim H (2015) Obstructive sleep apnea and its influence on intracranial aneurysm. Sleep Med. https://doi.org/10.1016/j.sleep.2015.02.076

    Article  Google Scholar 

  26. Zaremba S, Albus L, Güresir E (2017) FV 26—Inzidenz der aneurysmatischen Subarachnoidalblutungen bei Patienten mit Schlafstörungen. Somnologie 21(Suppl):92

    Google Scholar 

  27. Mason RH, Ruegg G, Perkins J et al (2011) Obstructive sleep apnea in patients with abdominal aortic aneurysms: highly prevalent and associated with aneurysm expansion. Am J Respir Crit Care Med. https://doi.org/10.1164/rccm.201001-0051OC

    Article  Google Scholar 

  28. Chalouhi N, Ali MS, Jabbour PM et al (2012) Biology of intracranial aneurysms: role of inflammation. J Cereb Blood Flow Metab. https://doi.org/10.1038/jcbfm.2012.84

    Article  Google Scholar 

  29. Hashimoto T, Meng H, Young WL (2006) Intracranial aneurysms: links among inflammation, hemodynamics and vascular remodeling. Neurol Res. https://doi.org/10.1179/016164106X14973

    Article  Google Scholar 

  30. Abruzzo T, Shengelaia GG, Dawson RC, Owens DS, Cawley CM, Gravanis MB (1998) Histologic and morphologic comparison of experimental aneurysms with human intracranial aneurysms. Am J Neuroradiol 19(7):1309–14

    CAS  Google Scholar 

  31. Backes D, Rinkel GJE, Laban KG, Algra A, Vergouwen MDI (2016) Patient-and aneurysm-specific risk factors for intracranial aneurysm growth: a systematic review and meta-analysis. Stroke. https://doi.org/10.1161/STROKEAHA.115.012162

    Article  Google Scholar 

  32. Güresir E, Vatter H, Schuss P et al (2013) Natural history of small unruptured anterior circulation aneurysms: a prospective cohort study. Stroke. https://doi.org/10.1161/STROKEAHA.113.001107

    Article  Google Scholar 

  33. Tada Y, Wada K, Shimada K et al (2014) Roles of hypertension in the rupture of intracranial aneurysms. Stroke. https://doi.org/10.1161/STROKEAHA.113.003072

    Article  Google Scholar 

  34. Greving JP, Wermer MJH, Brown RD et al (2014) Development of the PHASES score for prediction of risk of rupture of intracranial aneurysms: a pooled analysis of six prospective cohort studies. Lancet Neurol. https://doi.org/10.1016/S1474-4422(13)70263-1

    Article  Google Scholar 

  35. Haentjens P, Van Meerhaeghe A, Moscariello A et al (2007) The impact of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea syndrome: evidence from a meta-analysis of placebo-controlled randomized trials. Arch Intern Med. https://doi.org/10.1001/archinte.167.8.757

    Article  Google Scholar 

  36. Kohler M, Stradling JR (2010) Mechanisms of vascular damage in obstructive sleep apnea. Nat Rev Cardiol. https://doi.org/10.1038/nrcardio.2010.145

    Article  Google Scholar 

  37. Somers VK, Dyken ME, Mark AL, Abboud FM (1993) Sympathetic-nerve activity during sleep in normal subjects. N Engl J Med. https://doi.org/10.1056/NEJM199302043280502

    Article  Google Scholar 

  38. Serebrovskaya TV, Manukhina EB, Smith ML, Downey HF, Intermittent Hypoxia MRT (2008) Cause of or therapy for systemic hypertension? Exp Biol Med. https://doi.org/10.3181/0710-MR-267

    Article  Google Scholar 

  39. Narkiewicz K, Somers VK (2003) Sympathetic nerve activity in obstructive sleep apnoea. Acta Physiol Scand. https://doi.org/10.1046/j.1365-201X.2003.01091.x

    Article  Google Scholar 

  40. Li Y, Wang JG, Dolan E et al (2006) Ambulatory arterial stiffness index derived from 24-hour ambulatory blood pressure monitoring. Hypertension. https://doi.org/10.1161/01.HYP.0000200695.34024.4c

    Article  Google Scholar 

  41. Laurent S, Boutouyrie P (2015) The structural factor of hypertension: large and small artery alterations. Circ Res. https://doi.org/10.1161/CIRCRESAHA.116.303596

    Article  Google Scholar 

  42. Mitchell GF, Van Buchem MA, Sigurdsson S et al (2011) Arterial stiffness, pressure and flow pulsatility and brain structure and function: the Age, Gene/Environment Susceptibility-Reykjavik Study. Brain. https://doi.org/10.1093/brain/awr253

    Article  Google Scholar 

  43. Humphrey JD, Tellides G (2018) Central artery stiffness and thoracic aortopathy. Am J Physiol Heart Circ Physiol. https://doi.org/10.1152/ajpheart.00205.2018

    Article  Google Scholar 

  44. Szymanski MP, Metaxa E, Meng H, Kolega J (2008) Endothelial cell layer subjected to impinging flow mimicking the apex of an arterial bifurcation. Ann Biomed Eng. https://doi.org/10.1007/s10439-008-9540-x

    Article  Google Scholar 

  45. Sakamoto N, Saito N, Han X, Ohashi T, Sato M (2010) Effect of spatial gradient in fluid shear stress on morphological changes in endothelial cells in response to flow. Biochem Biophys Res Commun. https://doi.org/10.1016/j.bbrc.2010.04.002

    Article  Google Scholar 

  46. Aoki T, Nishimura M, Matsuoka T et al (2011) PGE 2‑EP 2 signalling in endothelium is activated by haemodynamic stress and induces cerebral aneurysm through an amplifying loop via NF-κB. Br J Pharmacol. https://doi.org/10.1111/j.1476-5381.2011.01358.x

    Article  Google Scholar 

  47. Peppard PE, Young T, Palta M, Skatrud J (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. https://doi.org/10.1056/NEJM200005113421901

    Article  Google Scholar 

  48. Nieto FJ (2000) Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. JAMA. https://doi.org/10.1001/jama.283.14.1829

    Article  Google Scholar 

  49. Somers VK, Dyken ME, Clary MP, Abboud FM (1995) Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest. https://doi.org/10.1172/JCI118235

    Article  Google Scholar 

  50. Kotikoski S, Huttunen J, Huttunen TJ et al (2018) Secondary hypertension in patients with saccular intracranial aneurysm disease: a population based study. PLoS ONE 13:e206432

    Article  Google Scholar 

  51. Pepperell JCT, Ramdassingh-Dow S, Crosthwaite N et al (2002) Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial. Lancet. https://doi.org/10.1016/S0140-6736(02)07445-7

    Article  Google Scholar 

  52. Drager LF, Polotsky VY, Lorenzi-Filho G (2011) Obstructive sleep apnea: an emerging risk factor for atherosclerosis. Chest. https://doi.org/10.1378/chest.10-2223

    Article  Google Scholar 

  53. Lui MMS, Ip MSM (2012) OSA and atherosclerosis. J Thorac Dis. https://doi.org/10.3978/j.issn.2072-1439.2012.01.06

    Article  Google Scholar 

  54. Sánchez-de-la-Torre M, Campos-Rodriguez F, Barbé F (2013) Obstructive sleep apnoea and cardiovascular disease. Lancet Respir Med. https://doi.org/10.1016/S2213-2600(12)70051-6

    Article  Google Scholar 

  55. Tuleta I, Franca CN, Wenzel D et al (2014) Hypoxia-induced endothelial dysfunction in apolipoprotein E‑deficient mice; effects of infliximab and L‑glutathione. Atherosclerosis. https://doi.org/10.1016/j.atherosclerosis.2014.08.021

    Article  Google Scholar 

  56. Badran M, Ayas N, Laher I (2014) Cardiovascular complications of sleep apnea: role of oxidative stress. Oxid Med Cell Longev. https://doi.org/10.1155/2014/985258

    Article  Google Scholar 

  57. Yamauchi M, Kimura H (2008) Oxidative stress in obstructive sleep apnea: putative pathways to the cardiovascular complications. Antioxid Redox Signal. https://doi.org/10.1089/ars.2007.1946

    Article  Google Scholar 

  58. Dyugovskaya L, Lavie P, Lavie L (2002) Increased adhesion molecules expression and production of reactive oxygen species in leukocytes of sleep apnea patients. Am J Respir Crit Care Med. https://doi.org/10.1164/ajrccm.165.7.2104126

    Article  Google Scholar 

  59. Wei H, Mao Q, Liu L et al (2011) Changes and function of circulating endothelial progenitor cells in patients with cerebral aneurysm. J Neurosci Res. https://doi.org/10.1002/jnr.22696

    Article  Google Scholar 

  60. Draghia F, Draghia AC, Onicescu D (2008) Electron microscopic study of the arterial wall in the cerebral aneurysms. Rom J Morphol Embryol 49(1):101–103

    Google Scholar 

  61. Tamura T, Jamous MA, Kitazato KT et al (2009) Endothelial damage due to impaired nitric oxide bioavailability triggers cerebral aneurysm formation in female rats. J Hypertens. https://doi.org/10.1097/HJH.0b013e328329d1a7

    Article  Google Scholar 

  62. Xu Y, Tian Y, Wei HJ et al (2011) Erythropoietin increases circulating endothelial progenitor cells and reduces the formation and progression of cerebral aneurysm in rats. Neuroscience. https://doi.org/10.1016/j.neuroscience.2011.02.051

    Article  Google Scholar 

  63. Drager LF, Polotsky VY, O’Donnell CP, Cravo SL, Lorenzi-Filho G, Machado BH (2015) Translational approaches to understanding metabolic dysfunction and cardiovascular consequences of obstructive sleep apnea. Am J Physiol Heart Circ Physiol. https://doi.org/10.1152/ajpheart.00094.2015

    Article  Google Scholar 

  64. Bradley TD, Floras JS (2009) Obstructive sleep apnoea and its cardiovascular consequences. Lancet. https://doi.org/10.1016/S0140-6736(08)61622-0

    Article  Google Scholar 

  65. Mayer G, Arzt M, Braumann B et al (2017) S3-Leitlinie Nicht erholsamer Schlaf/Schlafstörungen – Kapitel „Schlafbezogene Atmungsstörungen“. Somnologie 20(Suppl: s2):97–180

    Google Scholar 

  66. Kapur VK, Auckley DH, Chowdhuri S et al (2017) Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: An American academy of sleep medicine clinical practice guideline. J Clin Sleep Med. https://doi.org/10.5664/jcsm.6506

    Article  Google Scholar 

  67. Ramar K, Dort LC, Katz SG et al (2015) Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med. https://doi.org/10.5664/jcsm.4858

    Article  Google Scholar 

  68. Killer-Oberpfalzer M, Aichholzer M, Weis S et al (2012) Histological analysis of clipped human intracranial aneurysms and parent arteries with short-term follow-up. Cardiovasc Pathol. https://doi.org/10.1016/j.carpath.2011.09.010

    Article  Google Scholar 

  69. Kosierkiewicz TA, Factor SM, Dickson DW (1994) Immunocytochemical studies of atherosclerotic lesions of cerebral berry aneurysms. J Neuropathol Exp Neurol. https://doi.org/10.1097/00005072-199407000-00012

    Article  Google Scholar 

  70. Barcelo A, Miralles C, Barbe F, Vila M, Pons S, Agusti AGN (2000) Abnormal lipid peroxidation in patients with sleep apnoea. Eur Respir J. https://doi.org/10.1034/j.1399-3003.2000.16d13.x

    Article  Google Scholar 

  71. Song D, Fang G, Greenberg H, Liu SF (2015) Chronic intermittent hypoxia exposure-induced atherosclerosis: a brief review. Immunol Res. https://doi.org/10.1007/s12026-015-8703-8

    Article  Google Scholar 

  72. Arnaud C, Poulain L, Lévy P, Dematteis M (2011) Inflammation contributes to the atherogenic role of intermittent hypoxia in apolipoprotein-E knock out mice. Atherosclerosis. https://doi.org/10.1016/j.atherosclerosis.2011.07.122

    Article  Google Scholar 

  73. Savransky V, Nanayakkara A, Li J et al (2007) Chronic intermittent hypoxia induces atherosclerosis. Am J Respir Crit Care Med. https://doi.org/10.1164/rccm.200612-1771OC

    Article  Google Scholar 

  74. Jun J, Reinke C, Bedja D et al (2010) Effect of intermittent hypoxia on atherosclerosis in apolipoprotein E‑deficient mice. Atherosclerosis. https://doi.org/10.1016/j.atherosclerosis.2009.10.017

    Article  Google Scholar 

  75. Rinkel GJE (2018) Management of patients with unruptured intracranial aneurysms. Curr Opin Neurol. https://doi.org/10.1097/WCO.0000000000000642

    Article  Google Scholar 

  76. Backes D, Hendrikse J, van der Schaaf I et al (2018) Determinants of gadolinium-enhancement of the aneurysm wall in Unruptured Intracranial aneurysms. Neurosurgery 83:719–725

    Article  Google Scholar 

  77. Liu P, Qi H, Liu A et al (2016) Relationship between aneurysm wall enhancement and conventional risk factors in patients with unruptured intracranial aneurysms: a black-blood MRI study. Interv Neuroradiol. https://doi.org/10.1177/1591019916653252

    Article  Google Scholar 

  78. Hu P, Yang Q, Wang DD, Guan SC, Zhang HQ (2016) Wall enhancement on high-resolution magnetic resonance imaging may predict an unsteady state of an intracranial saccular aneurysm. Neuroradiology. https://doi.org/10.1007/s00234-016-1729-3

    Article  Google Scholar 

  79. Edjlali M, Guédon A, Hassen BW et al (2018) Circumferential thick enhancement at vessel wall MRI has high specificity for Intracranial aneurysm instability. Radiology. https://doi.org/10.1148/radiol.2018172879

    Article  Google Scholar 

  80. Larsen N, Von Der Brelie C, Trick D et al (2018) Vessel wall enhancement in unruptured intracranial aneurysms: an indicator for higher risk of rupture? High-resolution MR imaging and correlated histologic findings. AJNR Am J Neuroradiol. https://doi.org/10.3174/ajnr.A5731

    Article  Google Scholar 

  81. Ollikainen E, Tulamo R, Frösen J et al (2014) Mast cells, neovascularization, and microhemorrhages are associated with saccular intracranial artery aneurysm wall remodeling. J Neuropathol Exp Neurol. https://doi.org/10.1097/NEN.0000000000000105

    Article  Google Scholar 

  82. Hoh BL, Hosaka K, Downes DP et al (2014) Stromal cell—derived factor-1 promoted angiogenesis and inflammatory cell infiltration in aneurysm walls. J Neurosurg. https://doi.org/10.3171/2013.9.JNS122074

    Article  Google Scholar 

  83. Gounis MJ, Vedantham S, Weaver JP et al (2014) Myeloperoxidase in human intracranial aneurysms: preliminary evidence. Stroke. https://doi.org/10.1161/STROKEAHA.114.004956

    Article  Google Scholar 

  84. Ar soy A, Ekin S, Sertogullarindan B et al (2016) The relationship among oxidative and anti-oxidative parameters and myeloperoxidase in subjects with obstructive sleep apnea syndrome. Respir Care. https://doi.org/10.4187/respcare.04277

    Article  Google Scholar 

  85. Kent BD, Ryan S, McNicholas WT (2011) Obstructive sleep apnea and inflammation: relationship to cardiovascular co-morbidity. Respir Physiol Neurobiol. https://doi.org/10.1016/j.resp.2011.03.015

    Article  Google Scholar 

  86. Yamauchi M, Tamaki S, Tomoda K et al (2006) Evidence for activation of nuclear factor kappaB in obstructive sleep apnea. Sleep Breath. https://doi.org/10.1007/s11325-006-0074-x

    Article  Google Scholar 

  87. Lavie L (2008) Intermittent hypoxia: the culprit of oxidative stress, vascular inflammation and dyslipidemia in obstructive sleep apnea. Expert Rev Respir Med. https://doi.org/10.1586/17476348.2.1.75

    Article  Google Scholar 

  88. Arnaud C, Dematteis M, Pepin JL, Baguet JP, Lévy P (2009) Obstructive sleep apnea, immuno-inflammation, and atherosclerosis. Semin Immunopathol. https://doi.org/10.1007/s00281-009-0148-5

    Article  Google Scholar 

  89. Pawlowska E, Szczepanska J, Wisniewski K, Tokarz P, Jaskólski DJ, Blasiak J (2018) NF-κB-mediated inflammation in the pathogenesis of intracranial aneurysm and subarachnoid hemorrhage. Does autophagy play a role? Int J Mol Sci. https://doi.org/10.3390/ijms19041245

    Article  Google Scholar 

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  1. Department of Neurology, Rheinische Friedrich-Wilhelms-University, Sigmund-Freud-Str. 25, 53127, Bonn, Germany

    Sebastian Zaremba MD

  2. Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Bonn, Germany

    Erdem Güresir MD, PhD

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Zaremba, S., Güresir, E. Is there a causal relationship between obstructive sleep apnea and the pathophysiology of intracranial aneurysm?. Somnologie 23, 29–35 (2019). https://doi.org/10.1007/s11818-019-0191-y

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