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Obstructive Sleep Apnea and Stroke: Determining the Mechanisms Behind their Association and Treatment Options

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Abstract

Sleep-disordered breathing (SDB) can be a sequela of stroke caused by vascular injury to vital respiratory centers, cerebral edema, and increased intracranial pressure of space-occupying lesions. Likewise, obstructive sleep apnea (OSA) contributes to increased stroke risk through local mechanisms such as impaired ischemic cerebrovascular response and systemic effects such as promoting atherosclerosis, hypercoagulability, cardiac arrhythmias, vascular-endothelial dysfunction, and metabolic syndrome. The impact of OSA on stroke outcomes has been established, yet it receives less attention in national guidelines on stroke management than hyperglycemia and blood pressure dysregulation. Furthermore, whether untreated OSA worsens stroke outcomes is not well-described in the literature. This scoping review provides an updated investigation of the correlation between OSA and stroke, including inter-relational pathophysiology. This review also highlights the importance of OSA treatment and its role in stroke outcomes. Knowledge of pathophysiology, the inter-relationship between these common disorders, and the impact of OSA therapy on outcomes affect the clinical management of patients with acute ischemic stroke. In addition, understanding the relationship between stroke outcomes and pre-existing OSA will allow clinicians to predict outcomes while treating acute stroke.

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Data Availability

All data generated or analyzed during this study are included in this article.

Abbreviations

AHI :

Apnea-Hypopnea Index

AF :

Atrial Fibrillation

BPAP :

BiLevel Positive Airway Pressure

CPAP :

Continuous Positive Airway Pressure

CRP :

C-reactive protein

CSA :

Central Sleep Apnea

EDS :

Excessive Daytime Sleepiness

eNOS :

Endothelial Nitric Oxide Synthase

ESS :

Epworth Sleepiness Scale

IH :

Intermittent Hypoxia

mRS :

Modified Rankin Scale

OSA :

Obstructive Sleep Apnea

PSG :

Polysomnography

TBI :

Traumatic Brain Injury

SDB :

Sleep-Disordered Breathing

TIA :

Transient Ischemic Attack

TNF :

Tumor Necrosis Factor

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Acknowledgements

The authors would like to thank and acknowledge members of the Neuro-ICU DoréLab. Figures were created using BioRender.com. This study was partly supported by the University of Florida Department of Anesthesiology and by grants from the Department of Defense (AZ180127) and the National Institutes of Health (R21NS110008, R56NS116076, and NR018848).

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Authors and Affiliations

  1. Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA

    Basma Mohamed, Keerthi Yarlagadda, Zachary Self, Alexandra Simon, Frank Rigueiro, Maryam Sohooli & Sylvain Doré

  2. Department of Neurology, University of Florida College of Medicine, Gainesville, FL, 32610, USA

    Stephan Eisenschenk & Sylvain Doré

  3. Departments of Neurology, Psychiatry, Pharmaceutics, and Neuroscience, Center for Translational Research in Neurodegenerative Disease, McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, 32610, USA

    Sylvain Doré

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  1. Basma Mohamed
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  2. Keerthi Yarlagadda
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  8. Sylvain Doré
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Contributions

SD conceptualized the paper and contributed to the writing, tables, and figures. BM, KY, ZS, FR, AS, MS, SE, and SD contributed to the tables and figures. KY and ZS wrote the first draft of the manuscript. All authors have read and agreed to the final version of the manuscript.

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Correspondence to Sylvain Doré.

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Mohamed, B., Yarlagadda, K., Self, Z. et al. Obstructive Sleep Apnea and Stroke: Determining the Mechanisms Behind their Association and Treatment Options. Transl. Stroke Res. 15, 239–332 (2024). https://doi.org/10.1007/s12975-023-01123-x

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