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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EObstructive sleep apnea (OSA) is prevalent in the general population and has been linked to chronically elevated blood pressure and an increased risk of stroke and death. This article discusses the relationship of OSA and stroke and emphasized the need for clinical trials to assess the effectiveness of OSA treatment in improving stroke outcomes.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EEpisodic \u0026amp; Paroxysmal Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ESleep Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECerebrovascular Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EObstructive sleep apnea (OSA) is prevalent in the general population and has been linked to chronically elevated blood pressure and an increased risk of stroke and death. Mark Eric Dyken, MD, Sleep Disorders Center, University of Iowa College of Medicine, Iowa City, IA, discussed the relationship of OSA and stroke and emphasized the need for clinical trials to assess the effectiveness of OSA treatment in improving stroke outcomes.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ERisk factors, treatment response, and short-term and long-term outcome of OSA in stroke patients are just starting to be studied. OSA is common, particularly in elderly male stroke patients with diabetes, nighttime stroke onset, and macroangiopathy, where it may have the potential to act as a precipitant to stroke. Although OSA can be treated with continuous positive airway pressure (CPAP), CPAP is used in a small percentage of patients due to compliance issues [Bassetti CL et al. \u003Cem\u003EStroke\u003C\/em\u003E 2006].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003ESimultaneous sympathetic and parasympathetic activation during episodes of apnea may be among the factors that connect OSA and stroke. Patients with OSA have high sympathetic activity when they are awake and experience further increases in blood pressure and sympathetic activity during sleep. These increases can be attenuated by treatment with CPAP [Somers VK et al. \u003Cem\u003EJ Clin Invest\u003C\/em\u003E 1995].\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003E\u201cIf treatment is proven to reduce morbidity and mortality in a cost-effective manner, routine screening [for OSA] and more aggressive treatment might become standard care,\u201d concluded Dr. Dyken.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003ESleep apnea is a significant risk of stroke or death from any cause, concluded Michael Zupancic, MD, Pacific Sleep Medicine Services, Scripps Memorial Hospital, La Jolla, CA. It is estimated that about 2% of women and 4% of men in the United States have sleep apnea [Young T et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 1993]. In addition, the risk of heart disease and stroke increases in snorers. The age-adjusted relative risk of ischemic heart disease between individuals who are classified as habitual or frequent snorers and nonsnorers is 1.91 (p\u0026gt;0.01). For both ischemic heart disease and stroke, the RR is 2.38 (p\u0026gt;0.001) [Koskenvuo M et al. \u003Cem\u003EBrit Med J\u003C\/em\u003E 1987]. Although lower than for men, the RR for stroke and heart disease in women who snore also is increased.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EA physiological explanation of snoring\/sleep apnea was presented by Andrei V. Alexandrov, MD, Comprehensive Stroke Center, University of Alabama Hospital, Birmingham, AL, which he explained as the CBF steal phenomenon, or \u201creversed Robin Hood syndrome.\u201d Dr. Alexandrov described CBF steal as transient, spontaneous, or vasodilatory stimuli-induced velocity reductions in areas of the brain with poor hemodynamic reserve at the time of velocity increase in normal vessels. Such stealing of blood flow from poor flow areas to normal areas can lead to negative neurological changes. When associated with desaturation of oxygen\u2014a common occurrence in sleep apnea\u2014and with the natural blood pressure dip that is observed in sleep, Dr. Alexandrov believes that this would create a \u201cperfect storm\u201d during nocturnal sleep to further damage brain tissues with poor hemodynamic reserve [Alexandrov AV et al. \u003Cem\u003EStroke\u003C\/em\u003E 2007].\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2009 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/9\/1\/26.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmlkq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}