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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\u003EThis article gives an overview of obstructive sleep apnea (OSA) as a risk factor for cerebrovascular disease and stroke [Culebras A, editor. \u003Cem\u003ESleep, Stroke and Cardiovascular Disease\u003C\/em\u003E. Cambridge University Press, 2013].\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\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\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\u003ENeurology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EAntonio Culebras, MD, SUNY Upstate Medical University, Syracuse, New York, USA, provided on overview of obstructive sleep apnea (OSA) as a risk factor for cerebrovascular disease and stroke [Culebras A, editor. \u003Cem\u003ESleep, Stroke and Cardiovascular Disease\u003C\/em\u003E. Cambridge University Press, 2013].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ESleep apnea may contribute to cerebrovascular disease in a variety of ways (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14314\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14314\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14314\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003ESleep Apnea-Related Contributors to Cerebrovascular Disease\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ESLEEP APNEA-RELATED HYPERTENSION\u003C\/h2\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EThe regularity of arousals from apnea influences hypertension [Jamasebi R et al. \u003Cem\u003ESleep\u003C\/em\u003E 2008]. The Sleep Heart Health Study reported a progressive increase in adjusted odds of hypertension with \u226515 episodes of apnea per hour [Nieto FJ et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2000].\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ECARDIAC ARRHYTHMIA\u003C\/h2\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EMany atrial fibrillation (AF) episodes (40%) occur during the typical sleep period (midnight to 8:00 AM) and AF risk increases nearly 3-fold with sleep apnea-mediated decreases in blood oxygen. Sleep apnea is significantly more prevalent (p=0.0004) in patients with AF (49%) than in patients with other cardiovascular diseases who are at high-risk for AF (32%) [Gami AS et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2004], and significantly more frequent in those with AF compared with age-matched healthy individuals (81.6% vs 60%; p=0.03) [Braga B et al. \u003Cem\u003ESleep Med\u003C\/em\u003E 2009]. OSA is a univariate predictor of AF (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [Gami AS et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2007].\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/1\/31\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Cumulative Frequency of AF for Subjects With and Without Obstructive Sleep Apnea\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-181358015\u0022 data-figure-caption=\u0022Cumulative Frequency of AF for Subjects With and Without Obstructive Sleep Apnea\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/1\/31\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/1\/31\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/1\/31\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14312\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003ECumulative Frequency of AF for Subjects With and Without Obstructive Sleep Apnea\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EOSA=obstructive sleep apnea.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced from Gami AS et al. Obstructive Sleep Apnea, Obesity, and the Risk of Incident Atrial Fibrillation. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2007;5(6):565\u2013571. With permission from Elsevier.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EPATENT FORAMEN OVALE\u003C\/h2\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EPatent foramen ovale has been significantly associated (p\u0026lt;0.05) with sleep apnea in 27% of subjects compared with 15% of subjects with a normal heart [Beelke M et al. \u003Cem\u003ESleep Med\u003C\/em\u003E 2003]. The presence of right-to-left shunt in 72% of 100 consecutive patients with OSA [Guchlerner M et al. \u003Cem\u003EJ Clin Sleep Med\u003C\/em\u003E 2012] is evidence of an association of patent foramen ovale with sleep apnea. In a study of 335 patients, OSA lasting \u226520 seconds was associated with wake-up strokes and transient ischemic attack in patients with right-to-left shunt (27\/69) compared with patients with apnea alone (70\/266; OR, 1.91; 95% CI, 1.08 to 3.38; p=0.03) [Ciccone A et al. \u003Cem\u003EThorax\u003C\/em\u003E 2013].\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EThe data to date supports the suggestion that OSA significantly increases the risk of stroke or death from any cause, independent of other risk factors including hypertension [Yaggi HK et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2005]. Additionally, apnea has been linked to cognitive impairment [Yaffe K et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2011; Rom\u00e1n GC et al. \u003Cem\u003ELancet Neurol\u003C\/em\u003E 2002].\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003ETherapeutic use of continuous positive airway pressure has been explored in OSA. Encouraging findings include lowered cardiovascular risk [Kohler M et al. \u003Cem\u003EEur Respir J\u003C\/em\u003E 2008], decreased blood pressure [Jaimchariyatam N et al. \u003Cem\u003ESleep Med\u003C\/em\u003E 2010; Mart\u00ednez-Garc\u00eda MA et al. \u003Cem\u003EEur Respir J\u003C\/em\u003E 2007], and potential value in reducing mortality [Mart\u00ednez-Garc\u00eda MA et al. \u003Cem\u003EAm J Respir Crit Care Med\u003C\/em\u003E 2009].\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\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\/14\/1\/31.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_figures.js?nzpdy2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzpdy2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzpdy2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}