Division of Neurology, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand; Neurology Center, Vibhavadi Hospital, Bangkok, Thailand.
Department of Medicine, Corporal Michael J. Crescenz VA, Medical Center, Philadelphia, PA, United States; Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
Sleep Med Rev. 2021 Oct;59:101499. doi: 10.1016/j.smrv.2021.101499. Epub 2021 Apr 30.
Stroke is the leading cause of death and disability globally. Sleep disordered breathing (SDB), a potentially modifiable risk factor of stroke, is highly prevalent in stroke survivors. Evidence supports a causal, bidirectional relationship between SDB and stroke. SDB may increase the risk of stroke occurrence and recurrence, and worsen stroke outcome. While SDB is associated with an increased incidence of hypertension and cardiac arrhythmias, both of which are traditional stroke risk factors, SDB is also an independent risk factor for stroke. A number of characteristics of SDB may increase stroke risk, including intermittent hypoxemia, sympathetic activation, changes in cerebral autoregulation, oxidative stress, systemic inflammation, hypercoagulability, and endothelial dysfunction. On the other hand, stroke may also cause new SDB or aggravate preexisting SDB. Continuous positive airway pressure treatment of SDB may have a beneficial role in reducing stroke risk and improving neurological outcome after stroke. The treatment should be considered as early as possible, particularly when SDB is present post-stroke. The goal of this review is to highlight the strong link between SDB and stroke and to raise awareness for practitioners to consider the possibility of SDB being present in all stroke survivors.
中风是全球范围内导致死亡和残疾的主要原因。睡眠呼吸障碍（SDB）是中风的一个潜在可改变的危险因素，在中风幸存者中非常普遍。有证据支持 SDB 与中风之间存在因果关系和双向关系。SDB 可能会增加中风发生和复发的风险，并使中风的预后恶化。虽然 SDB 与高血压和心律失常的发生率增加有关，而这两者都是传统的中风危险因素，但 SDB 也是中风的独立危险因素。SDB 的一些特征可能会增加中风的风险，包括间歇性低氧血症、交感神经激活、脑自动调节的变化、氧化应激、全身炎症、高凝状态和内皮功能障碍。另一方面，中风也可能导致新的 SDB 或加重先前存在的 SDB。SDB 的持续气道正压通气治疗可能对降低中风风险和改善中风后的神经功能结局有有益作用。应尽早考虑进行治疗，尤其是在中风后存在 SDB 的情况下。本综述的目的是强调 SDB 与中风之间的紧密联系，并提高临床医生对所有中风幸存者都可能存在 SDB 的认识。
