University of Pennsylvania, PA, United States.
Aggarwal Hospital, Jagadhri, India.
J Stroke Cerebrovasc Dis. 2022 May;31(5):106383. doi: 10.1016/j.jstrokecerebrovasdis.2022.106383. Epub 2022 Feb 18.
The abnormalities in the vertebrobasilar arterial system such as enlarged, tortuous or dilated arteries and aneurysms can generate pressure and distortion of brain structures especially in the medulla and pons. This brainstem compression by abnormal arteries can lead to various sleep disorders such as sleep related hypoventilation, central sleep apnea, obstructive sleep apnea, and positional sleep apnea.
To highlight brainstem compression due to vascular abnormalities as a cause of sleep disordered breathing.
Manuscripts were identified using the National Institutes of Health PubMed literature search system. Search terms included sleep disorders, vertebrobasilar dolichoectasia, tortuous vertebral arteries, vertebrobasilar aneurysms, vascular compression and brainstem compression. Inclusion criteria required that the articles were written in English, highlighted both a sleep disorder and a vascular abnormality.
The literature search resulted in 10 case reports where vascular abnormalities were leading to sleep disorders. Out of these: four patients had central sleep apnea; three had sleep related hypoventilation; one had positional central sleep apnea; one had positional central apnea along with obstructive sleep apnea; and one had obstructive sleep apnea. The various vascular lesions identified were: megadolichobasilar artery; dolichoectatic vertebral artery; fusiform vertebrobasilar aneurysm; tortuous and elongated vertebral arteries; calcified vertebral artery and medullary telangiectasia.
Arterial compression of the respiratory centers in the pons and medulla can lead to central sleep apnea. Obstructive sleep apnea can also result from vascular compression of the medulla. The proposed mechanism is compression of nucleus ambiguus which controls pharyngeal tone. Pressure on cranial nerves IX and X can lead to pharyngeal dysfunction leading to occlusive apnea.
椎基底动脉系统的异常，如增粗、迂曲或扩张的动脉和动脉瘤，可对脑结构，尤其是延髓和脑桥造成压力和扭曲。异常动脉对脑桥的压迫可导致各种睡眠障碍，如与睡眠相关的低通气、中枢性睡眠呼吸暂停、阻塞性睡眠呼吸暂停和体位性睡眠呼吸暂停。
强调由于血管异常引起的脑干压迫是睡眠呼吸障碍的一个原因。
使用美国国立卫生研究院 PubMed 文献检索系统确定文献。检索词包括睡眠障碍、椎基底动脉延长扩张、迂曲椎动脉、椎基底动脉瘤、血管压迫和脑干压迫。纳入标准要求文章为英文，同时突出睡眠障碍和血管异常。
文献检索结果显示 10 例血管异常导致睡眠障碍的病例报告。其中：4 例患者患有中枢性睡眠呼吸暂停；3 例患者患有睡眠相关低通气；1 例患者患有体位性中枢性睡眠呼吸暂停；1 例患者患有体位性中枢性呼吸暂停合并阻塞性睡眠呼吸暂停；1 例患者患有阻塞性睡眠呼吸暂停。确定的各种血管病变包括：巨长基底动脉；延长扩张椎动脉；梭形椎基底动脉瘤；迂曲和延长椎动脉；钙化椎动脉和延髓毛细血管扩张症。
延髓和脑桥呼吸中枢的动脉压迫可导致中枢性睡眠呼吸暂停。血管对延髓的压迫也可导致阻塞性睡眠呼吸暂停。其发病机制可能是延髓疑核受压，从而影响咽肌张力。颅神经 IX 和 X 的受压可导致咽功能障碍，导致阻塞性呼吸暂停。
