Resting state functional thalamic connectivity abnormalities in patients with post-stroke sleep apnoea: a pilot case-control study

OBJECTIVE: Sleep apnoea is common after stroke, and has adverse effects on the clinical outcome of affected cases. Its pathophysiological mechanisms are only partially known. Increases in brain connectivity after stroke might influence networks involved in arousal modulation and breathing control. The aim of this study was to investigate the resting state functional MRI thalamic hyper connectivity of stroke patients affected by sleep apnoea (SA) with respect to cases not affected, and to healthy controls (HC). PATIENTS AND METHODS: A series of stabilized strokes were submitted to 3T resting state functional MRI imaging and full polysomnography. The ventral-posterior-lateral thalamic nucleus was used as seed. RESULTS: At the between groups comparison analysis, in SA cases versus HC, the regions significantly hyper-connected with the seed were those encoding noxious threats (frontal eye field, somatosensory association, secondary visual cortices). Comparisons between SA cases versus those without SA, revealed in the former group significantly increased connectivity with regions modulating the response to stimuli independently to their potentiality of threat (prefrontal, primary and somatosensory association, superolateral and medial-inferior temporal, associative and secondary occipital ones). Further significantly functionally hyper connections were documented with regions involved also in the modulation of breathing during sleep (pons, midbrain, cerebellum, posterior cingulate cortices), and in the modulation of breathing response to chemical variations (anterior, posterior and para-hippocampal cingulate cortices). CONCLUSIONS: Our preliminary data support the presence of functional hyper connectivity in thalamic circuits modulating sensorial stimuli, in patients with post-stroke sleep apnoea, possibly influencing both their arousal ability and breathing modulation during sleep

Adherence issues related to sublingual immunotherapy as perceived by allergists

Objectives: Sublingual immunotherapy (SLIT) is a viable alternative to subcutaneous immunotherapy to treat allergic rhinitis and asthma, and is widely used in clinical practice in many European countries. The clinical efficacy of SLIT has been established in a number of clinical trials and meta-analyses. However, because SLIT is self-administered by patients without medical supervision, the degree of patient adherence with treatment is still a concern. The objective of this study was to evaluate the perception by allergists of issues related to SLIT adherence. Methods: We performed a questionnaire-based survey of 296 Italian allergists, based on the adherence issues known from previous studies. The perception of importance of each item was assessed by a VAS scale ranging from 0 to 10. Results: Patient perception of clinical efficacy was considered the most important factor (ranked 1 by 54% of allergists), followed by the possibility of reimbursement (ranked 1 by 34%), and by the absence of side effects (ranked 1 by 21%). Patient education, regular follow-up, and ease of use of SLIT were ranked first by less than 20% of allergists. Conclusion: These findings indicate that clinical efficacy, cost, and side effects are perceived as the major issues influencing patient adherence to SLIT, and that further improvement of adherence is likely to be achieved by improving the patient information provided by prescribers. © 2010 Scurati et al, publisher and licensee Dove Medical Press Ltd

Targeting stroke awareness public campaigns.

[No abstract available

MRI and polysomnographic findings of patients affected by post-stroke sleep apnea

ABSTRACT Aim: The aim of our study was to to compare characteristics of stroke patients who presented Obstructive Sleep Apnea/Hypopnea (OSAH) to those of cases that presented Central Sleep Apnea/Hypopnea (CSAH) events at PSG, and to investigate relationships between the type of breathing disturb during sleep and the location of brain damage. Methods: Thirty four patients were submitted to clinical, neuroradiological and polisomnographyc study (PSG) after 4 months of stroke. A Sleep Disordered Breathing (SDB) was diagnosed in all cases with an AHI > 5. Patients were classified as affected by pre-dominantly OSAH (pOSAH), or predominantly CSAH (pCSAH). Comparisons were made among the groups and correlation analyses were done in each group. Significance was set at p < 0.005. Results: Twenty six patients with ischemic strokes had a SDB during sleep (56% embolic, 31% lacunar, 8% large artery, 8% with undeter-mined cause). The 61% of them showed pOSAH. Except for age, no statistical differences were found between the two groups as to clinical findings, risk factors for stroke, PSG data, or location of brain lesion. Correlation analysis outlined that in pOSAH cases the time interval from stroke to PSG (Δt), was inversely related to both TST (p = 0.017) and TSP (p = 0.039); in pCSAHs it was inversely related to SE Index (p = 0.021) and directly related to both ODI (p = 0.016) and with the n. of arrhythmias/h sleep (p = 0.033). In pCSAH, AHI did not correlate with ODI. Con-clusions: our data suggest that among cases with post stroke SDB are included 3 different subgroups of cases: OSAHs who terminate the obstruction by arousal, OSAHs who do not arise and alternate obstructive to central events, and CSAHs due to the direct effect of stroke on the breathing network; in a forth subgroup of cases the microstructure of sleep might be altered, with the consequent occurrence of sleep-related events. Further studies are needed to clarify these hypotheses as well as the role of post- stroke depression on the nature and occurrence of SDB after stroke

Sleep and media habits in school children and adolescents

oai:DiVA.org:hkr-17473The aim was to investigate the effects of sleep, television use and texting and computer habits on overweight, enjoyment of school and feelings of tiredness at school in school-age children and adolescents. This cross-sectional study was conducted in Sweden on school children aged 6-16. A questionnaire was distributed to the children (n=3011 in survey I; n=204 in survey II). Children who slept less than the median length of time reported enjoying school to a lesser degree. Fewer hours of sleep were found to be associated with having a bedroom television using the television or computer more than 2 hours a day, being tired at school and having difficulties in sleeping and waking up. Overweight and obesity were found in 15.8% of the study population; obesity alone was found in 3.1%. Relationships between lifestyle factors and overweight were studied using multivariate logistic regression analysis. Having a bedroom television and using the television more than 2 hours per day were found to be associated with overweight but using the computer more than 2 hours a day was not. About 61% of the students aged 16 reported checking Facebook or social media at least once a day and 27% reported doing so for more than 10 times a day. One fourth of the students aged 16 had a habit of sending or receiving text messages at night at least once a week. Texting at night and frequent checking of Facebook and social media sites were related to sleep problems

May stroke cause a Complex Sleep Apnea-CompSA?

[No abstract available

Types of stroke recurrence in patients with ischemic stroke: a substudy from the PRoFESS trial.

Background Risk profiles for stroke recurrence are poorly characterized. Aims We determined the variation in the risk and type of recurrent stroke among index ischemic stroke subtypes, and whether index stroke subtype and conventional stroke risk factors were predictors of stroke recurrence. Methods Patients enrolled in the Prevention Regimen for Effectively Avoiding Second Strokes trial were included in this study. Results In 1794 patients' recurrent stroke subtypes were the same as the index stroke in: 48 center dot 3% of patients with large artery atherothrombosis stroke; 50% of patients with cardioembolic stroke; 48 center dot 7% of patients with small artery occlusion stroke; 8 center dot 1% of patients with stroke of other etiology, and 45 center dot 3% of patients with undetermined etiology stroke. Patients with cardioembolic stroke, who were unwilling or unable to take oral anticoagulants, had the greatest risk of stroke recurrence. Predictors of stroke recurrence in multivariable analysis were: older age and previous stroke among large artery atherothrombosis strokes; older age, male sex, previous stroke, previous transient ischemic attack, hypertension, diabetes, and tobacco use among small artery occlusion strokes; older age among cardioembolic strokes; atrial fibrillation and anti-diabetic medications among other etiology strokes; older age, previous stroke and atrial fibrillation among undetermined etiology strokes. Predictors of brain hemorrhage as recurrent stroke were index small artery occlusion stroke, older age, previous stroke, and antiplatelet treatment with aspirin plus extended-release dipyridamole. Conclusions Risk predictors for stroke recurrence and for brain hemorrhage differ by index ischemic stroke subtype, information that is important when initiating secondary prevention therapy