Devin L Brown1, Azadeh Yadollahi2,3, Kevin He4, Yuliang Xu4, Bryan Piper2,3, Erin Case5, Ronald D Chervin6, Lynda D Lisabeth1,5. 1. Stroke Program (D.L.B., L.D.L.), University of Michigan, Ann Arbor. 2. University Health Network-Toronto Rehabilitation Institute, Canada (A.Y., B.P.). 3. Institute of Biomaterials & Biomedical Engineering, University of Toronto, Canada (A.Y., B.P.). 4. Department of Biostatistics (K.H., Y.X.), School of Public Health, University of Michigan, Ann Arbor. 5. Department of Epidemiology (E.C., L.D.L.), School of Public Health, University of Michigan, Ann Arbor. 6. Sleep Disorders Center and Department of Neurology (R.D.C.), University of Michigan, Ann Arbor.
Abstract
Background and Purpose: Overnight shifts of fluid from lower to upper compartments exacerbate obstructive sleep apnea (OSA) in some OSA populations. Given the high prevalence of OSA after stroke, decreased mobility and use of IV fluids among hospitalized patients with stroke, and improvement in OSA in the months after stroke, we hypothesized that overnight fluid shifts occur and are associated with OSA among patients with subacute ischemic stroke. Methods: Within a population-based project, we performed overnight sleep apnea tests (ApneaLink Plus) during ischemic stroke hospitalizations. Before sleep that evening, and the following morning before rising from bed, we assessed neck and calf circumference, and leg fluid volume (bioimpedance spectroscopy). The average per subject overnight change in the 3 fluid shift measurements was calculated and compared with zero. Linear regression was used to test the crude association between each of the 3 fluid shift measurements and the respiratory event index (REI). Results: Among the 292 participants, mean REI was 24 (SD=18). Within individuals, calf circumference decreased on average by 0.66 cm (SD=0.75 cm, P<0.001), leg fluid volume decreased by a mean of 135.6 mL (SD=132.8 mL, P<0.001), and neck circumference increased by 0.20 cm (SD=1.71 cm, P=0.07). In men, when the overnight change of calf circumference was negative, an interquartile range (0.8 cm) decrease in calf circumference overnight was significantly associated with a 25.1% increase in REI (P=0.02); the association was not significant in women. The relationship between overnight change in leg fluid volume and REI was U shaped. Conclusions: This population-based, multicenter, cross-sectional study showed that in hospitalized patients with ischemic stroke, nocturnal rostral fluid shifts occurred, and 2 of the 3 measures were associated with greater OSA severity. Interventions that limit overnight fluid shifts should be tested as potential treatments for OSA among patients with subacute ischemic stroke.
Background and Purpose: Overnight shifts of fluid from lower to upper compartments exacerbate obstructive sleep apnea (OSA) in some OSA populations. Given the high prevalence of OSA after stroke, decreased mobility and use of IV fluids among hospitalized patients with stroke, and improvement in OSA in the months after stroke, we hypothesized that overnight fluid shifts occur and are associated with OSA among patients with subacute ischemic stroke. Methods: Within a population-based project, we performed overnight sleep apnea tests (ApneaLink Plus) during ischemic stroke hospitalizations. Before sleep that evening, and the following morning before rising from bed, we assessed neck and calf circumference, and leg fluid volume (bioimpedance spectroscopy). The average per subject overnight change in the 3 fluid shift measurements was calculated and compared with zero. Linear regression was used to test the crude association between each of the 3 fluid shift measurements and the respiratory event index (REI). Results: Among the 292 participants, mean REI was 24 (SD=18). Within individuals, calf circumference decreased on average by 0.66 cm (SD=0.75 cm, P<0.001), leg fluid volume decreased by a mean of 135.6 mL (SD=132.8 mL, P<0.001), and neck circumference increased by 0.20 cm (SD=1.71 cm, P=0.07). In men, when the overnight change of calf circumference was negative, an interquartile range (0.8 cm) decrease in calf circumference overnight was significantly associated with a 25.1% increase in REI (P=0.02); the association was not significant in women. The relationship between overnight change in leg fluid volume and REI was U shaped. Conclusions: This population-based, multicenter, cross-sectional study showed that in hospitalized patients with ischemic stroke, nocturnal rostral fluid shifts occurred, and 2 of the 3 measures were associated with greater OSA severity. Interventions that limit overnight fluid shifts should be tested as potential treatments for OSA among patients with subacute ischemic stroke.
Authors: Stefania Redolfi; Isabelle Arnulf; Michel Pottier; Jacques Lajou; Isabelle Koskas; T Douglas Bradley; Thomas Similowski Journal: Am J Respir Crit Care Med Date: 2011-11-01 Impact factor: 21.405
Authors: Devin L Brown; Fatema Shafie-Khorassani; Sehee Kim; Ronald D Chervin; Erin Case; Lewis B Morgenstern; Azadeh Yadollahi; Susan Tower; Lynda D Lisabeth Journal: Stroke Date: 2019-03 Impact factor: 7.914
Authors: Rosilene M Elias; T Douglas Bradley; Takatoshi Kasai; Shveta S Motwani; Christopher T Chan Journal: Nephrol Dial Transplant Date: 2011-11-05 Impact factor: 5.992
Authors: C-Y Hsu; M Vennelle; H-Y Li; H M Engleman; M S Dennis; N J Douglas Journal: J Neurol Neurosurg Psychiatry Date: 2006-06-13 Impact factor: 10.154
Authors: Oded Friedman; T Douglas Bradley; Christopher T Chan; Robert Parkes; Alexander G Logan Journal: Hypertension Date: 2010-11-08 Impact factor: 10.190
Authors: Edward C Jauch; Jeffrey L Saver; Harold P Adams; Askiel Bruno; J J Buddy Connors; Bart M Demaerschalk; Pooja Khatri; Paul W McMullan; Adnan I Qureshi; Kenneth Rosenfield; Phillip A Scott; Debbie R Summers; David Z Wang; Max Wintermark; Howard Yonas Journal: Stroke Date: 2013-01-31 Impact factor: 7.914
Authors: Lewis B Morgenstern; Melinda A Smith; Lynda D Lisabeth; Jan M H Risser; Ken Uchino; Nelda Garcia; Paxton J Longwell; David A McFarling; Olubumi Akuwumi; Areej Al-Wabil; Fahmi Al-Senani; Devin L Brown; Lemuel A Moyé Journal: Am J Epidemiol Date: 2004-08-15 Impact factor: 4.897
Authors: Devin L Brown; Mollie McDermott; Ashkan Mowla; Lindsey De Lott; Lewis B Morgenstern; Kevin A Kerber; Garnett Hegeman; Melinda A Smith; Nelda M Garcia; Ronald D Chervin; Lynda D Lisabeth Journal: Sleep Med Date: 2014-05-02 Impact factor: 3.492
Authors: Jordan R Moon; Sarah E Tobkin; Michael D Roberts; Vincent J Dalbo; Chad M Kerksick; Michael G Bemben; Joel T Cramer; Jeffrey R Stout Journal: Nutr Metab (Lond) Date: 2008-03-19 Impact factor: 4.169