Mecanismos fisiopatológicos involucrados en la relación entre la apnea-hipopnea del sueño y el infarto cerebral

Marbelys Guevara Rodríguez

Texto completo:

PDF (239 KB) HTML

Resumen

OBJETIVO: Describir los mecanismos fisiopatológicos en la relación entre la apnea-hipopnea del sueño y el infarto cerebral.

ADQUISICIÓN DE LA EVIDENCIA: Se realizó una búsqueda bibliográfica en la base de datos Medline entre 2014 y 2019, mediante los términos ischemic stroke prognosis o outcome; sleep apnea o sleep disordered breathing o apnea-hipopnea índex, y pathophysiology mechanistic o endothelial dysfunction o inflammation. Fueron encontrados 41 artículos originales, 5 metaanálisis y 4 revisiones sistemáticas.

RESULTADOS: Por cada unidad que aumente el índice de apnea-hipopnea, el riesgo de infarto cerebral se incrementa en un 6 %. Los episodios de apnea agravan la hipoperfusión en el área cerebral lesionada mediante un mecanismo de robo de flujo sanguíneo. Después de un primer accidente cerebrovascular, por cada una unidad adicional de índice de apnea-hipopnea, aumenta en un 5 % el riesgo de mortalidad. La escala NIHSS aumenta en 17,6 % en el grupo de pacientes apneicos con infarto cerebral en comparación con 12,5 % en pacientes no apneicos. La apnea del sueño severa se asocia independientemente a puntuaciones en la escala de Ranquin ≥2 a los 6 meses del ictus (OR: 9,7; 95 % CI: 1,3-73,8; p= 0,03).

CONCLUSIONES: Los principales mecanismos fisiopatológicos involucrados en la relación entre la apnea-hipopnea del sueño y el infarto cerebral fueron la hipoxemia e hipercapnia intermitente, la descarga catecolaminérgica, la disfunción autonómica, el estrés oxidativo, la disfunción endotelial y la inflamación sistémica. Por dicha razón, la apnea del sueño favorece el desarrollo de factores de riesgo vascular y predice resultados adversos después de un ictus isquémico en términos de mortalidad, severidad del déficit neurológico, complicaciones y recuperación funcional.

Palabras clave

apnea-hipopnea del sueño; infarto cerebral; mecanismos fisiopatológicos

Referencias

Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013 Jul [citado: 05/12/2017];44:2064-89. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/23652265

Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM. Statistical Update. Heart Disease and Stroke Statistics—2018 Update: A Report from the American Heart Association. Circulation. 2018 [citado: 0301/2018];137(12). Disponible en: https://doi.org/10.1161/CIR.0000000000000558

Ezejimofor MC, Chen YF, Kandala NB, Ezejimofor BC, Ezeabasili AC, Stranges S, et al. Stroke survivors in low- and middle-income countries: A meta-analysis of prevalence and secular trends. J Neurol Sci. 2016 May [citado: 12/12/2017];364:68-76. Disponible en: https://www.jns-journal.com/article/S0022-510X(16)30148-4/fulltext

Buergo Zuaznábar MA, Fernández Concepción O, Coutín Marre G, Torres Vidal RM. Epidemiology of cerebrovascular disease in Cuba, 1970-2006. MEDICC Rev. 2008 Apr [citado: 05/01/2017];10:33-8. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/21483367

Ministerio de Salud Pública. Dirección de registros médicos y estadísticas de salud. Anuario Estadístico de Salud 2015. La Habana: MINSAP; 2016 [citado: 08/10/2018]. Disponible en: http://files.sld.cu/dne/files/2016/04/Anuario_2015_electronico-1.pdf.

Birkbak J, Clark AJ, Rod NH. The Effect of Sleep Disordered Breathing on the Outcome of Stroke and Transient Ischemic Attack: A Systematic Review. J Clin Sleep Med. 2014 [citado: 13/10/2017];10(1). Disponible en: /http://jcsm.aasm.org/ViewAbstract.aspx?pid=29285

Good DC, Henkle JQ, Gelber D, Welsh J, Verhulst S. Sleep-disordered breathing and poor functional outcome after stroke. Stroke. 1996 [citado: 13/10/2017];27(2):252-9. Disponible en: http://www.beachsleep.com/PDF/Stroke3.pdf

Parra O, Arboix A, Montserrat JM, Quintó L, Bechich S, García-Eroles L. Sleep-related breathing disorders: impact on mortality of cerebrovascular disease. Eur Respir J. 2004 [citado: 13/10/2017];24:267-72. Disponible en: https://www.10.1183/09031936.04.00061503

Mansukhani MP1, Bellolio MF, Kolla BP, Enduri S, Somers VK, Stead LG. Worse outcome after stroke in patients with obstructive sleep apnea: an observational cohort study. J Stroke Cerebrovasc Dis. 2011 Sep-Oct [citado: 13/10/2017];20(5):401-5. Disponible en: https://www.10.1016/j.jstrokecerebrovasdis.2010.02.011

Tsivgoulis G, Alexandrov AV, Katsanos AH, Barlinn K, Mikulik R, Lambadiari V, et al. Noninvasive ventilatory correction in patients with acute ischemic stroke: a systematic review and meta-analysis. Stroke. 2017 [citado: 03/05/2018];48(8). Disponible en: http://stroke.ahajournals.org/content/strokeaha/48/8/2285.full.pdf?download=true

Chokroverty S. Medicina de los trastornos del sueño. Aspectos básicos, consideraciones técnicas y aplicaciones clínicas. En: Thorpy MJ. Clasificación de los trastornos del sueño l. 3 raed. España: Elsevier; 2011. p. 275-83.

Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, et al. Rules for Scoring Respiratory Events in Sleep: Update of the 2007 AASM. Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. Clin Sleep Med. 2012 Oct 15 [citado: 03/05/2018];8(5). Disponible en: https://www.10.5664/jcsm.2172

Kepplinger J, Barlinn K, Boehme AK, Gerber J, Puetz V, Pallesen LP, et al. Association of sleep apnea with clinically silent microvascular brain tissue changes in acute cerebral ischemia. J Neurol. 2014 Feb [citado: 02/02/2018];261(2):343-9. Disponible en: https://www.10.1007/s00415-013-7200-z

Song TJ, Park JH, Choi KH, Kim JH, Choi Y, Chang Y. Is obstructive sleep apnea associated with the presence of intracranial cerebral atherosclerosis. Sleep Breath. 2017 Sep [citado: 06/04/2018];21(3):639-46. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/28168435

Young T, Shahar E, Nieto FJ, Redline S, Newman AB, Gottlieb DJ. Sleep Heart Health Study Research Group. Predictors of sleep-disordered breathing in community-dwelling adults: The Sleep Heart Health Study. Arch Intern Med. 2002 [citado: 06/04/2018];162(8):893-900. Disponible en: https://www.10.1001/archinte.162.8.893

Wang X, Ouyang Y, Wang Z, Zhao G, Liu L, Bi Y. Obstructive sleep apnea and risk of cardiovascular disease and all‐cause mortality: a meta‐analysis of prospective cohort studies. Int J Cardiol. 2013 [citado: 04/10/2017];169(3):207-14. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/24161531

Hanninen MR, Niiranen TJ, Puukka PJ, Kesaniemi YA, Kahonen M, Jula AM. Target organ damage and masked hypertension in the general population: the Finn-Home study. J Hypertens. 2013 Jun [citado: 03/03/2018];31(6):1136-43. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/23466942

Dobrowolski P, Klisiewicz A, Florczak E, Prejbisz A, Przemysław B, Śliwiński P, et al. Independent association of obstructive sleep apnea with left ventricular geometry and systolic function in resistant hypertension: the RESIST-POL study. Sleep Med. 2014 Nov [citado: 03/03/2018];15(11):1302-8. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/25260432

Correa CM, Gismondi RA, Cunha AR, Neves MF, Oigman W. Twenty-four hour blood pressure in obese patients with moderate-to-severe obstructive Sleep Apnea. Arq Bras Cardiol. 2017 Oct [citado: 09/02/2018];109(4):313-20. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/25724552

May AM, Blackwell T, Stone PH, Stone KL, Cawthon PM, Sauer WH, et al. Central-sleep-disordered breathing predicts incident atrial fibrillation in older man. Am J Respir Crit Care Med. 2016 Apr [citado: 08/04/2018];193(7):783-91. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/26595380

Gottlieb DJ. Sleep apnea and the risk of atrial fibrillation recurrence: Structural or functional effects. J Am Heart Assoc. 2014 Feb [citado: 05/04/2018];3(1):e000654. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/24390147

Porto F, Saho Sakamoto Y, Salles C. Association between obstructive sleep apnea and myocardial infarction: a systematic review. Arq Bras Cardiol. 2017 Apr [citado: 07/04/2018];108(4):361-9. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/28380133

Schahab N, Sudan S, Schaefer C, Tiyerili V, Steinmetz M, Nickenig G, et al. Sleep apnoea is common in severe peripheral arterial disease. PLoS One. 2017 [citado: 08/04/2018];12(7):e0181733. Disponible en: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0181733

Tosur Z, Green D, De Chavez PJ, Knutson KL, Goldberger JJ, Zee P. The association between sleep characteristics and prothrombotic markers in a population-based sample: Chicago area slepp study. Sleep Med. 2014 Aug [citado: 05/03/2018];15(8):973-8. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/24924657

D'Aurea CVR, Cerazi BGA, Laurinavicius AG, Janovsky CCPS, Conceição RDO, Santos RD. Association of subclinical inflammation, glycated hemoglobin and risk for obstructive sleep apnea syndrome. Einstein (Sao Paulo). 2017 Apr-Jun [citado: 06/03/2018];15(2):136-40. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/28767909

Varadharaj S, Porter K, Pleister A, Wannemacher J, Sow A, Jarjoura D, et al. Endothelial Nitric Oxide Synthase uncoupling: a novel pathway in OSA induced vascular endothelial dysfunction. Respir Physiol Neurobiol. 2015 Feb [citado: 08/05/2018];207:40-7. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/25534145

Ifergane G, Ovanyan A, Toledano R, Goldbart A, Abu-Salame, Tal A, et al. Obstructive Sleep Apnea in Acute Stroke. A Role for Systemic Inflammation. Stroke. 2016 May [citado: 09/05/2018];47:1207-12. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/27073238

Jia L, Fan J, Cui W, Liu S, Lau WB, Ma X. Endothelial Cell-Derived Microparticles from Patients with Obstructive Sleep Apnea Hypoxia Syndrome and Coronary. Cell Physiol Biochem. 2017 [citado: 04/03/2018];43(6):2562-70. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/29130961

Wang J, Yu W, Gao M, Zhang F, Gu C, Yu Y, et al. Impact obstructive sleep apnea síndrome on endotelial function, arterial stiffening, and serum inflammatory markers: an uptaded meta-analysis and metaregression of 18 studies. J Am Heart Assoc. 2015 Nov [citado: 05/03/2018];4(11):e002454. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/26567373

Zeng F, Wang X, Hu W, Wang L. Association of adiponectin level and obstructive sleep apnea prevalence in obese subjects. Medicine (Baltimore). 2017 Aug [citado: 02/02/2018];96(32):e7784. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5556243/

Emin M, Wang G, Castagna F, Rodriguez López J, Wahab R, Wang J. Increased internalization of complement inhibitor CD59 may contribute to endotelial inflammation in obstructive sleep apnea. Sci Transl Med. 2016 Jan [citado: 08/03/2018];8(320):320-1. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/26738794

Zychowski KE, Sanchez B, Pedrosa RP, Lorenzi-Filho G, Drager LF, Polotsky VY. Serum from obstructive sleep apnea patients induces inflammatory responses in coronary artery endothelial cells. Atherosclerosis. 2016 Nov [citado: 07/04/2018];254:59-66. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/27693879

Seong Hwan A, Jin Ho K, Dong Uk K, In Seong C, Hyun Jin L, Hoo Won K. Interaction between Sleep-Disordered Breathing and Acute Ischemic Stroke. J Clin Neurol. 2013 Jan [citado: 08/03/2018];9(1):9-13. Disponible en: https://www.10.3988/jcn.2013.9.1.9

Kepplinger J, Barlinn K, Albright KC, Schrempf W, Amelia K, Lars-Peder Pallesen B, et al. Early sleep apnea screening on a stroke unit is feasible in patients with acute cerebral ischemia. J Neurol. 2013 [citado: 08/03/2018];260(5):1343-50. Disponible en: https://www.10.1007/s00415-012-6803-0

Lisabeth LD, Sánchez BN, Chervin RD, Morgenstern LB, Zahuranec DB, Tower SD, et al. High prevalence of poststroke sleep-disordered breathing in Mexican Americans. Sleep Med. 2017 [citado: 08/03/2018];33:97-102. Disponible en: https://www.10.1016/j.sleep.2016.01.010

Festic N, Alejos D, Bansal V, Mooney L, Fredrickson PA, Castillo PR. Sleep Apnea in Patients Hospitalized With Acute Ischemic Stroke: Under recognition and Associated Clinical Outcomes. J Clin Sleep Med. 2018 Jan 15 [citado: 06/04/2018];14(1):75-80. Disponible en: https://www.10.5664/jcsm.6884

Alexandrov AV, Sharma VK, Lao AY, Tsivgoulis G, Malkoff MD, Alexandrov AW. Reversed Robin Hood syndrome in acute ischemic stroke patients. Stroke. 2007 Nov [citado: 04/03/2018];38(11):3045-48. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/17916768

Rusek L, Svobodova K, Olson LJ, Ludka O, Cundrle JR. Increased microcirculatory heterogeneity in patients with obstructive sleep apnea. PLoS One. 2017 Sep [citado: 07/03/2018];12(9):e0184291. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/28863183

Ramos AR, Cabral D, Lee DJ, Sacco RL, Rundek T. Cerebrovascular pulsatility in patients with sleep-disordered breathing. Sleep Breath. 2013 May [citado: 07/01/2018];17(2):723-6. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/22773271

Hermann DM. Bassetti CL. Role of sleep-disordered breathing and sleep - wake disturbances for stroke and stroke recovery. Neurology. 2016 Sep 27 [citado: 10/05/2018];87(13):1407-16. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/27488603

Dewan NA, Nieto FJ, Somers VK. Intermittent hypoxemia and OSA, implications for comorbidities. Chest. 2015 Jan [citado: 04/04/2018];147(1):266-74. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/25560865

Steinhorst AP, Goncalves SC, Oliveira AT, Massierer D, Gus M, Fuchs SC. Influence of sleep apnea severity on blood pressure variability of patients with hypertension. Sleep Breath. 2014 May [citado: 08/04/2018];18(2):397-401. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/24092449

Toraldo DM, De Nuccio F, De Benedetto M, Scoditti E. Obstructive sleep apnoea syndrome: a new paradigm by chronic nocturnal intermittent hypoxia and sleep disruption. Acta Otorhinolaryngol Ital 2015 Apr [citado: 06/05/2017];35(2):69-74. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/pmc4443563/

Fox H, Bitter T, Horstkotte D, Oldenburg O. Sleep-disordered breathing and arrhythmia in heart failure patients. Sleep Med Clin. 2017 Jun [citado: 09/02/2018];12(2):229-41. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/28477777

Camilo MR, Sander HH, Eckeli AL. Sleep-disordered breathing among acute ischemic stroke patients in Brazil. Sleep Med. 2016 Mar [citado: 08/02/2018];19:8-12. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/27198940

Buratti L, Luzzi S, Petrelli C, Baldinelli S, Viticchi G, Provinciali L, et al. Obstructive Sleep Apnea Syndrome: An Emerging Risk Factor for Dementia. CNS Neurol Disord Drug Targets. 2016 [citado: 10/05/2018];15(6):678-82. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/27189468

Duffy SL, Lagopoulus J, Terpening Z, Lewis SJ, Grunstein R, Mowszowski L, et al. Association of anterior cingulate glutathione with sleep apnea in older adults at-risk for dementia. Sleep. 2016 [citado: 31/01/2018];39(4):899-906. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/26856906

Kernan WN, Ovbiagele B, Black HR. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014 May 1 [citado: 04/10/2017];45:2160-236. Disponible en: http://stroke.ahajournals.org/content/strokeaha/early/2014/04/30/STR.0000000000000024.full.pdf?download=true





Licencia de Creative Commons
Este obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial 4.0 Internacional.