Summary and Conclusion
Silent brain infarction (SBI) has been described as brain infarcts that are observed on either computed tomographic or MRI scans in the absence of any corresponding, clinically apparent cerebrovascular ischemic event.
Obstructive sleep apnea (OSA) is a form of sleep disordered breathing with a high prevalence rate and OSA is associated with hypertension, coronary artery disease, stroke, peripheral vascular disease, heart failure, and arrhythmias.
This study was designed to detect the occurance of silent cerebral infarction and measure the fibrinogen level in patients with obstructive sleep apnea syndrome.
This study was performed in the chest departement of Benha University Hospital in the period between February 2017 and January 2019.
The study included 170 patients with obstructive sleep apnea.
Inclusion criteria:
Cases with obstructive sleep apnea more than 18 years old, both males and females are included & accept to give consent to be included in the study.
Exclusion criteria:
1. Patients with history of cerebrovascular stroke.
2. Patients with central sleep apnea.
3. Patients with mixed sleep apnea.
4. Comorbid inflammatory diseases (eg: SLE, Rheumatoid arthritis).
5. Comorbid infection.
6. Patients with renal or hepatic impairment.
7. Patients unable or refuse to give formal consent.
All patients were subjected to the following:
• Medical history taking, general and neurological examination.
• Polysomnography at the sleep laboratory of the Chest Department of our Faculty of Medicine to confirm the diagnosis of OSA.
An overnight polysomnography will be performed with continuous monitoring by a sleep technician. The system consists of 6 channels of EEG and 2 channels of EOG, recording submental EMG, oronasal air flow, thoracic and abdominal movements, ECG, pulse oximeter oxygen saturation, tibial EMG& body position.
• Lab investigations:
1. Complete blood count.
2. Random blood sugar level.
3. Serum electrolytes level (Na, K, Ca).
4. Liver function test (AST, ALT, albumin, bilirubin).
5. Kidney function test (urea, creatinine &uric acid).
6. Lipid profile (TG, cholesterol).
7. Indicators of inflammation as TLC, Rh factor and ESR.
8. Plasma fibrinogen level measurement: 2 ml of venous blood will be collected from patients on an anticoagulant (sodium citrate) under complete aseptic conditions in sterile tubes, centrifuged to separate the plasma then plasma fibrinogen level will be measured by fibrinogen assay kits.
• Imaging investigation:
Brain MRI (T1-WI, T2-WI & FLAIR images).
Results were tabulated and statistically analyzed:
• The study group included 170 patients, 80 females& 90 males with mean age of 56.1%±12.5 years.
• All patients have OSA but 48.8% of the studied sample have SBI & 68% of cases with SBI have high fibrinogen level.
• Of the studied sample 18.2% have DM, 49.4% have HTN & 35.3 % are smokers with mean BMI 38.8 ranging from 25 to 59.
• There is a significant relation between SBI & DM, high Fibrinogen level, Snoring index ≥172, Snoring intensity and AHI.
Conclusion
We concluded the following from this study:
• There is correlation between SBI & OSA.
• Patients with SBI and OSA have elevated fibrinogen levels which correlate positively with indices of sleep apnea severity.
• The related increase in coagulation activity and vasoreactivity may represent a possible pathophysiological mechanism behind the increased vascular morbidity of patients with OSA.
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