The Interplay of Dyslipidemia, Oxidative Stress, and Clinical Outcomes in Acute Ischemic Stroke Patients with and without Coronary Artery Disease.

We assessed lipid and lipoprotein profiles, along with oxidative stress (OS) parameters, in patients within the crucial 24 h period following an acute ischemic stroke (AIS), comparing those with and without coronary artery disease (CAD). We aimed to correlate these measures with clinical condition scales (NIHSS, mRS) post-AIS. This study included 27 AIS patients without CAD (AIS group) and 37 AIS patients with CAD (CAD-AIS group). Using polyacrylamide gel electrophoresis (Lipoprint system), we determined plasma LDL and HDL subfractions. Spectrophotometric methods were used to assess plasma antioxidant capacity, lipoperoxides, homocysteine (HC) levels, paraoxonase1, and catalase activities. We also measured urine isoprostanes and the activities of antioxidant enzymes (SOD, GPx) with commercial kits. CAD-AIS patients had notably higher HC levels, while there were no significant differences in lipoprotein subfractions and OS parameters between both groups. In the AIS group, mRS scores showed negative correlations with catalase, GPx activities, and total cholesterol. In the CAD-AIS group, atherogenic lipoproteins (IDLC, LDL2, LDL3-7) exhibited a significant positive correlation with mRS. This study underscores the role of dyslipidemia and OS in the development of AIS and CAD. It emphasizes the complex connections between specific biomarkers and post-stroke clinical outcomes. Our results suggest a significant impact of CAD treatment on lipid profile but not on homocysteine levels. The traditional narrative associating high cholesterol as the ultimate risk factor for cardiovascular diseases needs to be challenged, at least with respect to neurological outcomes. These insights may guide more targeted therapeutic approaches.

Lipoprotein Subfractions Associated with Endothelial Function in Previously Healthy Subjects with Newly Diagnosed Sleep Apnea-A Pilot Study.

BACKGROUND: Obstructive sleep apnea (OSA) activates several pathophysiological mechanisms which can lead to the development of vascular diseases. Endothelial dysfunction (ED) is an initial step in the development of atherosclerosis. The association between ED and OSA has been described in several studies, even in previously healthy subjects. High-density lipoproteins (HDL) were generally considered to be atheroprotective, and low-density lipoprotein (LDL) to be an atherogenic component of lipoproteins. However, recent findings suggest a pro-atherogenic role of small HDL subfractions (8-10) and LDL subfractions (3-7). This study aimed to evaluate the relationship between endothelial function and lipid subfractions in previously healthy OSA subjects. MATERIAL AND METHODS: We prospectively enrolled 205 subjects with sleep monitoring. Plasma levels of triacylglycerols, total cholesterol, LDL, HDL, and their subfractions were assessed. Endothelial function was determined using peripheral arterial tonometry, and reperfusion hyperemia index (RHI) was assessed. RESULTS: Plasma levels of small and intermediate HDL subfractions have statistically significant pro-atherogenic correlations with endothelial function (p = 0.015 and p = 0.019). In other lipoprotein levels, no other significant correlation was found with RHI. In stepwise multiple linear regression analysis, small HDL (beta = -0.507, p = 0.032) was the only significant contributor in the model predicting RHI. CONCLUSIONS: In our studied sample, a pro-atherogenic role of small HDL subfractions in previously healthy subjects with moderate-to-severe OSA was proven.

No Difference in Sleep Desaturations Severity between Patients with Wake-Up and Non-Wake-Up Stroke: A PRESS Study Results.

BACKGROUND: Wake-up stroke (WUS) is a certain type of ischemic stroke in which a patient wakes up with a new neurological deficit due to cerebral ischemia. Sleep-disordered breathing is an independent risk factor for stroke, but the role of nocturnal oxygen desaturation in the pathophysiology of WUS is still insufficiently explored. According to several studies, patients with WUS have a significantly more severe sleep apnea syndrome and lower mean blood oxygen saturation. This study aimed to assess the severity of nocturnal desaturations in acute WUS and non-WUS patients using nocturnal pulse oximetry. MATERIAL AND METHODS: The cohort of 225 consecutive patients with neuroimaging-verified acute cerebral ischemia was prospectively enrolled. For further analyses, 213 subjects with known WUS/non-WUS status were selected (111 males and 102 females, average age 70.4 ±12.9, median baseline NIHSS = 5, median baseline mRS = 3). Patients were divided into the WUS group (n = 45) and the non-WUS group (n = 168). Overnight pulse oximetry was performed within 7 days of the stroke onset and data of both of the studied groups were compared. RESULTS: We found oxygen desaturation index (ODI) in the WUS group was 14.5 vs. 16.6 (p = 0.728) in the non-WUS group, basal O2 saturation was 92.2% vs. 92.5% (p = 0.475), average low O2 saturation was 90.3% vs. 89.6% (p = 0.375), minimal O2 saturation was 79.5% vs. 80.6% (p = 0.563), and time with O2 saturation <90% (T90) was 4.4% vs. 4.7% (p = 0.729). CONCLUSIONS: In the studied sample, monitored respiratory parameters including ODI, basal O2 saturation, average low O2 saturation, minimal O2 saturation, and T90 did not significantly differ between groups of WUS and non-WUS patients.

Adherence to positive airway pressure therapy initiated in the early subacute phase of ischemic stroke: a PRESS study follow-up.

BACKGROUND: Sleep-disordered breathing (SDB) is frequent in stroke patients and negatively affects stroke outcomes. Positive airway pressure (PAP) is the standard first-line treatment for patients with moderate-to-severe SDB. Despite a strong link between PAP adherence and therapeutic response, rates of post-stroke PAP adherence remain underexplored. Our study aimed to determine PAP adherence in patients undergoing comprehensive sleep apnea assessment and in-lab PAP titration in the early subacute phase of stroke. METHODS: In-hospital screening pulse oximetry was performed in consecutive patients with imaging-confirmed acute ischemic stroke. Subjects with desaturation index ≥ 15.3/h were selected as PAP candidates, and polysomnography was recommended. In a sleep laboratory setting, subjects underwent a diagnostic night followed by a titration night, and PAP therapy was initiated in subjects with apnea-hypopnea index ≥ 15/h. Adherence to PAP therapy was assessed at a 6-month follow-up visit. RESULTS: Of 225 consecutive patients with acute ischemic stroke, 116 were PAP candidates and 52 were able to undergo polysomnography. PAP therapy was initiated in 35 subjects. At a 6-month follow-up visit, out of 34 stroke survivors, PAP adherence (PAP use of > 4 h per night) was present in 47%. Except for the significantly lower minimal nocturnal O2 saturation determined from the polysomnography (74.6 ± 11.7% vs. 81.8 ± 5.2%, p = 0.025), no other significant difference in characteristics of the groups with PAP adherence and PAP non-adherence was found. CONCLUSIONS: Less than half of the stroke subjects remained adherent to PAP therapy at 6 months post-PAP initiation. Special attention to support adaptation and adherence to PAP treatment is needed in this group of patients.

Cognition in Patients with Sleep-Disordered Breathing: Can Obstructive and Central Apneic Pauses Play a Different Role in Cognitive Impairment?

BACKGROUND: There are increasing data linking sleep apnea with cognitive impairment. We aimed to clarify the relationship between sleep-disordered breathing (SDB) and cognition. Detailed attention was assigned to the potential role of central versus obstructive apneic pauses in cognitive impairment. METHODS: Patients with suspected SDB were prospectively enrolled, and a complex sleep study was performed that included overnight polysomnography. A revised version of Addenbrooke's Cognitive Examination (ACE-R) was used to assess cognition, evaluating overall cognition and individual subdomains. RESULTS: A total number of 101 participants were included in the study. In multivariate binary logistic regression analysis, obstructive apnea index ([OAI], 95% CI: 1.009-1.057, p = 0.008) was the only significant contributor to the model predicting attention deficit. The proportion of N1 stage of NREM sleep was the only significant contributor to the model predicting impaired verbal fluency (95% CI: 1.004-1.081, p = 0.029). No significant differences in sleep-related indices were observed in the remaining ACE-R subdomains. CONCLUSION: Except for verbal fluency and attention, we failed to find any significant association of sleep-related indices with the impairment in different cognitive subdomains. Our data suggest that impairment observed in verbal fluency is associated with a higher proportion of shallow NREM sleep, and attention deficit is associated with higher OAI. Obstructive respiratory episodes seem to play a more important role in cognitive impairment when compared to central ones.

Psychotic Episode and Schizophrenia in Slovakian Narcolepsy Database.

Narcolepsy type 1 (NT1), a central disorder of hypersomnolence, is associated with mood, anxiety or hyperactivity mental disorders. Association with psychotic episode or schizophrenia is rare and could be the source of diagnostic and therapeutic difficulties. Their frequency in the national narcolepsy database has not been systematically studied. The aim of the presented study was to calculate the frequency of NT1 patients diagnosed with psychosis and/or schizophrenia, to identify clinical characteristics of these cases, and to look for narcoleptic and psychotic symptoms during re-evaluation years later. We identified three (4%) cases diagnosed with a psychotic episode in the course of NT1. They were diagnosed with NT1 by age ≤18 years. In the re-evaluation (mean follow-up 9.8 years), we identified one case with a dual diagnosis of NT1 and schizophrenia; two cases were diagnosed with a solitary psychotic episode in the course of NT1. NT1 patients diagnosed in the age ≤18 years are at higher risk of psychotic episode, and this may be related to higher vulnerability during the ongoing neurodevelopmental period. Comorbid schizophrenia with NT1 in the Slovakian Narcolepsy Database was within the prevalence expected in the general population. The solitary psychotic episode in the course of NT1 did not reduce the possibility of subsequent symptomatic treatment afterwards.

The impact of sleep apnea syndrome on the altered lipid metabolism and the redox balance.

BACKGROUND: Obstructive sleep apnea (OSA) is a disorder with a significant risk for cardiovascular diseases. Dyslipidemia and redox imbalance belong to potential mechanisms linking OSA with the development of vascular diseases. The main aim of this study was the evaluation of the presence of lipid abnormalities in OSA patients, focusing on small dense low-density lipoprotein (LDL) and high-density lipoprotein (HDL) subfractions and determination of the redox imbalance by evaluating the marker of oxidative damage to plasma lipids - lipoperoxides. METHODS: The study included 15 male subjects with polysomnographically confirmed OSA and 16 male healthy controls. Plasma levels of total cholesterol, LDL and HDL and their subfractions, triacylglycerols and lipoperoxides were determined in all study individuals. Plasma LDL and HDL subfractions were separated by the Lipoprint system which is a polyacrylamide gel electrophoresis. Lipoperoxide levels were determined spectrophotometrically. RESULTS: OSA patients had significantly higher triacylglycerols, total cholesterol and LDL-cholesterol compared to healthy controls. HDL cholesterol was not significantly different. Of the LDL and HDL subfractions, OSA patients had significantly lower levels of atheroprotective LDL1 and large HDL subfractions and significantly higher levels of atherogenic small dense LDL3-7 and HDL8-10 subfractions. Lipoperoxide levels in patients with OSA were significantly elevated compared to healthy individuals. CONCLUSION: The lipoprotein pro-atherogenic phenotype was found in individuals with OSA characterized by increased levels of atherogenic lipoprotein subfractions and reduced levels of atheroprotective subfractions. In addition, a plasma redox imbalance was found in patients with OSA compared to controls by detecting higher oxidative damage to lipids. Abnormalities in lipoprotein levels in patients with OSA, as well as the redox imbalance, could lead to an acceleration of the atherosclerotic process in predisposed individuals and thus represent a significant risk factor for vasular diseases.

Cerebral blood flow in stroke patients with sleep apnea: any role of single-night positive airway pressure therapy?

BACKGROUND AND OBJECTIVE: Sleep-disordered breathing (SDB) is more prevalent in patients with stroke than in the population without a history of stroke. SDB is an independent risk factor for stroke. SDB impairs cerebral circulation by several mechanisms, and therefore possibly contributes to wake-up stroke. Ultrasound-tagged near-infrared spectroscopy (UT-NIRS) is a novel technology able to detect cerebral blood flow noninvasively and in real-time, displaying cerebral flow as cerebral flow index (CFI). Positive airway pressure (PAP) is the most effective approach in the treatment of SDB. We aimed to assess if single-night PAP impacts cerebral blood flow in sleep apnea patients after stroke and without a history of stroke. MATERIALS AND METHODS: 11 stroke patients and six controls with sleep apnea were enrolled. Stroke patients underwent overnight pulse oximetry within seven days after stroke. Desaturation index ≥ 15/hour was considered a positive screening. Six weeks after stroke, patients with positive screening underwent overnight polysomnography together with cerebral blood flow monitoring using UT-NIRS (diagnostic night) and also with additional PAP therapy (therapeutic night). RESULTS: The number of respiratory events decreased significantly in the group of stroke patients (apnea-hypopnea index [AHI] from 22.6±9.0 to 9.9±9.9) and controls (AHI from 58.1±14.9 to 7.0±9.7). CFI showed no significant changes between a diagnostic and therapeutic night in both groups. CONCLUSION: Despite the significant reduction of respiratory events, single-night PAP therapy does not improve overall cerebral blood flow, as defined by CFI.

Mood disorders in patients with hypersomnia: comparison of sleep-related breathing disorders versus narcolepsy.

BACKGROUND: Anxiety and depression are common comorbidities of excessive daytime sleepiness (EDS). Sleep-related breathing disorders (SBD) and central disorders of hypersomnolence (like narcolepsy [NA]) are the most frequent causes of EDS. This study aimed to evaluate mood disorders in NA patients compared to the subjects with EDS due to SBD (SBD-EDS). METHODS: In a retrospective analysis, subjects with NA and SBD-EDS were compared. All subjects underwent overnight polysomnography. NA patients underwent also multiple sleep latency test. Epworth sleepiness scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Becks questionnaire, and Zung depression scale were used to assess EDS, sleep quality, anxiety, and depression, respectively. RESULTS: We enrolled 24 NA and 41 SBD-EDS subjects. Values of PSQI and Zung scale were significantly worse in the SBD-EDS group than in NA patients (8.34±3.84 vs. 6.83±2.25, p=0.04; 46.86±12.69 vs. 40.81±11.27, p=0.03, respectively). Anxiety was significantly more frequent in SBD-EDS subjects compared to NA (63.4% vs. 37.5%, p=0.04). Out of all observed sleep-related indices, PSQI was the only factor, that significantly correlated with the measures of anxiety in both groups (NA: r=0.65, p=0.001; SBD-EDS: r=0.45, p=0.003) and with the measures of depression in NA subjects (r=0.51, p=0.01). In SBD-EDS group, measures of depression significantly correlated with PSQI (r=0.46, p=0.002), oxygen desaturation index (r=0.35, p=0.03), and ESS (r=0.5, p=0.001). CONCLUSION: Compared to NA, our results suggest significantly worse measures of depression and a significantly higher frequency of anxiety in the SBD-EDS population. Measures of anxiety and depression significantly correlated with quality of sleep in both groups.

Manifestation of Intracranial Lesions at High Altitude: Case Report and Review of the Literature.

Speidel, Victor, Jan Christoph Purrucker, and Katarína Klobucníková. Manifestation of intracranial lesions at high altitude: case report and review of the literature. High Alt Med Biol. 22:87-89, 2021.-A 32-year-old man trekked to the South Everest Base Camp (5,364 m) in Nepal. On the last day of the ascent, he noticed some dysesthesia in his right leg and descended by helicopter. He suffered a generalized seizure shortly after his descent, followed by right-sided hemiparesis and speech arrest. Without the possibility of cerebral imaging, the patient was given dexamethasone intravenously who showed a marked improvement and regained the ability to speak. Magnetic resonance imaging later revealed a lesion in the left frontotemporal region with compression of brain parenchyma and minimal paralesional edema. A meningioma was later surgically resected. Although seizures are a common first manifestation of meningioma, we argue that the exposure to high altitude may have contributed to his symptoms, either by increasing the peritumoral edema by pathophysiology similar to high-altitude cerebral edema (HACE) or lowering the seizure threshold otherwise. This case shows a before unknown pre-existing condition becoming symptomatic at high altitude and illustrates the necessity for careful and immediate evaluation of every patient with new onset of unexplained focal neurological deficits or seizures at high altitude in addition to unspecific neurological symptoms commonly associated with HACE such as headaches, dizziness, lightheadedness, or ataxia.

Association of lipoprotein levels with sleep apnea: role of autonomic dysfunction.

Objectives. Although multiple mechanisms, including autonomic dysfunction, seem to link sleep-disordered breathing (SDB) with dyslipidemia in animal studies, the data in clinical studies are limited. The aim of this study was to explore the association of lipoprotein levels with SDB measures in healthy habitual snorers. We supposed that autonomic dysfunction is the linking mechanism.Methods. We enrolled 110 previously healthy subjects with complaints of habitual snoring. To assess SDB, polysomnography was performed. Blood samples for the analysis of total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein cholesterol (LDL), and triglycerides (TG) were obtained in a fasting condition after the polysomnography. Baroreflex sensitivity (BRS) was used to assess the autonomic dysfunction.Results. In stepwise multiple linear regression analysis, minimal nocturnal blood oxygen saturation (beta=-0.240, p=0.020) and neck circumference (beta=0.224, p=0.03) were the only significant contributors in model predicting TG. SDB measures were not identified as significant contributors in models predicting TC, LDL, and HDL. We failed to find any significant difference in BRS in SDB subjects when compared according to the presence or absence of hypercholesterolemia/ hypertriglyceridemia. In SDB subjects, the area under the curve in a receiver operating curve to predict hypercholesterolemia and hypertriglyceridemia by BRS was 0.468 (95% CI: 0.328-0.608) and 0.425 (95% CI: 0.304-0.546), respectively.Conclusions. Our results suggest that minimal nocturnal blood oxygen saturation is significant contributor in model predicting TG. No significant decrease in BRS was found in SDB subjects with hypercholesterolemia and hypertriglyceridemia. In SDB subjects, the role of autonomic dys-function in the development of dyslipidemia remains controversial.

Sleep apnea prediction in acute ischemic stroke (SLAPS score): a derivation study.

BACKGROUND: Despite its high prevalence and negative impact, sleep-disordered breathing (SDB) remain commonly underdiagnosed and undertreated in stroke subjects. Multiple stroke comorbidities and risk factors, including obesity, hypertension, diabetes mellitus, ischemic heart disease, atrial fibrillation, and heart failure (H.F.) have been associated with SDB. This study aimed to examine associations of clinical and demographic characteristics with moderate-to-severe SDB (msSDB) in stroke patients and to develop a predictive score. METHODS: Consecutive patients with ischemic stroke were enrolled in an open, prospective study. SDB was assessed using standard polysomnography. Clinical and demographic characteristics, as well as findings from echocardiography, entered the analysis. Multivariate logistic regression models were used to examine the associations with msSDB. Based on the results, an original score to predict msSDB was proposed and tested. RESULTS: 120 patients with acute ischemic stroke (mean age: 64.0 ± 12.2 years, median NIHSS: 4) were included. Body-mass index (BMI), wake-up stroke onset (WUS), and diastolic dysfunction were independently associated with msSDB. A score allocating 1 point for BMI≥25 kg/m2 and <30 kg/m2, 2 points for BMI≥30 kg/m2, 1 point for WUS and 1 point for diastolic dysfunction resulted in an area under the curve of 0.81 (95% CI 0.71-0.90, p<0.001), sensitivity 82.9%, specificity 71.9% to identify stroke patients with msSDB. CONCLUSIONS: BMI, WUS, and diastolic dysfunction were associated with msSDB. A simple score might help to identify acute stroke patients with msSDB, who are usual candidates for positive airway pressure therapy.

Obstructive sleep apnea and hypertension: the role of gut microbiome.

Obstructive sleep apnea is common disorder affecting approximately one quarter of the common population. Prevalence is even higher in a population with increased vascular risk. Obstructive sleep apnea is a significant risk factor for hypertension, with approximately 50% of obstructive sleep apnea patients suffering hypertension. While the relationship between sleep apnea and hypertension has been firmly established, mechanisms linking these disorders are still poorly understood. Importance of sympathetic nervous system and renin-angiotensin-aldosterone system hyperactivity as well as endothelial dysfunction is suspected. There is increasing evidence supporting gut dysbiosis as one of the underlying mechanisms. Current article describes possible mechanisms linking obstructive sleep apnea with the development of hypertension. The role of gut microbiota in this process is discussed more closely.

Pulse oximetric routine examination of sleep apnea in acute stroke (PRESS).

BACKGROUND: Sleep-disordered breathing (SDB) is present in more than 70% of stroke patients. Despite its association with increased morbidity, mortality, and reduced functional outcomes, targeted assessment of SDB in stroke patients, remain controversial. Polysomnography ("gold standard" examination) is a technically demanding and costly test with limited availability. The use of screening questionnaires is limited due to low specificity and sensitivity. Pulse oximetry seems to be a sensible alternative. Our study aimed to assess the feasibility and predictive value of routine pulse oximetric screening for assessment of SDB in patients with acute stroke. METHODS: Patients with acute stroke were enrolled in an open, prospective study. A single-night pulse oximetric assessment was used for SDB screening. Subsequently, polysomnography was performed to confirm SDB. Moderate-to-severe SDB was defined as apnea-hypopnea index ≥15. RESULTS: Out of 420 enrolled patients, refusal to undergo examination was reported in 4 and non-cooperation during the investigation in 21 subjects. The area under the curve in a receiver operating curve to predict moderate-to-severe SDB by desaturation index (DI) was 0.86 (95% CI: 0.76-0.97), and optimal DI cut-off by Youden index was 15.3. Positive pulse oximetric screening (DI ≥ 15.3) had 90.5% sensitivity and 75% specificity to predict moderate-to-severe SDB. CONCLUSIONS: Our results suggest a good adherence of acute stroke patients to the pulse oximetric screening. Pulse oximetry represents a simple, cost-effective, and sensitive examination that might be used in stroke patients as an appropriate tool for further selection for targeted diagnostic and therapeutic processes of SDB in the sleep laboratory.

Narcolepsy in Slovakia - Epidemiology, clinical and polysomnographic features, comorbid diagnoses: a case-control study.

OBJECTIVE: An increase in the incidence of narcolepsy after the pandemic influenza with the H1N1 vaccination in 2009 resulted in an interest in narcolepsy epidemiology. The aim of the study was to examine the incidence and prevalence rates of narcolepsy and to describe the associated characteristics in Slovakia. METHODS: Epidemiology data were calculated for each year from 2000 to 2017 based on records found in specialized centres. In sum, 61 narcoleptic patients were diagnosed, of which 51 (84%) had narcolepsy type 1 (NT1). Clinical data and results of polysomnography (PSG), Human Leukocyte Antigen (HLA)-typing, hypocretin (HCRT)-1 levels and body mass index (BMI) were summarised and evaluated for NT1 and narcolepsy type2 (NT2). Later, 244 sex and age matched controls were chosen to evaluate the comorbid diagnoses. RESULTS: The prevalence of narcolepsy in 2017 in Slovakia was 10.47 (CI 95% 8.26-14) cases/million inhabitants, and the mean incidence rate (2000-2017) was 0.57 (CI 95% 0.4-0.74) cases/million inhabitants. Narcoleptic patients were comorbid with arterial hypertension (17%), ischemic heart disease (8%), dyslipidaemia (18%), diabetes mellitus type 2 (10%), cardiac arrhythmia/atrial fibrillation (5%), autoimmune disorders (20%), allergy (11%), malignancy (3%), headache (15%) and mental disorders (20%). Patients with narcolepsy showed double the excess prevalence in mental disorders (OR 2.15, p < 0.05), and dyslipidaemia (OR 2.22, p < 0.05). The presence of autoimmune disorders and allergy showed a mild increase in the narcolepsy group (OR 1.46, resp. 1.63). Hashimoto thyroiditis (HT) was the most frequent autoimmune disorder. CONCLUSIONS: Narcolepsy is a rare disorder in Slovakia. From the phenotype, genetic characteristics and comorbidities the disorder does not vary from other European countries.

Obstructive sleep apnea and dyslipidemia.

Obstructive sleep apnea is a sleep disorder characterized by repetitive partial or complete upper airway obstruction that lead to hemodynamic changes, arousals from sleep and intermittent hypoxia. Obstructive sleep apnea activates multiple pathways that lead to vascular disease. The vascular risk imposed by obstructive sleep apnea may be mediated through the metabolic consequences of sleep-disordered breathing. There is increasing evidence that obstructive sleep apnea is independently associated with dyslipidemia, a well known vascular risk factor. However, the role of obstructive sleep apnea in causality of dyslipidemia remains to be established. Current article focuses on possible mechanisms linking obstructive sleep apnea with the development of dyslipidemia. Possible role of obstructive sleep apnea as a therapeutic target to improve dyslipidemia is also discussed. Key words: dyslipidemia - obstructive sleep apnea.

The Comorbidity of Focal Epilepsy and Narcolepsy Type 1 - Two Case Reports.

The aim of this study is to remind the possibility of co-occurrence of epilepsy and narcolepsy. In the first case report, narcolepsy type 1 was diagnosed in 29-year-old female. After one year of the treatment with modafinil a new episodes of automatic behavior appeared. Patient was reevaluated and the diagnosis of focal epilepsy with partial complex seizures was established. Patient was treated with modafinil and lamotrigine and became seizure-free. In the second case report a 21-year-old female was referred with a typical history of narcolepsy type 1, but also with atypical episodes of gazing and automatic behavior with amnesia for these episodes. Narcolepsy type 1 and focal epilepsy was diagnosed. Some clinical symptoms of narcolepsy (cataplexy, automatic behavior, episodes of sleep attacks) need to be carefully analyzed by EEG and video-EEG not to overlook the epilepsy.

Excessive Daytime Sleepiness in Acute Ischemic Stroke: Association With Restless Legs Syndrome, Diabetes Mellitus, Obesity, and Sleep-Disordered Breathing.

STUDY OBJECTIVES: Sleep disorders are frequent in stroke patients. The prevalence of sleep-disordered breathing (SDB), excessive daytime sleepiness (EDS), and restless legs syndrome (RLS) among stroke survivors is up to 91%, 72%, and 15%, respectively. Although the relationship between EDS and SDB is well described, there are insufficient data regarding the association of EDS with RLS. The aim of this study was to explore the association between EDS, SDB, and RLS in acute ischemic stroke. METHODS: We enrolled 152 patients with acute ischemic stroke. Epworth Sleepiness Scale (ESS) was used to assess EDS. SDB was assessed using standard overnight polysomnography. All patients filled in a questionnaire focused on RLS. Clinical characteristics and medication were recorded on admission. RESULTS: EDS was present in 16 (10.5%), SDB in 90 (59.2%) and RLS in 23 patients (15.1%). EDS was significantly more frequent in patients with RLS in comparison with the patients without RLS (26.1% versus 7.8%, P = .008). ESS was significantly higher in the population with RLS compared to the population without RLS (7 [0-14] versus 3 [0-12], P = .032). We failed to find any significant difference in the frequency of EDS and values of ESS in the population with SDB compared to the population without SDB. Presence of RLS (beta = 0.209; P = .009), diabetes mellitus (beta = 0.193; P = .023), and body mass index (beta = 0.171; P = .042) were the only independent variables significantly associated with ESS in multiple linear regression analysis. CONCLUSIONS: Our results suggest a significant association of ESS with RLS, diabetes mellitus, and obesity in patients with acute ischemic stroke.

EU questionnaire to screen for obstructive sleep apnoea validated in Slovakia.

OBJECTIVE: Obstructive sleep apnoea syndrome (OSAS) associated with daytime sleepiness (DS) contributes to a higher incidence of motor vehicle accidents. Validation of fitness to drive in driving license applicants, with special concern regarding OSAS accompanied by excessive DS, became mandatory under new EU legislation in January 2016. The aim of the study was to translate and validate the recommended questionnaire to screen for OSAS (Q-OSAS) in the Slovak population. No data on any Q-OSAS validation has previously been published. METHODS: The translated Q-OSAS was administered to 311 Slovak patients prior to a planned overnight polysomnography. The diagnostic accuracy of the Q-OSAS in OSAS with an apnoea-hypopnoea index of 15 or more/h of sleep was evaluated by calculating the area under the ROC curve. RESULTS: The sensitivity and specificity of the cut-off at 10 points for the Q-OSAS was 57% and 67%, respectively, with an increase of sensitivity and a decrease of specificity with a lowering of the cut-off values. Excluding the Epworth Sleepiness Scale (ESS) score from the final statistics yielded the best sensitivity (77%), specificity (50%), and an area under the ROC curve (0.637) for the cut-off value of 8 points (an equivalent of 10 points with the full version of the Q-OSAS). CONCLUSION: The Q-OSAS is an appropriate screening tool to facilitate the screening of subjects potentially at risk from moderate and severe OSAS. A modified two-step interpretation of the Q-OSAS in Slovakia yielded the best sensitivity, and in the future could promote evaluation of sleepiness in sleep and wake disorders other than OSAS for fitness to drive.

Carotid intima-media thickness is not associated with homocysteine and vitamin D levels in obstructive sleep apnea.

Obstructive sleep apnea syndrome (OSA) is associated with increased vascular morbidity. Accelerated atherosclerosis might be one of the most important mechanisms linking OSA with the development of vascular disorders. Homocysteine (HCY) and vitamin D has been associated with atherogenesis. The aim of this study was to assess a possible association between the levels of HCY and vitamin D and the carotid intima-media thickness (cIMT), which is a known marker for subclinical atherosclerosis in patients with OSA. We prospectively enrolled 110 patients with the history of snoring, who underwent standard overnight polysomnography. Clinical characteristics of the population were recorded on admission and blood samples were obtained in the fasting condition following morning. Extracranial cIMT measurements were performed according to the standardized scanning protocol. A significant correlation was found between cIMT and apnea-hypopnea index (r = .276, p = .006), age (r = .486, p < .001), diabetes mellitus (r = .377, p < .001), coronary artery disease (r = .274, p = .006) and history of stroke (r = .251, p = .012). We failed to find any significant correlation between cIMT and the levels of HCY (r = .036, p = .724) or vitamin D (r = .027, p = .800). In conclusion, our data suggest that the association of cIMT with the severity of OSA can be influenced by multiple metabolic consequences of OSA including traditional and non-traditional risk factors. HCY and vitamin D do not seem to play a superior role in this process.