Pathophysiology of Central Apnoeas in Stroke Patients

NCT ID: NCT01723189

Last Updated: 2012-11-07

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

120 participants

Study Classification

OBSERVATIONAL

Study Start Date

2012-08-31

Study Completion Date

2014-08-31

Brief Summary

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40% of patients with Sleep Disorder Breathing (SDB) appearing during the acute phase of stroke show a respiratory pattern characterized by central apnoeas and/or periodic breathing.

Clinical studies conducted in patients with hearth failure and central apnoeas have demonstrated the pathogenetic central role of hypersensitivity of central and peripheral chemoreceptors in association with baroreflex hypersensitivity, expression of hyperactivity of sympathetic nervous system.

The joint study of chemoreflexes and baroreflexes in patients with central apneas during the acute and subacute phase of ischemic stroke represents, to our knowledge, a novelty in literature, that should supply useful elements to clarify the pathogenesis and the clinical and prognostic significance of these disorders.

Investigators expect a difference in the analysis of the baroreflexes and chemoreflexes in patients with ischemic stroke/transient ischemic attack (TIA) and central apnoeas than patients with ischemic stroke not accompanied by respiratory problems and compared with healthy controls.

Detailed Description

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Investigators expected to include in the study of 120 patients, aged between 35 and 75 years, belonging to the following diagnostic categories:

* 30 patients diagnosed with TIA / ischemic stroke within 7 days of admission and evidence at polysomnography of central apnoea (central apnoea index\> 10 / h, or Cheyne-Stokes breathing for more than 30% of total sleep time or mixed apneas with central apnoeas\> 50% of total apneas)
* 30 patients diagnosed with TIA / ischemic stroke within 7 days of admission and evidence at polysomnography of obstructive sleep apnea (apnea-hypopnea index\> 20 / h)
* 30 patients diagnosed with TIA / stroke within 7 days of admission and no evidence of sleep respiratory disorders at polysomnography
* 30 healthy controls matched for age, sex, race and BMI.

For the study of the baroreflexes, patients will be subjected to continuous monitoring of ECG, beat-to-beat blood pressure measured at the finger by Portapress system, respiratory rate and ventilation by pneumotachograph. The tests will be performed in the supine position and then repeated in a sitting position. Data from such monitoring will be used for analysis of the harmonic components of the cardiac rate (RR interval) and the variability of blood pressure and respiratory rate, through the method of auto regressive analysis.

For the study of central chemoreceptors, investigator will use the steady-state hypercapnic test, which measures the ventilatory response to hypercapnia at a constant level of Oxygen partial pressure (PaO2). The ventilatory response to hypercapnia is calculated by the method of linear regression and is represented by the angular coefficient of the straight line that describes the variation of ventilation for each variation of alveolar carbon dioxide partial pressure (PCO2).

For the study of peripheral chemoreceptors will be used the single-breath or transient hypercapnia test. The patient makes a single deep breath of a gas mixture containing 85% O2 and 15% CO2 and then resume normal breathing. It is expected, therefore, a period of 3 seconds, required because the gases contained in the mixture may come from the pulmonary circulation to the peripheral circulation, at the level of peripheral chemoreceptors. The ventilation is recorded within the next 20-30 seconds, because in this time interval is evaluated only the sensitivity of the peripheral chemoreceptors, being the latency of response of the central chemoreceptors greater than 1 minute.

Conditions

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Central Apnoeas Stroke Patients

Keywords

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central apnoeas stroke

Study Design

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Observational Model Type

CASE_CONTROL

Study Time Perspective

PROSPECTIVE

Study Groups

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Central Apnoeas Patients

• 30 patients diagnosed with TIA / ischemic stroke within 7 days of admission and evidence at polysomnography of central apnoea (central apnoea index\> 10 / h, or Cheyne-Stokes breathing for more than 30% of total sleep time or mixed apneas with central apnoeas\> 50% of total apneas)

No interventions assigned to this group

Obstructive apnoea patients

• 30 patients diagnosed with TIA / ischemic stroke within 7 days of admission and evidence at polysomnography of obstructive sleep apnea (apnea-hypopnea index\> 20 / h)

No interventions assigned to this group

No SDB patients

* • 30 patients diagnosed with TIA / stroke within 7 days of admission and no evidence of sleep respiratory disorders at polysomnography

No interventions assigned to this group

Healthy controls

• 30 healthy controls matched for age, sex, race and BMI.

No interventions assigned to this group

Eligibility Criteria

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Inclusion Criteria

* Patients

* ≥35 years old and \< 75 years old
* with clinical diagnosis of TIA or ischemic stroke
* admitted in a Stroke Unit within 2 days from onset of symptoms
* signed Informed Consent

Exclusion Criteria

* Patients

* with unstable clinical situation (cardio-respiratory or life-threatening medical conditions)
* currently on continuous positive airway pressure (CPAP) or on CPAP during the last 3 months before stroke
* with non-ischemic events (intracerebral/subarachnoid haemorrhage)
* Patients with coma/stupor
Minimum Eligible Age

35 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Advisory Board of scientific Reserch Ente Ospedaliero Cantonale, ABREOC

UNKNOWN

Sponsor Role collaborator

University of Geneva, Switzerland

OTHER

Sponsor Role collaborator

University of Milan

OTHER

Sponsor Role collaborator

MPons

OTHER_GOV

Sponsor Role lead

Responsible Party

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MPons

Professor

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Marco Pons, MD

Role: PRINCIPAL_INVESTIGATOR

Ospedale Regionale di Lugano - Civico

Locations

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Ospedale Civico

Lugano, Canton Ticino, Switzerland

Site Status RECRUITING

Countries

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Switzerland

Central Contacts

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Marco Pons, Professor

Role: CONTACT

Phone: 0041-91-8116449

Email: [email protected]

Alessia Riglietti, MD

Role: CONTACT

Phone: 0041-91-8116317

Email: [email protected]

Facility Contacts

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Marco Pons, MD

Role: primary

Alessia Riglietti, MD

Role: backup

References

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Bassetti CL. Sleep and stroke. Semin Neurol. 2005 Mar;25(1):19-32. doi: 10.1055/s-2005-867073.

Reference Type BACKGROUND
PMID: 15798934 (View on PubMed)

Giannoni A, Emdin M, Poletti R, Bramanti F, Prontera C, Piepoli M, Passino C. Clinical significance of chemosensitivity in chronic heart failure: influence on neurohormonal derangement, Cheyne-Stokes respiration and arrhythmias. Clin Sci (Lond). 2008 Apr;114(7):489-97. doi: 10.1042/CS20070292.

Reference Type BACKGROUND
PMID: 17961123 (View on PubMed)

Nopmaneejumruslers C, Kaneko Y, Hajek V, Zivanovic V, Bradley TD. Cheyne-Stokes respiration in stroke: relationship to hypocapnia and occult cardiac dysfunction. Am J Respir Crit Care Med. 2005 May 1;171(9):1048-52. doi: 10.1164/rccm.200411-1591OC. Epub 2005 Jan 21.

Reference Type BACKGROUND
PMID: 15665317 (View on PubMed)

Siccoli MM, Valko PO, Hermann DM, Bassetti CL. Central periodic breathing during sleep in 74 patients with acute ischemic stroke - neurogenic and cardiogenic factors. J Neurol. 2008 Nov;255(11):1687-92. doi: 10.1007/s00415-008-0981-9. Epub 2008 Nov 13.

Reference Type BACKGROUND
PMID: 19009334 (View on PubMed)

Robinson TG, James M, Youde J, Panerai R, Potter J. Cardiac baroreceptor sensitivity is impaired after acute stroke. Stroke. 1997 Sep;28(9):1671-6. doi: 10.1161/01.str.28.9.1671.

Reference Type BACKGROUND
PMID: 9303008 (View on PubMed)

Eames PJ, Blake MJ, Dawson SL, Panerai RB, Potter JF. Dynamic cerebral autoregulation and beat to beat blood pressure control are impaired in acute ischaemic stroke. J Neurol Neurosurg Psychiatry. 2002 Apr;72(4):467-72. doi: 10.1136/jnnp.72.4.467.

Reference Type BACKGROUND
PMID: 11909905 (View on PubMed)

Sykora M, Diedler J, Turcani P, Hacke W, Steiner T. Baroreflex: a new therapeutic target in human stroke? Stroke. 2009 Dec;40(12):e678-82. doi: 10.1161/STROKEAHA.109.565838. Epub 2009 Oct 15.

Reference Type BACKGROUND
PMID: 19834010 (View on PubMed)

Yumino D, Bradley TD. Central sleep apnea and Cheyne-Stokes respiration. Proc Am Thorac Soc. 2008 Feb 15;5(2):226-36. doi: 10.1513/pats.200708-129MG.

Reference Type BACKGROUND
PMID: 18250216 (View on PubMed)

Related Links

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http://www.eoc.ch

Homepage of study center

Other Identifiers

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EOC.NSI.12.04

Identifier Type: -

Identifier Source: org_study_id