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NCPAP Decreases Cerebrovascular Risk in OSA Patients

Patients with sleep apnea having significantly higher serum levels of inflammatory markers, as well as lesions associated with silent brain infarction//, have an elevated risk of stroke, according to Japanese medical researchers.

The results appear in the second issue for March 2007 of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.

Kenji Minoguchi, M.D., Ph.D., of Showa University School of Medicine in Tokyo, and nine associates studied silent brain infarction, brain tissue death from lack of blood supply, in 50 male patients with obstructive sleep apnea (OSA). The researchers also examined the effects of three months of treatment with nasal continuous positive airway pressure (nCPAP) on serum inflammatory marker levels in 24 male patients who had moderate to severe OSA.

According to the authors, the occurrence of stroke in patients with OSA is likely preceded by subclinical cerebrovascular disease, or silent brain infarction, which is detectable with brain magnetic resonance imaging (MRI). The lesions identified as silent brain infarction were either wedge-shaped or round and showed up in brain white matter on MRI scans.

"The percentage of silent brain infarction in patients with moderate to severe OSA at 25 percent was higher than that for obese control subjects at 6.7 percent, or even patients with mild OSA who had 7.7 percent," said Dr. Minoguchi.

The investigators noted that cardiovascular disease is commonly characterized by ongoing inflammatory responses that can enhance platelet activation and increase the prevalence of silent brain infarction.

Platelets are small, colorless, irregular blood cells that promote blood clotting. Two important proteins called soluble C40 ligand and soluble P-selectin are markers of platelet activation and appear to forecast future cerebrovascular events.

The researchers found that use o
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