Sleep apnea, the next frontier, after proof of concept in RD? (FYI, daytime sleepiness is probably the leading historical indicator predicting significant sleep apnea)
This summary from MEDSCAPE/neurology CME(requires registration for access)
>> Unintentional regular daytime dozing can more than quadruple stroke risk in elderly patients and significantly increase their risk for other vascular events.
Presented here at the International Stroke Conference 2008, these latest findings from the Northern Manhattan Study (NOMAS), a prospective study of stroke and stroke risk factors in a multiethnic population, showed individuals with excessive daytime sleepiness had a 4.5-fold increased risk for stroke vs their counterparts who did not doze off during the day.
According to study investigator Bernadette Boden-Albala, PhD, from Columbia University, in New York, NY, this is the first large, prospective study to show that daytime sleepiness is an independent risk factor for stroke and all vascular events.
"At this point it is fair to say doctors don't fully appreciate the impact of sleep disturbance on vascular disease. However, these results clearly indicate it is very important," Dr. Boden-Albala told Medscape Neurology & Neurosurgery.
Previous research has linked poor or diminished quality of sleep to an increased risk for vascular events, including stroke. However, prospective studies are limited and have included only populations diagnosed with a sleep disorder such as sleep apnea.
The researchers used the Epworth Sleepiness Scale (ESS), which measures daytime sleepiness, and 2 nighttime sleep questions about snoring and choking as a marker of sleep disturbance. They then examined the risk for stroke and other vascular events.
In 2004, investigators began collecting daytime dozing data using the ESS as part of the annual NOMAS follow-up. Subjects, who were stroke-free at study entry, were divided into 3 groups: no dozing, some dozing, and significant dozing.
A total of 2153 subjects were included in the final analysis. Of these, 44% reported no dozing, 47% reported some dozing, and 9% reported significant dozing. At 2-year follow-up, investigators found there had been 40 strokes and 127 vascular events.
Unexpectedly High Risk
After adjusting for age, race or ethnicity, sex, education, systolic blood pressure, diabetes, obesity, and physical activity, investigators found an unexpectedly high risk among the "some dozing" and "significant-dozing" groups.
"At 2 years of follow-up we really didn't expect to see any effect, but, boy, did we see something. I think it is really significant that in this very short period of time we saw this strong an effect," said Dr. Boden-Albala.
Compared with those who reported "no dozing," individuals reporting "significant dozing" had a 4.5-fold increased risk for stroke, and those who reported "some dozing" had a 2.6-fold increased stroke risk.
Additional adjusted analyses revealed that daytime sleepiness also markedly increased the risk for all vascular events, with a 60% increased risk among those who reported some dozing and a 2.6-fold increased risk in the "significant dozing" group.
One of the "troubling" aspects of these findings, said Dr. Boden-Albala, is the fact that more than half of the study population (56%) had sleep disturbance. At this point, she said, it is not clear whether sleep apnea is driving the observed risk, but what is clear is the importance of sleep on vascular health.
The study was funded by the National Institute of Neurological Disorders and Stroke.
American Stroke Association International Stroke Conference 2008: Abstract 94. Presented February 21, 2008.<<
My question would be whether the Epworth Sleepiness Scale (ESS) might not be a convenient + cost efficient surrogate marker to evaluate the ampakine RD effect in sleep apnea patients and perhaps strengthen the patent scope in this patient group. CPAP, though state of the art, is still a very primitive type of treatment (for sleep apnea) might become more adjunctive therapy to an ampakine. Just speculating or dreaming Cor dreams.
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