S troke or known as cerebrovascular accident, is a disease that causes death number 3 after heart disease and violence, and become the top cause of disability in patients who survive, and provide many economic and social problems, both for themselves and their environment.
The best way is to prevent the occurrence of stroke, both the first and 2nd attack with knows what the risk factor is, especially factors that can be change, such as the existence of hypertension, diabetes mellitus, dislipidemia, heart disease and so forth, and that is not less important and not yet known by many people is OSA / Obstructive Sleep Apnea
What is the OSA?
American Academy of Sleep Medicine (AASM), 2005, divides into several sleep disturbances category namely:
- Sleep related movement disorder
- Sleep related breathing disorder
- Sleep disorder Circadian Rhytm
- Isolated syndrome
OSA, including a disruption of sleep in the start of a breath snore or gasp at the episode follow with a stop of breath / apneu or stop some of the breath / hipopneu over a period of more than 10 seconds, follow the move in the chest and stomach muscles in an effort to enter the air, and This causes decreased oxygen content of blood / oxygen saturation more than 3%. Someone had said to get in the OSA if AHI> 5 per hour (Apneu Hipopneu Index).
While the degree of OSA in the following:
. Mild / mild if AHI 5-15/hour
. Moderate / moderate if AHI 15-30/hour
. Bearat / severe if AHI> 30/hour
OSA is known with signs snore hard with the other people who accompanied can be witnessed by a friend suffering from sleep and sleepy in the afternoon / excesive daily sleepness, headache in the morning and etc.Diagnosa OSA can know in the examination Overnight Polysomnography (PSG )
Relationship between OSA and Stroke
OSA is know as one of the risk factors of stroke after going through a lot of research. Many things that happen in people who have OSA are:
1. Growth simpatic nervous system activity associated with hypertension and diabetes
mellitus as insulin resistance.
2. The occurrence of interference function endothel.
3. Increasinglevel of fibrinogen.
4. Increasing activities chip blood cells / thrombosyt
5. Increasing of cloting time system.
6. Decrease Cerebral blood flow / blood flow to the brain
7. Process of thickening of blood vessel carotid wall.
In general society found that frequency OSA is 2% in women and 4% in men, but research on Aliye Tonin (2008) found OSA in 73.7% in stroke patients, while research Hemran (2007) report found 58% of stroke patients first suffered sleep disordered breathing, 9.7% of them are central periodic breathing and the rest is OSA.
Relationships OSA and High Blood Pressure
The increase in high blood pressure occur in OSA patients in the phase after apneu (stop the breath at the time of grunt), this is in the know with the PSG examination (Lavie et al 2000). As in the know during the period apnea measure blood oxygen level down and carbon dioxide increased nerve activity will increase with the result simpatic stimulate the occurrence of blood vessel constriction to occur increasing blood pressure.
Relationships OSA and Cerebral Blood Flow Velocity
In the research with doppler examination of the find during the period apneu decrease blood flow to the brain, especially at the end of the apneu following by increasing of blood pressure
OSA and the relationship Artheriosclerois
Also found that OSA associated with artheriosclerosis contribute to the occurrence of stroke, OSA causes increasing blood fibrinogen level, increasing C reactive protein, interleukin 6 and plasminogen activator inhibitor (yokoe, 2003), It also can happen matrix metalloproteinase 9 increase and vasculair angiogenic cytokine to cause the occurrence of artherosclerosis. Thus, OSA is also the process multiplen inflammation that can increase platelet activation and also become a cause of Silent Brain Infarction / SBI which little is known as stroke, that in the future will cause many problems. There are 2 type of protein related to the platelet activation process increasing / thrombosit that is the CD40 ligand (sCD40L) and soluble P selectin (sp selectin). Both protein is important marking in platelet activation.
Another thing that is not less important than that OSA is a risk factor of a stroke on the stroke of the respiratory center in the medulla / brain stem will trigger the occurrence of sleep disorder breathing (Askenasy, 1988). The same also happens if the patient had difficulty swallow / or difficulty speaking dysphagy / if dysrthri. However if stroke attacked on both sides of the brain / bilateral then the breath will be cheyne Stoke (one breath).
Iranzo (2002) found 62% of stroke patients suffering from respiratory disturbance / OSA and this fact impedes healing.
In addition, post-stroke patients who suffered from OSA generally have a lower Barthel index and lower cognitive ability and motivation, and trigger the occurrence of recurrent stroke. While research Carin et al, 2008 found that OSA increase acute stroke mortality.
The above is reduced with the help of CPAP / continuous Positive Airway Pressure.
After the diagnosis confirm, then need to think about the cause. In addition to body weight correction, ENT examination should be carried out with a possible correction of deviation is also an expert review dental or mouth surgery (orthodontist) to correct the deviation.
CPAP therapy is recommended if the correction can not be implemented in.