Association between sleep myocardial infarction and stroke

What is the association between sleep myocardial infarction and stroke? 

Profound changes in centrally mediated sympathetic activity occur during rapid eye movement (REM) sleep, with small increases in blood pressure, heart rate, skin conductance changes, as well as momentary restorations in muscle tone, mesenteric and renal vasodilation, and skeletal muscle vasoconstriction.

In the elderly, it is hypothesized that large fluctuations in sympathetic activity associated with REM sleep also cause increased rates of arrhythmia and increased risk for cardiac vasospasm and subsequent stroke and MI.

The presence of heart rate abnormalities during sleep in normotensive patients is also reported to be a predictor of future cardiovascular disease.

Sleep-disordered breathing (SDB) also contributes to increased stroke risk in multiple ways. In patients with obstructive sleep apnea, apneic episodes can cause increased sympathetic activation and increases in blood pressure.

Compared to control subjects, atrial fibrillation is more common in patients with SDB.

Finally, hypoxia due to apnea may activate inflammatory pathways.

These pathways increase oxidative stress in blood vessels, leading to accelerated atherosclerosis.

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