Sleep Apnea: A Novel Risk Factor in Acute Stroke and Transient Ischemic Attack
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Published:
Feb 20, 2014
Keywords:
sleep apnea, stroke; CPAP therapy,obstructive
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Abstract
Obstructive sleep apnea (OSA) is a prevalent disease and has been increasingly recognized as an independent risk factor for hypertension, diabetes, cardiovascular disease, and stroke. Stroke is a frequent disease, a second leading cause of death worldwide which generates high healthcare costs. Recent studies suggest that sleep apnea is common after stroke with the prevalence of 50-94%. OSA is emerging as one of the important risk factors for stroke.
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1.
Pornsriniyom D. Sleep Apnea: A Novel Risk Factor in Acute Stroke and Transient Ischemic Attack. BKK Med J [Internet]. 2014 Feb. 20 [cited 2024 Dec. 27];7(1):32. Available from: https://he02.tci-thaijo.org/index.php/bkkmedj/article/view/218733
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Case Report
This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
1. Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle aged adults. N Engl J Med 1993;328:1203-5.
2. Ancoli-Israel S, Kripke DF, Klauber MR, et al. Sleep- disordered breathing in community dwelling elderly. Sleep 1991;14:486-95.
3. Dyken ME, Somers VK, Yamada T, et al. Investigating the relationship between stroke and obstructive sleep apnea. Stroke 1996;27:401-7.
4. Bassetti C, Aldrich M, Chervin R, et al. Sleep apnea in patients with transient ischemic attack and stroke. Neurology 1996;47:1167-73.
5. Bassetti C, Aldrich MS. Sleep apnea in acute cerebrovas- cular diseases: final report on 128 patients. Sleep 1999; 22:217-23.
6. Parra O, Arboix A, Bechich S, et al. Time course of sleep- related breathing disorders in first-ever stroke or transient ischemic attack. Am J Respir Crit Care Med 2000;161:375-80.
7. Wessendorf TE, Teschler H, Wang YM, et al. Sleep disor- dered breathing among patients with first-ever stroke. J Neurol 2000;247:41-7.
8. Turkington PM, Bamford J, Wanklyn P, et al. Prevalence and predictors of upper airway obstruction in the first 24 hours after acute stroke. Stroke 2002;33:2037-42.
9. Iranzo A, Santamaria J, Berenguer J, et al. Prevalence and clinical importance of sleep apnea in the first night after cerebral infarction. Neurology 2002;58:911-6.
10. Hui DS, Choy DK, Wong LK. Prevalence of sleep dis- ordered breathing and continuous positive airway pressure compliance: results in Chinese patients with first-ever ischemic stroke. Chest 2002;122:852-60.
11. Harbison J, Ford GA, James OF, et al. Sleep disordered breathing following acute stroke. QJM 2002;95:741-7.
12. Szucs A, Vitrai J, Janszky J, et al. Pathological sleep apnoea frequency remains permanent in ischaemic stroke and it is transient in haemorrhagic stroke. Eur Neurol 2002;47:15-9.
13. Bassetti CL, Milanova M, Gugger M. Sleep-disordered breathing and acute ischemic stroke: diagnosis, risk factors, treatment, evolution, and long-term clinical outcome. Stroke 2006;37:967-72.
14. Rola R, Wierzbicka A, Wichniak A, et al. Sleep related breathing disorders in patients with ischemic stroke and transient ischemic attacks: respiratory and clinical correlations. J Physiol Pharmacol 2007;58:575-82.
15. Yan-Fang S, Yu-Ping W. Sleep-disordered breathing: Impact on functional outcome of ischemic stroke patients. Sleep Med 2009;10:717-9.
16. Broadley SA, Jr gensen L, Cheek A, et al. Early investigation and treatment of obstructive sleep apnoea after acute stroke. J Clin Neurosci 2007;14:328-33.
17. Johnson KG, Johnson DC. Frequency of sleep apnea in stroke and TIA patients: a meta-analysis. J Clin Sleep Med 2010;6:131-7.
18. Dávalos A, Cendra E, Teruel J, et al. Deteriorating ischemic stroke: risk factors and prognosis. Neurology 1990;40:1865-9.
19. Toni D, Fiorelli M, Gentile M, et al. Progressing neu- rological deficit secondary to acute ischemic stroke. A study on predictability, pathogenesis, and prognosis. Arch Neurol 1995;52:670-5.
20. Partinen M, Palomaki H. Snoring and cerebral infarction.Lancet 1985; ii:1325-6.
21. Palomaki H. Snoring and the risk of ischemic brain infarction. Stroke 1991; 22:1021-5.
22. Spriggs DA, French JM, Murdy JM, et al. Snoring increases the risk of stroke and adversely affects progno- sis. Q J Med 1992;83:555-62.
23. Smirne S, Palazzi S, Zucconi M, et al. Habitual snoring as a risk factor for acute vascular disease. Eur Resp J 1993; 6:1357-61.
24. Jennum P, Schultz-Larsen K, Davidsen M, et al. Snoring and risk of stroke and ischaemic heart disease in a 70 year old population. A 6-year follow-up study. Int J Epidemiol 1994;23:1159-64.
25. Neau JP, Meurice JC, Paquereau J, et al. Habitual snoring as a risk factor for brain infarction. Acta Neurologica Scandinavica 1995;92:63-8.
26. Koskenvuo M, Kaprio J, Telakivi T, et al. Snoring as a risk factor for ischaemic heart disease and stroke in men. Br Med J 1987;294:16-9.
27. Marin JM, Carrizo SJ, Vicente E, et al. Long-term cardio- vascular outcomes in men with obstructive sleep apnoea- hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005;365:1046-53.
28. Yaggi HK, Concato J, Kernan WN, et al. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 2005;353:2034-41.
29. Young T, Finn L, Peppard PE, et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep 2008;31:1071-8.
30. Munoz R, Duran-Cantolla J, Martinez-Vila E, et al. Severe sleep apnea and risk of ischemic stroke in the elderly. Stroke 2006;37:2317-21.
31. Redline S, Yenokyan G, Gottlieb DJ, et al. Obstructive sleep apnea-hypopnea and incident stroke: the sleep heart health study. Am J Respir Crit Care Med 2010;182:269-77.
32. Nieto FJ, Young TB, Lind BK, et al. Association of sleep- disordered breathing, sleep apnea and hypertension in a large community-based study. Sleep Heart Health Study. JAMA 2000;283:1829-36.
33. Chung KF, Chan KN, Lam SP, et al. Previously unrecog- nized obstructive sleep apnea in Chinese subjects with essential hypertension. Thorax 1999;177:391-400.
34. Young T, Peppard P, Palta M, et al: Population-based study of sleep-disordered breathing as a risk factor for hypertension. Arch Intern Med 1997;157:1746-52.
35. Lavie P, Herer P, Hoffstein V. Obstructive sleep apnoea as a risk factor for hypertension: population study. BMJ 2000;320:479-82.
36. Worson CT, Naughton MT, Barter CE, etal. Theprevalence of obstructive sleep apnea in hypertensives. Am J Respir Crit Care Med 1998;157:111-5.
37. Logan AG, Perlikwski SM, Mente A, et al. High preva- lence of unrecognized sleep apnea in drug-resistant hypertension. J Hypertens 2001;19: 2271-7.
38. Peppard PE, Young T, Palta M, et al. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000;342:1378-84.
39. Gislason T, Almqvist M. Somatic diseases and sleep com- plaints: an epidemiological study of 3,201 Swedish men. Acta Med Scand 1987;221:475-81.
40. Mehra R, Benjamin EJ, Shahar E, et al. Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study. Am J Respir Crit Care Med 2006;173:910-6.
41. Netzer N, Werner P, Jochums I, et al. Blood flow of the middle cerebral artery with sleep-disordered breathing: correlation with obstructive hypopneas. Stroke 1998; 29:87-93.
42. Shamsuzzaman AS, Gersh BJ, Somers VK. Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA 2003;290:1906-14.
43. Fischer AQ, Chaudhary BA, Taormina MA, et al. Intracranial hemodynamics in sleep apnea. Chest 1992;102:1402-6.
44. Lorenzi-Filho G, Drager LF. Obstructive sleep apnea and atherosclerosis: a new paradigm. Am J Respir Crit Care Med 2007;175:1219-21.
45. Savransky V, Jun J, Li J, et al. Dyslipidemia and athero- sclerosis induced by chronic intermittent hypoxia are attenuated by deficiency of stearoyl coenzyme A desaturase. Circ Res 2008;103:1173-80.
46. Amatoury J, Howitt L, Wheatley JR, et al. Snoring-related energy transmission to the carotid artery in rabbits. J Appl Physiol 2006;100:1547-53
47. Beelke M, Angeli S, Del Sette M, et al. Prevalence of patent foramen ovale in subjects with obstructive sleep apnea: a transcranial Doppler ultrasound study. Sleep Med 2003;4:219-23.
48. Bassetti C, Aldrich MS, Quint D. Sleep-disordered breathing in patients with acute supra- and infratentorial strokes. A prospective study of 39 patients. Stroke 1997; 28:1765-72.
49. Dávalos A, Cendra E, Teruel J, et al. Deteriorating ischemic stroke: risk factors and prognosis. Neurology 1990; 40:1865-9.
50. Toni D, Fiorelli M, Gentile M, et al. Progressing neu- rological deficit secondary to acute ischemic stroke. A study on predictability, pathogenesis, and prognosis. Arch Neurol 1995;52:670-5.
51. Bradley TD, Floras JS. Obstructive sleep apnea and its cardiovascular consequences. Lancet 2009;373:82-93.
52. Good DC, Henkle JQ, Gelber D, et al. Sleep-disordered breathing and poor functional outcome after stroke. Stroke 1996;27:252-9.
53. Parra O, Arboix A, Montserrat JM, et al. Sleep-related breathing disorders: impact on mortality of cerebrovascular disease. Eur Respir J 2004;24:267-72.
54. Sahlin C, Sandberg O, Gustafson Y, et al. Obstructive sleep apnea is a risk factor for death in patients with stroke: a 10-year follow-up. Arch Intern Med 2008; 168:297-301.
55. Sandberg O, Franklin KA, Bucht G, et al. Nasal continuous positive airway pressure in stroke patients with sleep apnoea: a randomized treatment study. Eur Respir J 2001;18:630-4.
56. Kaneko Y, Hajek VE, Zivanovic V, et al. Relationship of sleep apnea to functional capacity and length of hospital- ization following stroke. Sleep 2003;26:293-7.
57. Brown DL, Lisabeth LD, Zupancic MJ, et al. High prevalence of supine sleep in ischemic stroke patients. Stroke 2008;39:2511-4.
58. Pepperell JC, Ramdassingh-Dow S, Crosthwaite N, et al. Ambulatory blood pressure after therapeutic and subther- apeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial. Lancet 2002;359:204-10.
59. Martínez-García MA, Galiano-Blancart R, Román- Sánchez P, et al. Continuous positive airway pressure treatment in sleep apnea prevents new vascular events after ischemic stroke. Chest 2005;128:2123-9.
60. Martínez-García MA, Soler-Cataluña JJ, Ejarque- Martínez L, et al. Continuous positive airway pressure treatment reduces mortality in patients with ischemic stroke and obstructive sleep apnea: a 5-year follow-up study. Am J Respir Crit Care Med 2009;180:36-41.
61. Chin K, Ohi M, Kita H, et al. Effects of NCPAP therapy on fibrinogen levels in obstructive sleep apnea syndrome. Am J Respir Crit Care Med 1996;153:1972-6.
62. Chin K, Kita H, Noguchi T, et al. Improvement of factor VII clotting activity following long-term NCPAP treat- ment in obstructive sleep apnea syndrome. QJM 1998; 91:627-33.
63. Arnardottir ES, Mackiewicz M, Gislason T, et al. Molecular signatures of obstructive sleep apnea in adults: a review and perspective. Sleep 2009;32:447-70.
64. Drager LF, Bortolotto LA, Figueiredo AC, et al. Effects of continuous positive airway pressure on early signs of atherosclerosis in obstructive sleep apnea. Am J Respir Crit Care Med 2007;176:706-12.
65. Oztura I, Kaynak D, Kaynak HC. Nocturia in sleep- disordered breathing. Sleep Med 2006;7:362-7.
66. Fitzgerald MP, Mulligan M, Parthasarathy S. Nocturic frequency is related to severity of obstructive sleep apnea, improves with continuous positive airways treatment. Am J Obstet Gynecol 2006;194:1399-403.
2. Ancoli-Israel S, Kripke DF, Klauber MR, et al. Sleep- disordered breathing in community dwelling elderly. Sleep 1991;14:486-95.
3. Dyken ME, Somers VK, Yamada T, et al. Investigating the relationship between stroke and obstructive sleep apnea. Stroke 1996;27:401-7.
4. Bassetti C, Aldrich M, Chervin R, et al. Sleep apnea in patients with transient ischemic attack and stroke. Neurology 1996;47:1167-73.
5. Bassetti C, Aldrich MS. Sleep apnea in acute cerebrovas- cular diseases: final report on 128 patients. Sleep 1999; 22:217-23.
6. Parra O, Arboix A, Bechich S, et al. Time course of sleep- related breathing disorders in first-ever stroke or transient ischemic attack. Am J Respir Crit Care Med 2000;161:375-80.
7. Wessendorf TE, Teschler H, Wang YM, et al. Sleep disor- dered breathing among patients with first-ever stroke. J Neurol 2000;247:41-7.
8. Turkington PM, Bamford J, Wanklyn P, et al. Prevalence and predictors of upper airway obstruction in the first 24 hours after acute stroke. Stroke 2002;33:2037-42.
9. Iranzo A, Santamaria J, Berenguer J, et al. Prevalence and clinical importance of sleep apnea in the first night after cerebral infarction. Neurology 2002;58:911-6.
10. Hui DS, Choy DK, Wong LK. Prevalence of sleep dis- ordered breathing and continuous positive airway pressure compliance: results in Chinese patients with first-ever ischemic stroke. Chest 2002;122:852-60.
11. Harbison J, Ford GA, James OF, et al. Sleep disordered breathing following acute stroke. QJM 2002;95:741-7.
12. Szucs A, Vitrai J, Janszky J, et al. Pathological sleep apnoea frequency remains permanent in ischaemic stroke and it is transient in haemorrhagic stroke. Eur Neurol 2002;47:15-9.
13. Bassetti CL, Milanova M, Gugger M. Sleep-disordered breathing and acute ischemic stroke: diagnosis, risk factors, treatment, evolution, and long-term clinical outcome. Stroke 2006;37:967-72.
14. Rola R, Wierzbicka A, Wichniak A, et al. Sleep related breathing disorders in patients with ischemic stroke and transient ischemic attacks: respiratory and clinical correlations. J Physiol Pharmacol 2007;58:575-82.
15. Yan-Fang S, Yu-Ping W. Sleep-disordered breathing: Impact on functional outcome of ischemic stroke patients. Sleep Med 2009;10:717-9.
16. Broadley SA, Jr gensen L, Cheek A, et al. Early investigation and treatment of obstructive sleep apnoea after acute stroke. J Clin Neurosci 2007;14:328-33.
17. Johnson KG, Johnson DC. Frequency of sleep apnea in stroke and TIA patients: a meta-analysis. J Clin Sleep Med 2010;6:131-7.
18. Dávalos A, Cendra E, Teruel J, et al. Deteriorating ischemic stroke: risk factors and prognosis. Neurology 1990;40:1865-9.
19. Toni D, Fiorelli M, Gentile M, et al. Progressing neu- rological deficit secondary to acute ischemic stroke. A study on predictability, pathogenesis, and prognosis. Arch Neurol 1995;52:670-5.
20. Partinen M, Palomaki H. Snoring and cerebral infarction.Lancet 1985; ii:1325-6.
21. Palomaki H. Snoring and the risk of ischemic brain infarction. Stroke 1991; 22:1021-5.
22. Spriggs DA, French JM, Murdy JM, et al. Snoring increases the risk of stroke and adversely affects progno- sis. Q J Med 1992;83:555-62.
23. Smirne S, Palazzi S, Zucconi M, et al. Habitual snoring as a risk factor for acute vascular disease. Eur Resp J 1993; 6:1357-61.
24. Jennum P, Schultz-Larsen K, Davidsen M, et al. Snoring and risk of stroke and ischaemic heart disease in a 70 year old population. A 6-year follow-up study. Int J Epidemiol 1994;23:1159-64.
25. Neau JP, Meurice JC, Paquereau J, et al. Habitual snoring as a risk factor for brain infarction. Acta Neurologica Scandinavica 1995;92:63-8.
26. Koskenvuo M, Kaprio J, Telakivi T, et al. Snoring as a risk factor for ischaemic heart disease and stroke in men. Br Med J 1987;294:16-9.
27. Marin JM, Carrizo SJ, Vicente E, et al. Long-term cardio- vascular outcomes in men with obstructive sleep apnoea- hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005;365:1046-53.
28. Yaggi HK, Concato J, Kernan WN, et al. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 2005;353:2034-41.
29. Young T, Finn L, Peppard PE, et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep 2008;31:1071-8.
30. Munoz R, Duran-Cantolla J, Martinez-Vila E, et al. Severe sleep apnea and risk of ischemic stroke in the elderly. Stroke 2006;37:2317-21.
31. Redline S, Yenokyan G, Gottlieb DJ, et al. Obstructive sleep apnea-hypopnea and incident stroke: the sleep heart health study. Am J Respir Crit Care Med 2010;182:269-77.
32. Nieto FJ, Young TB, Lind BK, et al. Association of sleep- disordered breathing, sleep apnea and hypertension in a large community-based study. Sleep Heart Health Study. JAMA 2000;283:1829-36.
33. Chung KF, Chan KN, Lam SP, et al. Previously unrecog- nized obstructive sleep apnea in Chinese subjects with essential hypertension. Thorax 1999;177:391-400.
34. Young T, Peppard P, Palta M, et al: Population-based study of sleep-disordered breathing as a risk factor for hypertension. Arch Intern Med 1997;157:1746-52.
35. Lavie P, Herer P, Hoffstein V. Obstructive sleep apnoea as a risk factor for hypertension: population study. BMJ 2000;320:479-82.
36. Worson CT, Naughton MT, Barter CE, etal. Theprevalence of obstructive sleep apnea in hypertensives. Am J Respir Crit Care Med 1998;157:111-5.
37. Logan AG, Perlikwski SM, Mente A, et al. High preva- lence of unrecognized sleep apnea in drug-resistant hypertension. J Hypertens 2001;19: 2271-7.
38. Peppard PE, Young T, Palta M, et al. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000;342:1378-84.
39. Gislason T, Almqvist M. Somatic diseases and sleep com- plaints: an epidemiological study of 3,201 Swedish men. Acta Med Scand 1987;221:475-81.
40. Mehra R, Benjamin EJ, Shahar E, et al. Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study. Am J Respir Crit Care Med 2006;173:910-6.
41. Netzer N, Werner P, Jochums I, et al. Blood flow of the middle cerebral artery with sleep-disordered breathing: correlation with obstructive hypopneas. Stroke 1998; 29:87-93.
42. Shamsuzzaman AS, Gersh BJ, Somers VK. Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA 2003;290:1906-14.
43. Fischer AQ, Chaudhary BA, Taormina MA, et al. Intracranial hemodynamics in sleep apnea. Chest 1992;102:1402-6.
44. Lorenzi-Filho G, Drager LF. Obstructive sleep apnea and atherosclerosis: a new paradigm. Am J Respir Crit Care Med 2007;175:1219-21.
45. Savransky V, Jun J, Li J, et al. Dyslipidemia and athero- sclerosis induced by chronic intermittent hypoxia are attenuated by deficiency of stearoyl coenzyme A desaturase. Circ Res 2008;103:1173-80.
46. Amatoury J, Howitt L, Wheatley JR, et al. Snoring-related energy transmission to the carotid artery in rabbits. J Appl Physiol 2006;100:1547-53
47. Beelke M, Angeli S, Del Sette M, et al. Prevalence of patent foramen ovale in subjects with obstructive sleep apnea: a transcranial Doppler ultrasound study. Sleep Med 2003;4:219-23.
48. Bassetti C, Aldrich MS, Quint D. Sleep-disordered breathing in patients with acute supra- and infratentorial strokes. A prospective study of 39 patients. Stroke 1997; 28:1765-72.
49. Dávalos A, Cendra E, Teruel J, et al. Deteriorating ischemic stroke: risk factors and prognosis. Neurology 1990; 40:1865-9.
50. Toni D, Fiorelli M, Gentile M, et al. Progressing neu- rological deficit secondary to acute ischemic stroke. A study on predictability, pathogenesis, and prognosis. Arch Neurol 1995;52:670-5.
51. Bradley TD, Floras JS. Obstructive sleep apnea and its cardiovascular consequences. Lancet 2009;373:82-93.
52. Good DC, Henkle JQ, Gelber D, et al. Sleep-disordered breathing and poor functional outcome after stroke. Stroke 1996;27:252-9.
53. Parra O, Arboix A, Montserrat JM, et al. Sleep-related breathing disorders: impact on mortality of cerebrovascular disease. Eur Respir J 2004;24:267-72.
54. Sahlin C, Sandberg O, Gustafson Y, et al. Obstructive sleep apnea is a risk factor for death in patients with stroke: a 10-year follow-up. Arch Intern Med 2008; 168:297-301.
55. Sandberg O, Franklin KA, Bucht G, et al. Nasal continuous positive airway pressure in stroke patients with sleep apnoea: a randomized treatment study. Eur Respir J 2001;18:630-4.
56. Kaneko Y, Hajek VE, Zivanovic V, et al. Relationship of sleep apnea to functional capacity and length of hospital- ization following stroke. Sleep 2003;26:293-7.
57. Brown DL, Lisabeth LD, Zupancic MJ, et al. High prevalence of supine sleep in ischemic stroke patients. Stroke 2008;39:2511-4.
58. Pepperell JC, Ramdassingh-Dow S, Crosthwaite N, et al. Ambulatory blood pressure after therapeutic and subther- apeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial. Lancet 2002;359:204-10.
59. Martínez-García MA, Galiano-Blancart R, Román- Sánchez P, et al. Continuous positive airway pressure treatment in sleep apnea prevents new vascular events after ischemic stroke. Chest 2005;128:2123-9.
60. Martínez-García MA, Soler-Cataluña JJ, Ejarque- Martínez L, et al. Continuous positive airway pressure treatment reduces mortality in patients with ischemic stroke and obstructive sleep apnea: a 5-year follow-up study. Am J Respir Crit Care Med 2009;180:36-41.
61. Chin K, Ohi M, Kita H, et al. Effects of NCPAP therapy on fibrinogen levels in obstructive sleep apnea syndrome. Am J Respir Crit Care Med 1996;153:1972-6.
62. Chin K, Kita H, Noguchi T, et al. Improvement of factor VII clotting activity following long-term NCPAP treat- ment in obstructive sleep apnea syndrome. QJM 1998; 91:627-33.
63. Arnardottir ES, Mackiewicz M, Gislason T, et al. Molecular signatures of obstructive sleep apnea in adults: a review and perspective. Sleep 2009;32:447-70.
64. Drager LF, Bortolotto LA, Figueiredo AC, et al. Effects of continuous positive airway pressure on early signs of atherosclerosis in obstructive sleep apnea. Am J Respir Crit Care Med 2007;176:706-12.
65. Oztura I, Kaynak D, Kaynak HC. Nocturia in sleep- disordered breathing. Sleep Med 2006;7:362-7.
66. Fitzgerald MP, Mulligan M, Parthasarathy S. Nocturic frequency is related to severity of obstructive sleep apnea, improves with continuous positive airways treatment. Am J Obstet Gynecol 2006;194:1399-403.