Stroke: People at Risk and its Consequences

"Stroke" is a the common term for an "acute cerebral infarction", which means injury with loss of neurons of the brain tissue. There are 2 main causes for stroke: the obstruction of one of the arteries that feeds blood to the brain and bleeding from blood vessels in the brain. Both situations are very serious and can lead to loss of brain cells, loss of physical or intellectual function and death.

The people who are at risk for stroke are diabetics, people with high blood pressure, smokers, obese and patients with high cholesterol. If someone already has had a stroke he or she has a higher risk to have another one. In addition, for an individual who has coronary artery disease or peripheral artery disease, there is an increased risk of stroke. Atrial fibrillation (AF; an irregular heart beat) increases the chances of stroke, that is the reason why many persons with AF have to take an anticoagulant (blood thinner). Finally, there are genetic conditions that can increase the risk of stroke. Examples of this are sickle cell disease and increased coagulation disorders such as Factor V Leyden.

Stroke can be a devastating condition for the individual and it is definitely a major public health problem¹ due to the immense cost it represents. It accounts for approximately 320 billion dollars every year in healthcare direct and indirect expenditures². The patient has to deal with loss of function, which could be physical  (paralysis of arms, legs and/or face), and intellectual deficits like the loss memory and inability to speak. The recovery from stroke is usually slow and involves the use different levels of rehabilitation services.

References

1. Hankey GJ. StrokeHow Large a Public Health Problem, and How Can the Neurologist Help?. Arch Neurol. 1999;56(6):748-754. 

2. Mozaffarian D, Benjamin EJ, Go AS, et al. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation. 2016;133:e38-e360.

Marco A. Ramos MD

What is Obstructive Sleep Apnea? Who is at Risk?

Obstructive Sleep Apnea (OSA) is a very common condition in which the upper airway gets obstructed by relaxed soft structures during sleep. This obstruction leads to inadequate air exchange in the lungs, increased diaphragm and chest wall muscle contractions as efforts to relieve the obstruction occur. In addition, OSA is characterized by poor sleep quality due to multiple brief periods of waking up during the night as the body moves and loud gasps happen. Finally, due the the poor sleep quality, daytime sleepiness is a feature of this condition, with all the problems this entrails.

There are certain groups of people who are at risk of having OSA. Obese or overweight individuals, patients with enlarged tonsils or large tongues, people with a thick or large neck or individuals who have upper airways with small diameters. The formal diagnosis of OSA is made with an overnight sleep study, however it can be strongly suspected if a person has daytime sleepiness, snores loudly and if there are visible episodes of “not breathing” (apnea) during sleep.

OSA can lead to elevated blood pressure, problems with attention and concentration, daytime sleepiness, irritability, and headaches. Treatment includes the avoidance of alcohol, sleeping on a side, use of a continuous positive air pressure (CPAP) device, surgery to remove extra tissue, and the use of an implantable upper airway stimulator. A primary physician will be able to refer someone who may have this condition to a local sleep specialist.

Marco A. Ramos MD

Who is Obese? 5 Dangers of Obesity

The healthcare community has defined obesity as a body mass index (BMI) of 30 or more. The BMI is the ratio between the weight of a person (in kilograms) and the square of the height (in meters). There are many calculators online that can calculate the BMI using pounds and feet/inches. This is a very inexact way of classifying overweight people because there could be very muscular people that could be obese according to this definition. In addition, it may cause shorter people to be overrepresented in the obese population.  In spite of this, the BMI provides an easy way of classifying people according to weight that can lead to meaningful research and can serve as an effective screening tool.

There are many dangers that originate from being obese. I will list here the five most relevant ones

1. Diabetes mellitus. Having excessive adipose tissue causes insulin resistance and some obese people may become diabetic because of this.

2. Hypertension. Obesity is associated with hormonal variations that may lead to salt and water retention and constriction of small arteries. These changes can elevate the blood pressure.

3. Sleep apnea.  This condition is related to obesity. It causes the breathing to stop many times during the night causing problems with oxygenation and getting rid of carbon dioxide.

4. Osteoarthrosis. The extra weight that the obese person has to carry has an impact on the hip and knee joints. This may lead to incapacitating pain and joint replacement surgeries.

5. Cancer. Breast, colon, gallbladder and endometrial malignancies are more common in overweight individuals than in people with normal weight

Diabetes and hypertension are  significant risk factors for coronary artery disease and stroke. Sleep apnea is directly related to hypertension. This means that obesity may impair a person’s health in multiple ways.

Marco A. Ramos MD