The patient underwent extensive routine physical examination including MR/CT imaging and laboratory analysis earlier this month. The MR Brain shows evidence of lacunar stroke and ischemic brain changes. Please advise if these might be connected to untreated obstructive sleep apnea (more than five years). If so, some recent research indicates that these cerebral changes might be partially reversible with CPAP treatment. Please let me know your professional opinion and suggested investigations and/or treatment.
Patient history: She is a 63-year-old businesswoman with a history of breathing difficulties such as allergies, and bronchial inflammation diagnosed by sputum analysis. It is moderately well controlled by inhaled medication (Ciclesonide and Salbutamol). She has untreated sleep apnea for more than five years and no other chronic illness. Imaging: MR upper abdomen: non-alcoholic fatty liver, right renal cyst.MRCP: normal. CT thorax: suspected tracheal diverticulum. MR brain: lacunar stroke, ischemic changes. Laboratory: Laboratory investigations are all within the normal range. Physical: BP: 148/78.P: 113.SO2: 98 %.
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I carefully went through your question and the patient's medical history. I reviewed her medical report and the uploaded brain MRI study (attachment removed to protect patient identity) and would explain that those changes are indicative of small vessel disease, which means chronic gradual blockage of small vessels inside the brain.
I agree with you that untreated sleep apnea, for such a long time, can lead to these brain changes. On the other hand, you should know that other risk factors such as uncontrolled high blood pressure, dyslipidemia, diabetes, age, migraine if present, smoking contacts, obesity, sedentary life, etc., also contribute to these changes, besides sleep apnea.
Unfortunately, these brain changes are irreversible. This means that adequate treatment of sleep apnea and a better control of blood pressure values or blood lipid profile, will not make them vanish. But, all these measures will help stop the progression of this disorder and prevent further changes to the brain.
You should know that sleep apnea is a known cardiovascular risk factor, which means that it contributes to uncontrolled hypertension and atherosclerosis process (generalized narrowing of blood vessels in the brain, heart and other organs). So, I am sure the CPAP (continuous positive airway pressure) device will help stop the progression of these changes. These brain changes in later stages can lead to dementia and depression or gait disturbances. That is why, it is necessary to keep under control all the above-mentioned risk factors (including sleep apnea), in order to stop the progression of this disorder.
I would also recommend checking fasting glucose and blood lipid profile every six months, to be sure that she does not suffer from dyslipidemia or diabetes. It is also advisable to take daily Aspirin of 80 to 100 mg (if there are no contraindications to this drug), in order to prevent the progression and further small strokes in the future. Consult your specialist doctor, discuss with him or her and start taking the medicines with their consent.
Hope you will find this answer helpful.
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