@article {744, title = {A prospective analysis of risk factors for white matter disease in the brain stem: the Cardiovascular Health Study.}, journal = {Neuroepidemiology}, volume = {22}, year = {2003}, month = {2003 Sep-Oct}, pages = {275-82}, abstract = {

BACKGROUND AND PURPOSE: White matter disease (WMD) in the brain stem may be a predictor of poor clinical outcome, independent of WMD in the periventricular and subcortical areas of the brain. Many cardiovascular risk factors such as older age, hypertension, and smoking have been suggested as risk factors for WMD in the periventricular and subcortical areas of the brain. However, no epidemiologic study has examined the associations between cardiovascular risk factors and WMD in the brain stem.

METHODS: A total of 789 participants, aged 65 years or older, from the Cardiovascular Health Study constituted the present study population. WMD, defined as hyperintensive lesions on magnetic resonance imaging (MRI), in the brain stem was measured in 1992/1993 and 1997/1998.

RESULTS: Of the 789 participants, 212 (26.9\%) had WMD in the brain stem in 1997/1998. In multivariate logistic regression analysis, the presence of WMD in the brain stem in 1997/1998 was significantly associated with several variables measured in 1992/1993: an increase by 5 years of age (OR = 1.51, 95\% CI: 1.25-1.83), a 10-pack-years increase in smoking (OR = 1.12, 95\% CI: 1.04-1.21), a 0.1-liter increase in first-second forced expiratory volume (OR = 0.95, 95\% CI: 0.92-0.99), a 1 micromol/l increase in fibrinogen level (OR = 1.13, 95\% CI: 1.03-1.23), and MRI infarction (OR = 2.58, 95\% CI: 1.78-3.74). Excluding those (n = 167) with WMD in the brain stem in 1992/1993, the pattern remained. Hypertension was not associated with WMD in the brain stem.

CONCLUSIONS: Increased age, smoking, lower forced expiratory volume, increased fibrinogen level, and MRI infarction, but not hypertension, may be independent risk factors for WMD in the brain stem in older adults.

}, keywords = {Age Factors, Aged, Brain Diseases, Brain Infarction, Brain Stem, Cardiovascular Diseases, Female, Fibrinogen, Forced Expiratory Volume, Humans, Magnetic Resonance Imaging, Male, Prospective Studies, Regression Analysis, Risk Factors, Smoking}, issn = {0251-5350}, doi = {10.1159/000071190}, author = {Ding, Jingzhong and Nieto, F Javier and Beauchamp, Norman J and Longstreth, W T and Manolio, Teri A and Hetmanski, Jacqueline B and Fried, Linda P} } @article {783, title = {Sleep-disordered breathing and white matter disease in the brainstem in older adults.}, journal = {Sleep}, volume = {27}, year = {2004}, month = {2004 May 01}, pages = {474-9}, abstract = {

STUDY OBJECTIVES: To examine whether sleep-disordered breathing is associated with white matter disease in the brainstem.

DESIGN: A population-based longitudinal study.

SETTING: Allegheny County, PA; Sacramento County, CA; and Washington County, MD.

PATIENTS OR PARTICIPANTS: A total of 789 individuals, aged 68 years or older, drawn from the Sleep Heart Health Study.

INTERVENTIONS: N/A.

MEASUREMENTS AND RESULTS: The participants underwent home polysomnography in 1995-1998 and cerebral magnetic resonance imaging in both 1992-1993 and 1997-1998. The apnea-hypopnea index was not associated with white matter disease in the brainstem, with or without adjusting for age, sex, race, community, body mass index, smoking status, alcohol use, systolic blood pressure, and the use of antihypertensive medication. In contrast, the arousal index (number of arousals per hour of sleep) was inversely associated with brainstem white matter disease (odds ratio = 0.75 for a SD increase in the arousal index, 95\% confidence interval: 0.62, 0.92).

CONCLUSIONS: The frequency of apneas and hypopneas was not associated with brainstem white matter disease in these older adults. A unique relationship with arousal frequency suggests that ischemic changes in the brainstem may be associated with arousals during sleep.

}, keywords = {Aged, Arousal, Brain, Brain Stem, Cerebrovascular Disorders, Electrooculography, Follow-Up Studies, Humans, Magnetic Resonance Imaging, Polysomnography, Population Surveillance, Severity of Illness Index, Sleep Apnea Syndromes, Sleep Stages}, issn = {0161-8105}, doi = {10.1093/sleep/27.3.474}, author = {Ding, Jingzhong and Nieto, F Javier and Beauchamp, Norman J and Harris, Tamara B and Robbins, John A and Hetmanski, Jacqueline B and Fried, Linda P and Redline, Susan} }