Respiratory disorders during sleep in patients with acute ischemic stroke
DOI:
https://doi.org/10.31053/1853.0605.v78.n3.28102Keywords:
stroke, polysomnography, sleep apnea syndromesAbstract
Introduction:
Sleep breathing disorders (SBD) especially obstructive hypopnea apnea syndrome (OSA) in patients with stroke are common and can complicate their evolution. The objective was analyzing the different sleep breathing disorders in patients with stroke.
Methods:
Descriptive, cross-sectional and retrospective study of acute ischemic stroke patients, using nightly polysomnography with oximetry (PSG).
Results:
It was a descriptive, cross-sectional, retrospective study during 19 months; 53 patients with stroke were included, with a men age of 67 ±12 years and 62% were men. SBD was evaluated by nocturnal polysomnography with oximetry within 10 days of installing the stroke. The Apnea hypopnea index (AHI) was 24.5±20, of mild grade in 21%, moderate in 31%, severe grade in 34%. The average oxygen saturation time less than 90% was 38 ±51 minutes. The minimum oxygen saturation was marked in infratentorial lesions.
Conclusion:
We found a high percentage of OSA, which was associated with older patients and a higher body mass index. There was a marked decrease in the minimum oxygen saturation and greater tendency to present central apneas in infratentorial lesion. Early diagnosis and treatment could minimize neuronal damage and improve prognosis.
Downloads
References
Ferre A, Ribó M, Rodriguez-Luna D et al. Strokes and their relationship with sleep and sleep disorders. Neurología 2013; 28(2): 103-18.
American Academy of Sleep Medicine. International classification of sleep disorders, 3rd ed. Darien, IL: American Academy of Sleep Medicine, 2014. ISBN: 0991543408 (online).
Elwood P, Hack M, Pickering J, Hughes J, Gallacher J. Sleep disturbance, stroke, and heart disease events: evidence from the Caerphilly cohort. J epidemiol Commnunity Health 2006; 60:69-73.
Parra O, Arboix A, Bechich S, et al. Time course of slep-related breathing disorders in first-ever stroke or transient ischemic attack. Am J Respir Crit Care Med 2000; 161: 375- 80.
Johnson KG, Johnson DC. Frequency of sleep apnea in stroke and TIA patients: a meta-analysis. J Clin Sleep Med 2010; 6: 131-7.
Durgan DJ, Bryan RM. Cerebrovascular consequences of obstructive sleep apnea. J Am Heart Assoc 2012; 1(4):e000091. DOI: 10.1161/JAHA.111.000091.
Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep disordered breathing in adults. Am J Epidemiol 2013; 177: 1006-14.
Senaratna VV, Perret JL, Lodge CJ, et al. Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev 2017; 34: 70-81.
Nogueira F, Borsini E, Cambursano H, and col. Guías prácticas de diagnóstico y tratamiento del síndrome de apneas e hipopneas obstructivas del sueño: Actualización 2019. Revista Americana de Medicina Respiratoria 2019; 1:59-90.
Berry RB, Brooks R, Gamaldo C, Harding SM, Lloyd RM, Quan SF, Troester MT, Vaughn BV. AASM Scoring Manual Updates for 2017 (Version 2.4). J Clin Sleep Med. 2017 May 15;13(5):665-666. doi: 10.5664/jcsm.6576. PMID: 28416048; PMCID: PMC5406946.
Dzialowski I, Hill MD, Coutts SB, et al. Extent of early ischemic changes on computed tomography (CT) before thrombolysis: prognostic value of the Alberta Stroke Program Early CT Score in ECASS II. Stroke 2006; 37:973-8.
Chalela JA, Kidwell CS, Nentwich LM, et al. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet 2007; 369:293-8.
Van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJA, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988; 19(5):604-7.
Quinn TJ, Dawson J, Walters MR, Lees KR. Reliability of the modified Rankin Scale: a systematic review. Stroke 2009; 40(10):3393-5.
Quinn TJ, Dawson J, Walters M, Lees K. Variability in modified Rankin scoring across a large cohort of inter-national observers. Stroke 2008; 39: 2975-9.
Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, Spilker J. et al. National Institute of Health Stroke Score. Measurement of acute cerebral infarction: a clinical examination scale. Stroke 1989; 20:864–70.
Montaner J, Álvarez-Sabín J. La escala de ictus del National Institute of Health (NIHSS) y su adaptación al español. Neurología 2006; 1: 192-202.
Jauch EC, Saver JL, Adams HP, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2013; 44: 870-947.
Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE.3rd. Stroke 1993 Jan; 24(1):35-41.
Amarenco P., Bogousslavsky J, Caplan LR, Donnan GA, Hennerici MG. Classification of stroke subtypes. Cerebrovasc Dis. 2009; 27:493-501.
Berry RB, Budhiraja R, Gottlieb DJ, Iber C, Kapur VK, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. J Clin Sleep Med 2012; 8: 597-619.
Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45: 2160-236.
McNicholas WT. Diagnosis of obstructive sleep apnea in adults. Proc Am Thorac Soc 2008; 5: 154-60.
Rapaport DM. POINT: is the apnea-hypopnea index to best way to quantify the severity of sleep disordered breathing? Yes. Chest 2016; 149:14-16.
Birkbak, J., A.J. Clark, and N.H. Rod, The effect of sleep disordered breathing on the outcome of stroke and transient ischemic attack: a systematic review. J Clin Sleep Med 2014. 10 (1): p. 103-8.
Iranzo A, Santamaría J, Berenguer J, Sánchez M, Chamorro A. Prevalence and clinical importance of sleep apnea in the first night after cerebral infarction. Neurology 2002; 58:911-916.
Camilo MR, Sander HH, Eckeli AL, et al.: SOS score: an optimized score to screen acute stroke patients for obstructive sleep apnea. Sleep Med 2014; 15 (9):1021-1024.
Turkington PM, Bamford J, Wanklyn P, Elliot MW. Prevalence and predictors of upper airway obstruction in the first 24 hours after acute stroke. Stroke 2002; 33:2037-42.
Martinez-García MA, Galiano-Blancart R, Soler-Cataluna JJ, Cabero-Salt L, Román Sánchez P. Improvement in nocturnal disordered breathing after first-ever ischemic stroke: role of dysphagia. Chest 2006; 129:238-45.
Netzer N, Werner P, Jochums I, et al.: Blood flow of the middle cerebral artery with sleep-disordered breathing. Stroke 1998; 29:87-93.
Beelke M, Angeli S, Del Sette M, De Carli F, Canovaro P, Nobili L, et al. Obstructive sleep apnea can be provocative for right-to-left shunting through a patent foramen ovale. Sleep 2002; 25:856—62.
Brown DL, Mc dermott M, Mowla A, et al., Brainstem infarction and sleep-disordered breathing in the BASIC sleep apnea study. Sleep Med 2014; 15: 887-891.
Bassetti CL, Milanova M, Gugger M. Sleep-disordered breathing and acute isquemic stroke diagnosed, risk factors, treatment, evolution and long-term clinical outcome. Stroke 2006; 37: 967-972.
Nopmaneejumruslers C, Kaneko Y, Hajek V, Zicanovic V, Bradley TD. Cheyne Stokes respiration in stroke: relationship to hipocapnia and occult cardiac dysfunction. Am J Respir Crit Care Med 2005; 171: 1048-52.
Rowart AM, Wardiaw JM, Dennis MS. Abnormal breathing patterns in stroke: relationshipo with location of acute stroke lesión and prior cerebrovascular disease. J Neurol Neurosurg Psychiatry 2007; 78: 277-9.
Siccoli MM, Valko PO, Hermann DM, Bassetti CL. Central ischemic stroke-neurogenic and cardiogenic factors. J Neurol 2008; 255: 1687-92.
Yumino D, Redolfi S, Ruttanaumpawan P, et al. Nocturnal rostral fluid shift: a unifying concept for the pathogenesis of obstructive and central sleep apnea in men with heart failure. Circulation 2010; 121:1598-1605.
Hermann DM, Bassetti CL. Sleep-related breathing and sleep wake disturbances in ischemic stroke. Neurology 2009; 73:1313-1322.
Baillieul S, Revol B, Jullian-Desayes I, Joyeux-Faure M, Tamisier R, Pépin JL. Diagnosis and management of central sleep apnea syndrome. Expert Rev Respir Med. 2019 Jun;13(6):545-557. doi: 10.1080/17476348.2019.1604226. Epub 2019 Apr 24. PMID: 31014146.
Lee MC, Klassen AC, Resch JA. Respiratory pattern disturbances in ischemic cerebral vascular disease. Stroke 1974; 5:612—6. DOI:10.1161/01.str.5.5.612.
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.
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Universidad Nacional de Córdoba
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The Faculty of Medical Sciences Journal (RFCM) subscribes to the Open Access policy and does not charge authors fees for publishing, nor does it charge readers fees for accessing published articles (APC).
