Distúrbios respiratórios durante o sono em pacientes com avc isquêmico
DOI:
https://doi.org/10.31053/1853.0605.v78.n3.28102Palavras-chave:
acidente vascular cerebral, polissonografia, síndromes da apneia do sonoResumo
Introdução:
Os distúrbios respiratórios durante o sono (TRDS), principalmente a síndrome da apneia hipopneia obstrutiva (SAHOS) em pacientes com acidente vascular cerebral ou AVC, são frequentes e podem complicar sua evolução. O objetivo foi analisar vários TRDS em pacientes com AVC.
Métodos:
Estudo descritivo, transversal e retrospectivo de 19 meses de pacientes com AVC utilizando polissonografia noturna com oximetria (PSG).
Resultados:
Foram incluídos 53 pacientes, com idade média de 67 ± 12 anos e 62% eram do sexo masculino. O TRDS foi avaliado por polissonografia noturna com oximetria nos 10 dias seguintes ao AVC. Um grau leve de apneia do sono por hipopneia (IAH) foi detectado em 21%, grau moderado em 31% e grave em 34%. O tempo médio de saturação de oxigênio <90% foi de 38 ± 51 minutos. A saturação mínima de oxigênio foi marcada nas lesões infratentoriais.
Conclusão:
Em nosso estudo, encontramos uma alta porcentagem de SAHOS, associada a pacientes mais velhos e um maior índice de massa corporal. Houve diminuição acentuada da saturação mínima e maior tendência a apresentar apneias centrais nas lesões infratentorial. O diagnóstico e tratamento precoces podem minimizar os danos neuronais e melhorar o prognóstico.
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Referências
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.
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