Objective: to evaluate the effectiveness of the STOP-BANG questionnaire, Berlin questionnaire, and the Epworth sleepiness scale in the screening diagnosis of sleep apnea syndrome in patients with ischemic stroke.Materials and methods. We examined 107 patients (45 women and 62 men; the median age was 64 (56; 74) (aged 36–88). The study involved questioning using the STOP-BANG questionnaire, Berlin questionnaire, Epworth sleepiness scale, and nocturnal respiratory polygraphy.Results. Among 75 patients with sleep apnea syndrome, the STOP-BANG questionnaire, Berlin questionnaire, and the Epworth sleepiness scale showed sensitivity — 91 %, 72 %, 51 %, respectively, specificity — 53 %, 78 %, 84 %, respectively, diagnostic accuracy — 72 %, 75 %, 68 % respectively, positive predictive value — 82 %, 89 %, 88 %, respectively, and negative predictive value — 71 %, 54 %, 42 %, respectively.Conclusion. The STOP-BANG questionnaire and the Berlin questionnaire are convenient and informative for the screening assessment of the risk of sleep apnea syndrome in patients with ischemic stroke, but their use should be complemented by instrumental diagnostic methods for reliable exclusion of sleep-disordered breathing.
The objective: to evaluate the diagnostic efficacy of neurotrophic proteins BDNF, NGF, NT3 as prognostic markers of neurological, functional and cognitive impairments in the acute period of cerebral infarction in patients with and without sleep apnea. Materials and methods. 52 patients were examined in the first 72 hours from the onset of cerebral infarction (CI). The survey included an assessment on the NIHSS, mRs and MOSA scales (in the first 72 hours and after a month); study of the concentration of proteins BDNF, NGF, NT3 in plasma by enzyme immunoassay and respiratory polygraphy. The patients were divided into the main group (32 patients with sleep apnea (SA)) and the comparison group (20 patients without SA). The control group consisted of 32 patients without CI and SA. Results. In patients of main group at the end of the acute period of CI threshold concentrations of BDNF ≤1605.2 pg/ml (AUC - 80%), NGF ≤697.37 pg/ml (AUC - 78%) and NT3 ≤400.7 pg/ml (AUC - 70%) were established as effective prognostic markers of an unfavorable functional outcome (MRs≥3); BDNF ≤1994.8 pg/ml (AUC - 75%) - of severe neurological deficit (NIHSS> 4); BDNF ≤1724.7 pg/ml (AUC - 76%) and NGF ≤858.55 pg/ml (AUC - 73%) - of the presence of cognitive impairments (MOCA <26). In patients of the comparison group the threshold concentration of BDNF protein ≤1189.6 pg/ml was established as an effective prognostic marker of unfavorable functional outcome (AUC - 85%) and severe neurological deficit (AUC - 80%). Conclusion. Neurotrophic proteins have good indicators of diagnostic accuracy as prognostic markers of neurological, functional, and cognitive impairments at the end of the acute period of CI in patients with and without SA.
The aim of the research. To study cognitive functions and their dynamics in acute cerebral infarction in patients with sleep apnoea syndrome. Material and methods. A total of 74 patients with cerebral infarction (CI) and sleep apnoea syndrome (SAS) (the main group) and 40 patients with CI without SAS (the comparison group) were examined. Cognitive functions were assessed using the Montreal Cognitive Assessment (MOCA) scale within the first 72 hours and one month after the onset of CI. SAS was detected through respiratory polygraphy or autonomous polysomnography. The control group included 40 patients without CI or SAS. CPAP therapy was administered to 20 patients of the main group for 7-10 days. Results. In patients of the main group, median MOCA scores were 20 (18; 23) within the first 72 hours after CI onset and 21.5 (19; 25) after one month, which was significantly lower than those in the comparison and the control groups (p<0.05). The most pronounced cognitive impairments in the main group were observed in patients with severe SAS (apnoea-hypopnea index (AHI) ≥30) (p <0.05). For SAS patients, inverse correlations between the MOCA score at the beginning and the end of acute CI, between the AHI and the maximum duration of the apnoea episode, as well as a direct correlation between the MOCA score and the minimum saturation (p<0.05) have been established. The AHI of over 11.6 respiratory events per hour has been revealed to be a prognostic marker of cognitive dysfunction at the end of acute СI (AUC - 81.1% (95% CI (70.3-89.2)). After a month, the patients receiving CPAP therapy did not significantly differ in cognitive impairments from the rest of the patients in the main group (p>0.05). Conclusion. In SAS patients in the acute period of СI, the AHI increase is accompanied by a decrease in the MOCA score. The AHI of over 11.6 respiratory events per hour can be used to identify risk groups of patients with cognitive impairments requiring correction of treatment and rehabilitation procedures.
Objective: to assess the effectiveness of the diagnosis of sleep apnea syndrome by the methods of respiratory monitoring and polysomnogaphу.Material and methods. 40 patients were examined (19 men and 21 women, their average age was 54 ± 14. All the patients underwent respiratory monitoring and polysomnography.Results. The comparative analysis of the parameters of sleep disordered breathing obtained by the methods of respiratory monitoring and polysomnography has revealed no significant differences in such main diagnostic indicators as index apnea/ hypopnea, apnea index, hypopnea index, snoring index, desaturation index, average SPO2 (p> 0.05). In the diagnosis of sleep apnea syndrome, the method of respiratory monitoring has showed a sensitivity of 96.7 %, specificity of 70.0 %, accuracy of 83.3 %, positive predictive value of 90.6 and negative predictive value of 87.5.Conclusion. Respiratory monitoring is comparable to polysomnography in terms of the main significant diagnostic indicators of sleep disordered breathing and taking in account its cheapness and easiness of performance may serve as an alternative to polysomnography.
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