Clinical Characteristics of Sleep-Disordered Breathing in Subacute Phase of Stroke

Abstract

ObjectiveTo assess the frequency and severity of sleep-disordered breathing (SDB) in subacute stroke patients in Korea.MethodsWe consecutively enrolled subacute stroke patients who were transferred to the Department of Rehabilitation Medicine from February 2016 to August 2016. The inclusion criteria were as follows: diagnosis of the first onset of cerebral infarction or hemorrhage in the brain by computed tomography or magnetic resonance imaging; patients between 18 and 80 years old; and patients admitted within 7 days to 6 months after stroke onset. We evaluated baseline clinical data on patients' admission to the Department of Rehabilitation Medicine. We assessed demographic data, stroke severity, neurologic impairment, cognition and quality of life. We used the Epworth Sleepiness Scale to assess quality of sleep. We used a portable polysomnography to detect SDB.ResultsOf the 194 stroke patients, 76 patients enrolled in this study. We evaluated and included 46 patients in the outcome analysis. The mean apnea-hypopnea index (AHI) was 24.2±17.0 and 31 patients (67.4%) exhibited an AHI ≥15. Those in the SDB group showed a higher National Institutes of Health Stroke Scale, lower Functional Ambulation Category, lower Korean version of Modified Barthel Index, and lower EuroQol five dimensions questionnaire (EQ-5D) at admission. Prevalence and clinical characteristics of SDB did not show significant differences among stroke types or locations.ConclusionSDB is common in subacute stroke patients. SDB must be evaluated after a stroke, particularly in patients presenting severe neurologic impairment.

Improvement of Cognitive Function after Continuous Positive Airway Pressure Treatment for Subacute Stroke Patients with Obstructive Sleep Apnea: A Randomized Controlled Trial

“…According to Hermann et al, 60–70% of patients with stroke have SDB, which is much higher than that of the normal population [20]. Other studies have reported SDB in 50–70% of patients with acute and subacute stroke [21,22,23].…”

The Impact of Sleep Disorders on Functional Recovery and Participation Following Stroke: A Systematic Review and Meta-Analysis

“…The impact of SDB on participation during the acute/subacute stage of recovery poststroke was also mixed. One study 39 found that participants with SDB had significantly worse outcomes on measures of participation and 2 studies 39,44 found no difference in participation outcomes between participants with and without SDB. A HSATS was used to diagnose SDB in most of the studies.…”

“…Twenty-three studies 35,36,38,39,[44][45][46][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65] examined the impact of SDB on recovery after stroke. In these studies, there were a total of 1,998 participants, with a prevalence of SDB of 57.4%.…”

“…The impact of SDB, which in these studies included OSA, central sleep apnea (CSA), and Cheyne Stokes respirations, on recovery of physical function at the activity level was mixed. Seven studies 35,36,38,39,51,61,63 found that participants with SDB had worse outcomes at the activity level during the acute/subacute stage of recovery (<3 months poststroke) compared with participants without SDB. However, 8 studies 35,44,45,55,56,[58][59][60] found no difference in outcomes of physical function at the activity level in the acute/ subacute stages of recovery.…”

“…[35][36][37] Individuals with stroke and SDB are more dependent both early and late after stroke compared to those without SDB, 35,36,38 have longer lengths of stay in the hospital, 36 and poorer quality of life. 37,39 Insomnia and periodic limb movements with sleep may also negatively impact recovery after stroke. 40,41 Balance and quality of life have been found to be different in patients with stroke with insomnia versus those without insomnia.…”