Increased incidence of nonfatal cardiovascular events in stroke patients with sleep apnoea: effect of CPAP treatment

Martínez-García, Miguel Ángel; Campos‐Rodríguez, Francisco; Soler-Cataluña, Juan José; Serra, Pablo Catalán; Román-Sánchez, Pilar; Montserrat, Josep M.

doi:10.1183/09031936.00011311

Cited by 119 publications

(81 citation statements)

References 26 publications

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“…7,12,13,[29][30][31] NOD secondary to sleepdisordered breathing could be a modifiable risk factor for stroke and other cardiovascular diseases. 32,33 Lifestyle modification, such as weight-loss intervention, may help improve sleep-disordered breathing symptom and may possibly lead to stroke prevention. 23,34,35 In addition, long-term continuous positive airway pressure treatment, the representative treatment of sleep apnea, is considered to provide protection against stroke in patients with sleep-disordered breathing.…”

Section: July 2016mentioning

confidence: 99%

Nocturnal Desaturation in the Stroke Unit Is Associated With Wake-Up Ischemic Stroke

Kim

Jeong

et al. 2016

Stroke

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Background and Purpose-Wake-up stroke (WUS) represents a quarter of all ischemic strokes and may be a specific subgroup. Nocturnal desaturation secondary to sleep-disordered breathing is an independent risk factor for stroke, but the association between nocturnal desaturation and WUS remains unclear. We investigated the relationship between nocturnal desaturation using oxygen desaturation index and WUS in patients with acute stroke in the stroke unit. Methods-A total of 298 patients admitted for acute ischemic stroke to the stroke unit between July 2013 and May 2015 were enrolled. The oxygen desaturation index was calculated using pulse oximetry data sampled every 1 minute during 9 hours on the first night (10:00 PM-7:00 AM) of the stroke unit admission, and nocturnal desaturation was defined as an oxygen desaturation index of 5 at least per hour. We compared the clinical characteristics and nocturnal desaturations between patients with and without WUS. Results-Among all patients (age, 67.7±12.6 years; male, 54.4%), 26.5% patients had WUS. The proportion of nocturnal desaturation was significantly greater in patients admitted with WUS (29.1% versus 12.3%, P=0.001). The age, sex, risk factors except for hyperlipidemia, stroke severity, and stroke mechanisms were similar between the 2 groups. After adjustment for covariates, it was found that nocturnal desaturation was significantly more common in the WUS group (odds ratio, 3.25; 95% confidence interval, 1.63-6.46). Conclusions-Nocturnal desaturation was more frequently observed in patients admitted with WUS during the first night in the stroke unit. This suggests that nocturnal desaturation is a possible modifiable risk factor for the occurrence of WUS. Baseline and Clinical AssessmentBaseline characteristics, including demographic data (age and sex) and vascular risk factors (hypertension, diabetes mellitus, hyperlipidemia, smoking history [current or past regular smoking], body mass index [BMI], and a past history of stroke/transient ischemic attack) were evaluated. Hypertension was defined as a history of antihypertensive treatment, a systolic blood pressure ≥140 mm Hg, or a diastolic blood pressure ≥90 mm Hg. 14 Hyperlipidemia was defined as a history of lipid-lowering medication, a serum total cholesterol level of >240 mg/dL, or a serum level of low-density lipoprotein cholesterol >160 mg/dL.15 Diabetes mellitus was defined as a hemoglobin A1C level of ≥6.5%, fasting blood glucose level of ≥7.0 mmol/L, nonfasting blood glucose level of ≥11.1 mmol/L, or the use of insulin or oral hypoglycemic drugs. 16 All of the patients were initially evaluated for stroke severity based on the National Institutes of Health Stroke Scale (NIHSS) neurological examination at SU admission. Ischemic strokes were categorized as large-artery atherosclerosis (LAA), small-vessel occlusion, cardioembolism, other determined, and undetermined based on the Trial of Org 10172 in Acute Stroke Treatment criteria. 17The ischemic lesion locations were divided into anterior circulation (ante...

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Section: July 2016mentioning

confidence: 99%

Nocturnal Desaturation in the Stroke Unit Is Associated With Wake-Up Ischemic Stroke

Kim

Jeong

et al. 2016

Stroke

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“…Study characteristics and main results for these are presented in Table 1. Six studies were European [22][23][24][25][26][27] and two were North American. 19,20 The sample sizes were small, ranging from 47 to 174 stroke or TIA patients.…”

Section: Sdb and Serious Adverse Events In Stroke And Tia Patientsmentioning

confidence: 99%

“…19,20 The sample sizes were small, ranging from 47 to 174 stroke or TIA patients. The study designs included seven prospective cohort studies 19,20,[23][24][25][26][27] and one cross-sectional study. 22 Two studies presented stroke recurrence as a primary outcome, 22,25 five studies addressed all-cause mortality as primary outcome, 19,20,23,26,27 and one study evaluated both fatal and nonfatal cardiovascular events.…”

Section: Sdb and Serious Adverse Events In Stroke And Tia Patientsmentioning

confidence: 99%

The Effect of Sleep Disordered Breathing on the Outcome of Stroke and Transient Ischemic Attack: A Systematic Review

Birkbak

Clark

Rod

2014

Journal of Clinical Sleep Medicine

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Study Objectives: The primary objective was to systematically review the literature on how sleep disordered breathing (SDB) affects recurrence and death among stroke or transient ischemic attack (TIA) patients. A secondary objective was to evaluate how treatment of SDB with continuous positive airway pressure (CPAP) affects the risk of recurrence and death in these patients. Methods: Adults (18+) with a stroke or TIA diagnosis were eligible for inclusion. Case groups consisted of patients with a sleep disorder. The outcomes of interest were all-cause mortality, recurrent vascular events, and case fatality. Results: Ten articles covering 1,203 stroke and TIA patients were included in the review. The results generally support a dose-response relationship between severity of SDB and risk of recurrent events and all-cause mortality in stroke and TIA patients. Three small-scale articles with substantial risk of bias evaluated the effects of CPAP therapy, and the results are inconclusive. Data on case fatality is too sparse to be conclusive. Conclusions: Existing studies provide suffi cient data to establish obstructive SDB as a negative predictor of all-cause mortality and recurrent vascular events following stroke or TIA. The ability of CPAP treatment to lower the risk of serious adverse outcomes after stroke remains controversial because of substantial risk of bias identifi ed in most of the eligible studies addressing this relation. Additional studies are needed. S leep disordered breathing (SDB) is a term used to describe nocturnal breathing and ventilatory problems. SDB includes obstructive sleep apnea, which is defi ned as partial or complete closure of the upper airways and central sleep apnea, which describes apneic events due to lack of respiratory effort.1 The severity of SDB is measured by the number of apneas and hypopneas per hours of sleep, the apneahypopnea index (AHI).SDB has been associated with 2-3 times higher risk of incident stroke in several large well-designed prospective studies.2-5 Moreover, a recent meta-analysis concludes that SDB with an AHI > 5 events/hour is seen in 72% and with AHI > 20 events/hour in 38% of all stroke or transient ischemic attack (TIA) patients. 6 The highest prevalence of SDB is seen among male patients, patients with recurrent strokes, and those with stroke of unknown etiology. The underlying mechanisms explaining a high prevalence of SDB among stroke and TIA patients remain to be established, but the hypothesized mechanisms behind a deleterious effect of SDB on stroke incidence and prognosis include hypertension, endothelial damage, cardiac arrhythmias, variability in cerebral blood fl ow, and oxygen desaturation . 7-9Two previous reviews have found that SDB in stroke patients leads to poorer outcomes and increased risk of recurrent strok e. 10,11 Another review is inconclusive about the benefi ts from treatment of SDB after stroke. 12 The relationship between stroke and SDB is being increasingly discussed in the scientifi c 12,13 and we aimed to systematically eval...

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“…We assume that they were addressed with the patients during the frequent visits and should have been resolved by the fourth months of follow-up. The second limitation is that we did not test coping, locus of control, and self-efficacy, which have previously been shown to predict adherence [19,20,21,[26][27][28][29]. They are probably mechanisms that lead to early non-adherence that ultimately continues long-term.…”

Section: Discussionmentioning

confidence: 99%

Does CPAP Use in the First 15 Days Predict its Use after 4 Months? A Prospective French Cohort Study

Gentina¹

2015

J Sleep Disord Ther

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Objective: Early prediction of which patients with obstructive sleep apnea will not adhere with CPAP can trigger physicians to correct possible causes or offer alternative therapies. This study aims to determine the ability of early CPAP use to predict long-term adherence with CPAP independent from its definition and to test previously described predictors of adherence.Method: This is a prospective, observational cohort study that was performed in nine sleep disorder centers in France. Patients were newly diagnosed with obstructive sleep apnea and a CPAP was prescribed for the first time. We collected socioeconomic, medical, sleep, and psychological variables to be associated with adherence with CPAP. The patients were evaluated 15 days after CPAP set up and monthly for 4 months until they were adherent. We assessed potential predictors of CPAP adherence at 4 months with emphasis on CPAP use at 15 days. CPAP adherence was defined as an average daily use of at least 3, 4, 5, and 6 hours. Results:We enrolled 420 patients. Early CPAP use and CPAP use at 4 months were similar. At 4 months, 94% of patients used a CPAP ≥3 hours and 49% of patients used it ≥6 hours. The area under the ROC curve for early CPAP use predicting adherence at 4 months was ≥0.85 for all adherence definitions. The optimal threshold for early CPAP use to predict adherence increased from 3.2 to 6.4 hours as the definition of CPAP adherence increased from 3 to 6 hours. CPAP use at 4 months was higher in older patients. Conclusions:Early CPAP use was the single best predictor of CPAP adherence and was independent of how adherence was defined. Physicians must assess CPAP use no later than 2 weeks to address its causes or prescribe an alternative therapy.

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Increased incidence of nonfatal cardiovascular events in stroke patients with sleep apnoea: effect of CPAP treatment

Cited by 119 publications

References 26 publications

Nocturnal Desaturation in the Stroke Unit Is Associated With Wake-Up Ischemic Stroke

Nocturnal Desaturation in the Stroke Unit Is Associated With Wake-Up Ischemic Stroke

The Effect of Sleep Disordered Breathing on the Outcome of Stroke and Transient Ischemic Attack: A Systematic Review

Does CPAP Use in the First 15 Days Predict its Use after 4 Months? A Prospective French Cohort Study

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