Sleep Apnea in Acute Cerebrovascular Diseases: Final Report on 128 Patients

Abstract

Although obstructive sleep apnea (OSA) appears to be a cardiovascular risk factor, its frequency in patients with transient ischemic attack (TIA) and stroke remains poorly known. We prospectively studied 128 patients (mean +/- SD age = 59 +/- 15 years) with stroke (n = 75) or TIA (n = 53). Assessment included body mass index (BMI); history of snoring and daytime sleepiness; cardiovascular risk factors and diseases; and severity of stroke (Scandinavian Stroke Scale = SSS). Polysomnography (PSG) was obtained in 80 subjects (group 1), a mean of 9 days (range, 1-71 days) after TIA or stroke. In 48 subjects (group 2), PSG was not available, refused, or inadequate. Groups 1 and 2 were similar with the exception of gender distribution. Clinical and PSG data were compared to those of 25 healthy controls matched for age, gender, and BMI. An apnea-hypopnea index (AHI) > 10 was found in 62.5% of subjects and 12.5% of controls. Between patients and controls there was a significant difference in AHI (mean [range]: 28 (0-140) vs 5 (0-24), p < 0.001), maximal apnea duration (mean + SD: 37 +/- 23 vs 23 +/- 13 seconds, p = 0.009), and minimal oxygen saturation (mean + SD: 82 +/- 10% vs 90 +/- 5%, p < 0.001). Conversely, frequency and severity of OSA were similar in stroke and TIA subjects. Multiple regression analysis identified age, BMI, diabetes, and SSS as independent predictors of AHI. Sleep apnea has a high frequency in patients with TIA and stroke, particularly in older patients with high BMI, diabetes, and severe stroke. These results may have implications for prevention, acute treatment, and rehabilitation of patients with acute cerebrovascular diseases.

Sleep Apnea and Cardiovascular Disease

“…204 Body position is important in interpreting polysomnographic findings after stroke because poststroke AHI often is highest when patients are maintained in the recumbent position, especially within the first 24 hours of stroke. 205,206 Bassetti and Aldrich 206 found an AHI Ն10 in 62% of transient ischemic attack patients compared with 12% of control subjects, suggesting that SDB may precede the onset of stroke. This was not confirmed in a case-control study of 86 transient ischemic attack patients, in whom the likelihood of sleep apnea was similar to that in control subjects.…”

Time to wake-up: Sleep problems and daytime sleepiness in long-term stroke survivors

“…In the context of a large body of literature suggesting a pivotal role of sleep and daytime sleepiness for good health and everyday safety, we felt that that our informal observations warranted a more systematic investigation. A literature review indicated that sleep disturbances and excessive daytime sleepiness are common co-morbidities of acute stroke [5][6][7][8][9], and that some sleep disorders (primarily obstructive sleep apnea) constitute a risk factor for stroke. It also revealed that it is unclear to what extent the sleep problems reported in the early phase after a stroke are transient.…”

Identificación de síntomas relacionados al Síndrome de Apnea Obstructiva del sueño en historias clínicas de pacientes con eventos vasculares agudos.

“…La proporción de pacientes con ACV en los que se consigna el diagnóstico de SAOS (3,09%) está muy por debajo a lo que se esperaría encontrar en dicha población (61% -80%) según estudios reportados (15,16).…”

“…Se sugiere entonces la necesidad de introducir un formato para detallar síntomas relacionados al sueño en todos los pacientes y realizar una ampliación de los datos anamnésicos convencionales, con acento en pacientes con mayor chance de tener el SAOS, como aquellos con un cuadro agudo cardiovascular o cerebrovascular (13)(14)(15)(16), accidentes de tránsito y laborales (5), síndrome metabólico (38), diabetes mellitus (39), enfermedad hipertensiva del embarazo (40), entre otros. Además se plantea la necesidad de emplear mayores recursos educativos para fomentar el reconocimiento médico del SAOS desde los estudios universitarios en las facultades de medicina humana, así como difundir a través de sociedades médicas los avances relativos a esta condición.…”

“…En cuanto a la relación de SAOS con la presencia de un evento cerebrovascular, se ha documentado la presencia de SAOS entre el 61 % y el 80 % de pacientes que desarrollaron un ACV (15,16). El análisis de factores de riesgo cerebrovasculares muestra al SAOS como factor independiente.…”