Sleep-Disordered Breathing in Acute Stroke: A Single-Center, Prospective, Longitudinal Study

Abstract

Background: Sleep-disordered breathing (SDB) is common among acute stroke patients. We sought to investigate the prevalence, severity and type of SDB in consecutive acute stroke patients. Moreover, we aimed to identify independent predictors of SDB in the acute stroke setting and investigate potential associations between SDB and functional outcomes at three months. Methods: We prospectively studied consecutive acute stroke patients, who underwent overnight polysomnography within 72 h from symptom onset. Demographics, clinical and imaging characteristics were documented. Daytime sleepiness preceding the stroke, stroke severity on admission and functional outcome at three months were evaluated using the Epworth-Sleepiness Scale (ESS), National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS), respectively. SDB was documented using standard polysomnography criteria. Results: A total of 130 consecutive acute stroke patients were prospectively evaluated [110 with ischemic stroke and 20 with intracerebral hemorrhage, mean age 60.5 ± 10.9 years, 77% men, median NIHSS score on admission: 3 (IQR:2–17)]. The rate of SDB detection on polysomnography recordings was 79% (95%CI:71–86). Three variables were independently associated with the likelihood of SDB detection in multivariable analyses adjusting for potential confounders: age (OR per 10-year-increase:2.318, 95%CI:1.327–4.391, p = 0.005), male sex (OR:7.901, 95%CI:2.349–30.855, p = 0.001) and abnormal ESS-score (OR:6.064, 95%CI:1.560–32.283, p = 0.017). Among patients with SDB, congestive heart failure was independently associated with the likelihood of central apnea detection (OR:18.295, 95%CI:4.464–19.105, p < 0.001). Among all patients, increasing NIHSS score on admission (OR:0.817, 95%CI:0.737-0.891, p < 0.001) and Apnea–Hypopnea Index (OR:0.979, 95%CI:0.962–0.996, p = 0.020) emerged as independent predictors of excellent functional outcome at 3 months (mRS-scores 0–1). Conclusion: The high prevalence and severity of SDB in acute stroke patients and its negative impact on functional outcome indicate the importance of polysomnography implementation in everyday clinical practice of acute stroke work-up and management.

Periodic Limb Movements during Sleep in Acute Stroke: Prevalence, Severity and Impact on Post-Stroke Recovery

“…A detailed description of our study population was also reported in our previous study [ 14 ]. Exclusion criteria for this study included: (1) diagnosis of transient ischemic attack, (2) previous known history of SDB or PLMS with or without treatment with continuous positive airway pressure (CPAP), (3) presence of situations that would render cooperation with PSG unfeasible such as high stroke severity (NIHSS score >25 points), speech comprehension disorders or altered mental status, (4) presence of confounders that could interfere with measurements such as baseline oxygen saturation <95%, acute respiratory infection, stroke mimics including brain tumours, seizures and Todd’s paralysis and toxic–metabolic disturbances [ 15 ].…”

Special Issue “Sleep Disorders: From Clinical Research to Daily Practice”

“…Finally, a prospective, longitudinal study investigating sleep-disordered breathing (SDB) in acute stroke patients by Plomaritis and coworkers showed the importance of PSG implementation in everyday clinical practice for acute stroke work-up and management [ 20 ]. SDB is common among acute stroke patients; therefore, the authors aimed to investigate the prevalence, severity, and type of SDB in consecutive patients.…”