A pilot study of the effects of non-invasive mechanical ventilation on the prognosis of ischemic cerebrovascular events in patients with obstructive sleep apnea syndrome

Abstract

Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for ischemic cerebrovascular diseases, and results in worse prognosis and higher mortality. We aimed to investigate the effects of early treatment of OSAS on the prognosis of ischemic stroke. We prospectively evaluated patients with acute supratentorial ischemic stroke and OSAS on admission (acute stage), at second week (subacute stage) and at second month (chronic stage); 11 (73.3%) out of 15 patients put on the non-invasive mechanical ventilation treatment within 48 h of stroke constituted the treatment group, and 13 patients constituted the control group. Patients with OSAS treatment showed significantly better prognosis and better functioning in activities of daily living in both subacute and chronic stages. The rate of shrinkage of the ischemic lesion was higher in the treatment group, though not significant. The early and effective treatment of OSAS provides a better clinical prognosis in ischemic stroke. The beneficial effects on radiological parameters need to be further studied.

Retinal Sensitivity Is Reduced in Patients With Obstructive Sleep Apnea

“…Quantitative variables MD, PSD, and VFI could be used to monitor the progression of the disease, treatment with oxygen therapy, or noninvasive mechanical ventilation. 45 The main criterion to begin treatment with continuous positive airway pressure (CPAP) is a graduated severity of OSA syndrome (moderate and severe). Thus, any changes detected in the VF could help to support the decision to begin CPAP in OSA patients.…”

Influence of periodic leg movements in sleep on stroke outcome

“…Sleep disturbances and sleep‐related disorders are often neglected in stroke patients, although recent studies suggested that they were more frequently observed in this group of patients with possible deteriorating effects on stroke outcome . There is accumulating evidence that heart diseases, hypertension and ischemic stroke are linked to restless legs syndrome and periodic limb movements in sleep .…”

“…In that study, however, the patients were evaluated clinically including IRLSSG criteria and Berlin questionnaire without performing polysomnography for the diagnosis of PLMS or the exclusion of sleep apnea. On the other hand, sleep apnea was also shown to affect the outcome in stroke patients, as well . In this paper, we investigated patients with supratentorial ischemic stroke aged between 50 and 80 years to have a rather homogenous group by clinical evaluation and polysomnography to better analyze the effects of PLMS on stroke outcome.…”

“…Sleep disturbances and sleep-related disorders are often neglected in stroke patients, although recent studies suggested that they were more frequently observed in this group of patients with possible deteriorating effects on stroke outcome. 13,16,19 There is accumulating evidence that heart diseases, hypertension and ischemic stroke are linked to restless legs syndrome and periodic limb movements in sleep. 14,20 We previously showed in patients with supratentorial infarction that PLMS was more commonly observed with a higher PLMS index in comparison to control subjects, supporting the role of cortical/subcortical disinhibition of spinal pathways due to destructive lesions on development of PLMS.…”

“…On the other hand, sleep apnea was also shown to affect the outcome in stroke patients, as well. 19,24 In this paper, we investigated patients with supratentorial ischemic stroke aged between 50 and 80 years to have a rather homogenous group by clinical evaluation and polysomnography to better analyze the effects of PLMS on stroke outcome. We demonstrated that the presence of PLMS associated with arousal reactions had a negative influence on stroke outcome.…”