Diagnosis and Treatment of Obstructive Sleep Apnea in a Stroke Rehabilitation Unit

Disler, Peter; Hansford, Alison; Skelton, Julie; Wright, Pamela; Kerr, Judy; O'Reilly, Jan; Hepworth, Judy; Middleton, Sally; Sullivan, Colin E.

doi:10.1097/00002060-200208000-00011

Cited by 44 publications

(27 citation statements)

References 17 publications

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“…This is, to our best knowledge, the first study proving a similar accuracy of a portable, automatic CPAP device to conventional polysomnography in this clinical setting; others have also reported the use of similar systems previously. 10,32,33 …”

Section: Diagnosis Of Sdb In Acute Stroke Can Be Made With Automatic mentioning

confidence: 99%

Sleep-Disordered Breathing and Acute Ischemic Stroke

Bassetti

Миланова

Gugger

2006

Stroke

397

148

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Background and Purpose-Sleep-disordered breathing (SDB) is frequent in stroke patients. Risk factors, treatment response, short-term and long-term outcome of SDB in stroke patients are poorly known. Methods-We prospectively studied 152 patients (mean age 56Ϯ13 years) with acute ischemic stroke. Cardiovascular risk factors, Epworth sleepiness score (ESS), stroke severity/etiology, and time of stroke onset were assessed. The apnea-hypopnea index (AHI) was determined 3Ϯ2 days after stroke onset and 6 months later (subacute phase). Continuous positive airway pressure (CPAP) treatment was started acutely in patients with SDB (AHI Ն15 or AHI Ն10ϩESS Ͼ10). CPAP compliance, incidence of vascular events, and stroke outcome were assessed 60Ϯ16 months later (chronic phase). Results-Initial AHI was 18Ϯ16 (Ն10 in 58%, Ն30 in 17% of patients) and decreased in the subacute phase (PϽ0.001).Age, diabetes, and nighttime stroke onset were independent predictors of AHI (r 2 ϭ0.34). In patients with AHI Ն30, age, male gender, body mass index, diabetes, hypertension, coronary heart disease, ESS, and macroangiopathic etiology of stroke were significantly higher/more common than in patients with AHI Ͻ10. Long-term incidence of vascular events and stroke outcome were similar in both groups. CPAP was started in 51% and continued chronically in 15% of SDB pts. Long-term stroke mortality was associated with initial AHI, age, hypertension, diabetes, and coronary heart disease. Conclusions-SDB is common particularly in elderly stroke male patients with diabetes, nighttime stroke onset, and macroangiopathy as cause of stroke; it improves after the acute phase, is associated with an increased poststroke mortality, and can be treated with CPAP in a small percentage of patients. (Stroke. 2006;37:967-972.)

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Section: Diagnosis Of Sdb In Acute Stroke Can Be Made With Automatic mentioning

confidence: 99%

Sleep-Disordered Breathing and Acute Ischemic Stroke

Bassetti

Миланова

Gugger

2006

Stroke

397

148

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“…Proposed mechanisms for the causative effect of OSA in the pathogenesis of stroke include atherosclerotic influences, hypertension, decreased cerebral perfusion due primarily to increased carotid wall thickness [59], low cardiac output, increased intracranial pressure, increased coagulopathy, and increased risk of clot formation due to arrhythmia [60, 61]. Because of high incidence of OSA and its potential adverse effects on morbidity and mortality, a routine search for OSA may be recommended in this population [62]. …”

Section: Strokementioning

confidence: 99%

Deleterious Effects of Sleep-Disordered Breathing on the Heart and Vascular System

Dincer

O’Neill

2006

Respiration

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Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing, affecting 5–15% of the population. It is characterized by intermittent episodes of partial or complete obstruction of the upper airway during sleep that disrupts normal ventilation and sleep architecture, and is typically associated with excessive daytime sleepiness, snoring, and witnessed apneas. Patients with obstructive sleep apnea present risk to the general public safety by causing 8-fold increase in vehicle accidents, and they may themselves also suffer from the physiologic consequences of OSA; these include hypertension, coronary artery disease, stroke, congestive heart failure, pulmonary hypertension, and cardiac arrhythmias. Of these possible cardiovascular consequences, the association between OSA and hypertension has been found to be the most convincing. Although the exact mechanism has not been understood, there is some evidence that OSA is associated with frequent apneas causing mechanical effects on intrathoracic pressure, cardiac function, and intermittent hypoxemia, which may in turn cause endothelial dysfunction and increase in sympathetic drive. Therapy with continuous positive airway pressure has been demonstrated to improve cardiopulmonary hemodynamics in patients with OSA and may reverse the endothelial cell dysfunction. Despite the availability of diagnostic measures and effective treatment, many patients with sleep-disordered breathing remain undiagnosed. Therefore, OSA continues to be a significant health risk both for affected individuals and for thegeneral public. Awareness and timely initiation of an effective treatment may prevent potential deleterious cardiovascular effects of OSA.

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“…The adherence to CPAP treatment seems even lower in stroke patients with SDB. With the exception of some studies performed in the rehabilitation poststroke setting and in selected patients showing higher adherence rates [10][11][12], reported CPAP compliance in the acute [13][14][15][16] and sub-acute stroke phase [12,[17][18][19] is around 25-50%. Most patients had stroke-related problems that caused non-compliance, including facial palsy inducing CPAP mask leaks [20].…”

Section: Introductionmentioning

confidence: 99%

Effect of transnasal insufflation on sleep disordered breathing in acute stroke: a preliminary study

et al. 2011

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Background and Purpose Sleep disordered breathing (SDB) is frequent in acute stroke patients and is associated with early neurologic worsening and poor outcome. Although continuous positive airway pressure (CPAP) effectively treats SDB, compliance is low. The objective of the present study was to assess the tolerance and the efficacy of a continuous high-flow-rate air administered through an open nasal cannula (transnasal insufflation, TNI), a less-intrusive method, to treat SDB in acute stroke patients. Methods Ten patients (age, 56.8±10.7 years), with SDB ranging from moderate to severe (apnea-hypopnea index, AHI, >15/h of sleep) and on a standard sleep study at a mean of 4.8±3.7 days after ischemic stroke (range, 1-15 days), were selected. The night after, they underwent a second sleep study while receiving TNI (18 L/min).Results TNI was well tolerated by all patients. For the entire group, TNI decreased the AHI from 40.4±25.7 to 30.8± 25.7/h (p=0.001) and the oxygen desaturation index >3% from 40.7±28.4 to 31±22.5/h (p=0.02). All participants except one showed a decrease in AHI. The percentage of slow-wave sleep significantly increased with TNI from 16.7± 8.2% to 22.3±7.4% (p=0.01). There was also a trend toward a reduction in markers of sleep disruption (number of awakenings, arousal index). Conclusions TNI improves SDB indices, and possibly sleep parameters, in stroke patients. Although these changes are modest, our findings suggest that TNI is a viable treatment alternative to CPAP in patients with SDB in the acute phase of ischemic stroke.

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Diagnosis and Treatment of Obstructive Sleep Apnea in a Stroke Rehabilitation Unit

Cited by 44 publications

References 17 publications

Sleep-Disordered Breathing and Acute Ischemic Stroke

Sleep-Disordered Breathing and Acute Ischemic Stroke

Deleterious Effects of Sleep-Disordered Breathing on the Heart and Vascular System

Effect of transnasal insufflation on sleep disordered breathing in acute stroke: a preliminary study

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