EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

Bassetti, Claudio; Randerath, Winfried; Vignatelli, Luca; Ferini‐Strambi, Luigi; Brill, Anne Kathrin; Bonsignore, Maria R.; Grote, Ludger; Jennum, Poul; Leys, D.; Minnerup, Jens; Nobili, Lino; Tonia, Thomy; Morgan, Rebecca L.; Kerry, Joel; Riha, Renata L.; McNicholas, Walter T.; Papavasileiou, Vasileios

doi:10.1111/ene.14201

Cited by 75 publications

(79 citation statements)

References 162 publications

(350 reference statements)

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“…In a systematic review of stroke and TIA patients, 10 studies all reported that BSD increased vascular events or mortality [ 52 ]. BSDs might improve with stroke recovery but elevated mortality continuously after the acute stage [ 53 , 54 ].…”

Section: Breathing-related Sleep Disorders (Bsds) and Strokementioning

confidence: 99%

Sleep Disorders in Stroke: An Update on Management

2021

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Stroke is a leading cause of disability and mortality all over the world. Due to an aging population, the incidence of stroke is rising significantly, which has led to devastating consequences for patients. In addition to traditional risk factors such as age, hypertension, hyperlipidemia, diabetes and atrial fibrillation, sleep disorders, as independent modifiable risk factors for stroke, have been highlighted increasingly. In this review, we provide an overview of common types of current sleep disturbances in cerebrovascular diseases, including insomnia, hypersomnia, breathing-related sleep disorders, and parasomnias. Moreover, evidence-based clinical therapeutic strategies and pitfalls of specific sleep disorders after stroke are discussed. We also review the neurobiological mechanisms of these treatments as well as their effects on stroke. Since depression after stroke is so prevalent and closely related to sleep disorders, treatments of post-stroke depression are also briefly mentioned in this review article.

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Section: Breathing-related Sleep Disorders (Bsds) and Strokementioning

confidence: 99%

Sleep Disorders in Stroke: An Update on Management

2021

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6,10 on behalf of the SAS-CARE study group ABSTRACT Sleep-disordered breathing (SDB) is frequent in patients with acute stroke. Little is known, however about the evolution of SDB after stroke.

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confidence: 99%

SAS Care 1: sleep-disordered breathing in acute stroke and transient ischaemic attack – prevalence, evolution and association with functional outcome at 3 months, a prospective observational polysomnography study

et al. 2020

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Sleep-disordered breathing (SDB) is frequent in patients with acute stroke. Little is known, however about the evolution of SDB after stroke. Most of our knowledge stems from smaller cohort studies applying limited cardiopulmonary sleep recordings or from cross-sectional data collected in different populations.This study aims to determine prevalence, type and intra-individual evolution of SDB based on full-night polysomnography (PSG) in acute stroke and 3 months thereafter. Furthermore, we aimed to identify predictors of SDB in the acute and chronic phase and to evaluate associations between SDB and functional outcome at 3 months (M3).A total of 166 patients with acute cerebrovascular events were evaluated by full PSG at baseline and 105 again at M3. The baseline prevalence of SDB (apnoea–hypopnoea index (AHI)>5·h−1) was 80.5% and 25.4% of the patients had severe SDB (AHI>30·h−1). Obstructive sleep apnoea was more prevalent than central sleep apnoea (83.8% versus 13%). Mean±SD AHI was 21.4±17.6·h−1and decreased significantly at M3 (18±16.4·h−1; p=0.018). At M3, 91% of all patients with baseline SDB still had an AHI>5·h−1 and in 68.1% the predominant type of SDB remained unchanged (78.9% in obstructive sleep apnoea and 44.4% in central sleep apnoea). The only predictors of SDB at baseline were higher age and body mass index and in the chronic phase additionally baseline AHI. Baseline AHI was associated with functional outcome (modified Rankin score >3) at M3.The high prevalence of SDB in acute stroke, its persistence after 3 months, and the association with functional outcome supports the recommendation for a rapid SDB screening in stroke patients.

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“…A recent statement of the European Neurology, Pulmonology, Sleep, and Stroke Societies [ 19 ] has come to a similar conclusion, while emphasizing the existence of a bidirectional relationship between sleep and stroke and stressing the need for further mechanistic and therapeutic investigations.…”

Section: Introductionmentioning

confidence: 87%

SAS CARE 2 – a randomized study of CPAP in patients with obstructive sleep disordered breathing following ischemic stroke or transient ischemic attack

et al. 2020

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Objective/background The benefit of Continuous Positive Airway Pressure (CPAP) treatment following ischemic stroke in patients with obstructive sleep-disordered breathing (SDB) is unclear. We set out to investigate this open question in a randomized controlled trial as part of the SAS-CARE study. Patients/methods. Non-sleepy patients (ESS < 10) with ischemic stroke or transient ischemic attack (TIA) and obstructive SDB (AHI ≥ 20) 3 months post-stroke were randomized 1:1 to CPAP treatment (CPAP+) or standard care. Primary outcome was the occurrence of vascular events (TIA/stroke, myocardial infarction/revascularization, hospitalization for heart failure or unstable angina) or death within 24 months post-stroke. Secondary outcomes included Modified Rankin Scale (mRS) and Barthel Index. Results Among 238 SAS-CARE patients 41 (17%) non-sleepy obstructive SDB patients were randomized to CPAP (n = 19) or standard care (n = 22). Most patients (80%) had stroke and were males (78%), mean age was 64 ± 7 years and mean NIHSS score 0.6 ± 1.0 (range: 0–5). The primary endpoint was met by one patient in the standard care arm (a new stroke). In an intent-to treat analysis disregarding adherence, this corresponds to an absolute risk difference of 4.5% or an NNT = 22. mRS and Barthel Index were stable and similar between arms. CPAP adherence was sufficient in 60% of evaluable patients at month 24. Conclusion No benefit of CPAP started three months post-stroke was found in terms of new cardio- and cerebrovascular events over 2 years. This may be related to the small size of this study, the mild stoke severity, the exclusion of sleepy patients, the delayed start of treatment, and the overall low event rate.

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EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

Cited by 75 publications

References 162 publications

Sleep Disorders in Stroke: An Update on Management

Sleep Disorders in Stroke: An Update on Management

SAS Care 1: sleep-disordered breathing in acute stroke and transient ischaemic attack – prevalence, evolution and association with functional outcome at 3 months, a prospective observational polysomnography study

SAS CARE 2 – a randomized study of CPAP in patients with obstructive sleep disordered breathing following ischemic stroke or transient ischemic attack

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