Longitudinal Polysomnographic Assessment from Acute to Subacute Phase in Infratentorial versus Supratentorial Stroke

Abstract

Background: Regulation of sleep and sleep-related breathing resides in different brain structures. Vascular lesions can be expected to differ in their consequences on sleep depending on stroke topography. However, studies addressing the differences in sleep and sleep-related breathing depending on stroke topography are scarce. The aim of the present investigation was to compare the sleep and sleep-related breathing of patients with supratentorial versus infratentorial stroke. Methods: This study was part of the prospective multicenter study SAS-CARE-1 (Sleep-Disordered Breathing in Transient Ischemic Attack (TIA)/Ischemic Stroke and Continuous Positive Airway Pressure (CPAP) Treatment Efficacy (SAS-CARE); NCT01097967). We prospectively included 14 patients (13 male, age 66 ± 6 years) with infratentorial lesions and 14 patients (14 male, age 64 ± 7 years) with supratentorial lesions, matched for age and stroke severity. Polysomnography was recorded in all during the acute phase within 9 days after stroke onset and 3 months later. Results: During the acute phase after stroke, patients with infratentorial lesions had significantly more sleep-related breathing disorders than patients with supratentorial lesions with an apnea-hypopnea index >20 observed in 8 (57%) patients with infratentorial stroke and in only 2 (14%) patients with supratentorial stroke. Sleep-related breathing improved from the acute to the subacute phase (3 months), albeit remaining elevated in a significant proportion of subjects. Sleep parameters did not differ between the two patient groups but there was a general improvement of sleep from the acute to the subacute phase which was comparable for both patient groups. Although stroke severity was mild, recovery after 3 months was worse in patients with infratentorial stroke with 12 of 14 patients with supratentorial stroke being symptom free (NIHSS = 0), while this was the case for only 6 of 14 patients with infratentorial stroke. Conclusions: Patients with infratentorial lesions are at an increased risk for sleep-related breathing disorders, which are frequent in this group. Monitoring of sleep-related breathing is therefore especially recommended in patients with infratentorial stroke. Because of the absence of reliable differences in sleep parameters between the two patient groups, polygraphy, with reduced diagnostic costs, rather than polysomnography could be considered. The higher prevalence of sleep-related breathing disorders and the poorer recovery of patients with infratentorial lesions suggest that early treatment interventions should be considered.

Role of sleep-disordered breathing and sleep-wake disturbances for stroke and stroke recovery

“…Initial studies found no link between SDB and stroke topography. Population-based 5 and clinical 6 cohorts recently noted an association of SDB with brainstem stroke, suggesting that lower cranial nerve dysfunction aggravates SDB. The most common form of SDB is obstructive sleep apnea (OSA), which is caused by cessation of nasal flow due to upper airway collapse.…”

Acute stroke and TIA patients have specific polygraphic features of obstructive sleep apnea

“…Short events have previously been associated with increased all-cause mortality, which might connect short events to lower arousal threshold and elevated sympathetic tone [8]. Acute phase of stroke has been previously associated with deterioration of sleep quality [18,19]. Possible low arousal threshold combined with light and fragmented sleep could at least partially explain the observed short event durations.…”

Pupillographic Sleepiness Test and Polysomnography in Nondemented Patients with Ischemic White Matter Lesions

“…Other studies have reported similar symptoms and disorders after both cortical and subcortical ischemic stroke [8,10,11]. Sleeprelated breathing disorders can be a consequence of stroke and represent an independent risk factor for cerebrovascular diseases [12,13]. Stroke-related sleep disturbances are very common during the acute phase and persist in 25% of the patients [12].…”

“…Since the patients with an elevated PUI had relevant sleep disorders as well as significantly more vascular risk factors, the PST might be an important screening technique to identify a subgroup of patients with WML at high risk of vascular events. This result is crucial especially for patients with sleep apnea, since sleep-related breathing disorders themselves increase the risk of cardiovascular and cerebrovascular pathology [12,13]. Furthermore, the PST distinguished insomnia patients with PLMS from insomnia patients without PLMS, so the PLMS might further reduce sleep quality in insomnia patients [29].…”

“…Sleeprelated breathing disorders can be a consequence of stroke and represent an independent risk factor for cerebrovascular diseases [12,13]. Stroke-related sleep disturbances are very common during the acute phase and persist in 25% of the patients [12]. Frequent complaints about sleep-wakedisorders with nonrestorative sleep and daytime sleepiness as core symptoms suggest comparable problems in patients with ischemic WML.…”