Obstructive and Central Sleep Apnea in First Ever Ischemic Stroke are Associated with Different Time Course and Autonomic Activation

Abstract

Introduction: Sleep-related breathing disorders are highly prevalent in patients with ischemic stroke. Among sleep-disordered breathing disorders, obstructive sleep apnea is the most represented one, but central sleep apnea, isolated or in the context of a periodic breathing/Cheyne-Stokes respiration, is frequently reported in these patients. Altered baroreflex responses have been reported in the acute phases of a cerebral event. Methods: We conducted, in a group of patients with ischemic stroke (n=60), a prospective 3-month follow-up physiological study to describe the breathing pattern during sleep and baroreflex sensitivity in the acute phase and in the recovery phase. Results: In the acute phase, within 10 days from the onset of symptoms, 22.4% of patients had a normal breathing pattern, 40.3% had an obstructive pattern, 16.4% had a central pattern, and 29.9% showed a mixed pattern. Smaller variations in the Apnea-Hypopnea Index were found in normal breathing and obstructive groups (ΔAHI 2.1±4.1 and −2.8±11.6, respectively) in comparison with central and mixed patterns (ΔAHI −6.9±15.1 and −12.5 ±13.1, respectively; ANOVA p=0.01). The obstructive pattern became the most frequent pattern, in 38.3% of patients at baseline and 61.7% of patients at follow-up. Modification of baroreflex sensitivity over time was influenced by the site of the lesion and by the sleep disorder pattern in the acute phase (MANOVA p=0.005). Conclusion:We suggest that a down-regulation of autonomic activity, possibly related to reduced vagal modulation, may help the recovery after stroke, or a transitory disconnection from the cortical node that participates in the regulation of sympathetic outflow.

Association of Obstructive Sleep Apnea and Atrial Fibrillation in Acute Ischemic Stroke: A Cross-Sectional Study

“…Notably, we excluded central apneas and hypopneas from the count of O-AHI. We excluded central events because of the well-documented relatively high prevalence of central apneas in both AF and acute stroke [ 16 , 17 ]. Additionally, central apneas recognize a different pathogenic mechanism compared to obstructive apneas [ 18 ].…”

Sleep and Stroke: Opening Our Eyes to Current Knowledge of a Key Relationship

“…Since the pathogenic pathways behind OSA and CSA are different, future studies should count separately the AHI of central and obstructive events and consider a mixed respiratory pattern when these two conditions coexist. In fact, studies that took into the account a mixed pattern, characterized by the coexistence of central and obstructive events, observed a high proportion of such pattern in both acute [41] and chronic phases [42•].…”

Clinically Silent Small Vessel Disease of the Brain in Patients with Obstructive Sleep Apnea Hypopnea Syndrome

“…Moderate-to-severe OSA is more frequent in wake-up strokes compared to non-wake up strokes [5]. A recent study observed a high prevalence and variability of Sleep-disordered breathing in the acute phase of cerebral ischemic events [6]. However, the correlation between OSAHS and cerebrovascular disease has not been studied extensively and a lot of queries remain unanswered, such as, the pathophysiological mechanism that links them.…”