Obstructive Sleep Apnea is Related to Impaired Cognitive and Functional Status after Stroke

Aaronson, Justine A.; Bennekom, Coen van; Hofman, W.F.; Bezeij, Tijs van; Aardweg, Joost G. van den; Groet, Erny; Kylstra, Wytske A; Schmand, Ben

doi:10.5665/sleep.4984

Cited by 94 publications

(64 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A recent case-control study among stroke patients admitted to a rehabilitation unit with and without OSA found an association with OSA and lower cognitive status, based on comprehensive neuropsychological testing, as well as overall functional status. 17 Yet, in a randomized trial of stroke patients diagnosed with moderately severe OSA and treated during intensive inpatient rehabilitation, CPAP had only marginal beneficial effects on cognitive testing but achieved significant effects on motor and overall functional outcome, as measured by the FIM among other tests. 11 In that unblinded clinical trial, stroke patients treated with CPAP showed greater recovery one month after randomization than those not treated with CPAP, mostly in motor-related impairments.…”

Section: Discussionmentioning

confidence: 98%

“…Four patients had sleep studies as part of the study procedures during rehabilitation and again, either during rehabilitation or after discharge, as part of routine clinical care. Overall, among the 26 patients who had any testing for sleep apnea (Table 5), the median time period from stroke onset to the first sleep study was 61 days (IQR 6-137), and the median AHI was [16][17][18][19][20][21][22][23][24][25][26], with an AHI ≥ 5 in 23/26 patients (88%). There was no significant difference in stroke severity or demographic factors between those who did and did not have sleep studies.…”

Section: R Esu Lt Smentioning

confidence: 99%

See 1 more Smart Citation

Effect of Continuous Positive Airway Pressure on Stroke Rehabilitation: A Pilot Randomized Sham-Controlled Trial

Khot

Davis

Crane

et al. 2016

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

Study Objectives: Obstructive sleep apnea (OSA) predicts poor functional outcome after stroke and increases the risk for recurrent stroke. Less is known about continuous positive airway pressure (CPAP) treatment on stroke recovery. Methods: In a pilot randomized, double-blind, sham-controlled trial, adult stroke rehabilitation patients were assigned to auto-titrating or sham CPAP without diagnostic testing for OSA. Change in Functional Independence Measure (FIM), a measure of disability, was assessed between rehabilitation admission and discharge. Results: Over 18 months, 40 patients were enrolled and 10 withdrew from the study: 7 from active and 3 from sham CPAP (p > 0.10). For the remaining 30 patients, median duration of CPAP use was 14 days. Average CPAP use was 3.7 h/night, with at least 4 h nightly use among 15 patients. Adherence was not influenced by treatment assignment or stroke severity. In intention-to-treat analyses (n = 40), the median change in FIM favored active CPAP over sham but did not reach statistical significance (34 versus 26, p = 0.25), except for the cognitive component (6 versus 2.5, p = 0.04). The on-treatment analyses (n = 30) yielded similar results (total FIM: 32 versus 26, p = 0.11; cognitive FIM: 6 versus 2, p = 0.06). Conclusions: A sham-controlled CPAP trial among stroke rehabilitation patients was feasible in terms of recruitment, treatment without diagnostic testing and adequate blinding-though was limited by study retention and CPAP adherence. Despite these limitations, a trend towards a benefit of CPAP on recovery was evident. Tolerance and adherence must be improved before the full benefits of CPAP on recovery can be assessed in larger trials. I NTRO DUCTI O N Stroke is the leading cause of long-term disability in the UnitedStates, yet treatments that improve function after stroke are limited. Obstructive sleep apnea (OSA) is increasingly recognized as a risk factor for ischemic and hemorrhagic stroke, 1,2 with prevalence after stroke or transient ischemic attack estimated to be over 70%.3 Stroke patients with OSA compared to those without have worse functional outcome, longer hospitalization and rehabilitation stays, and higher mortality. [4][5][6][7][8][9] Despite the high risk of sleep apnea among patients with stroke and the implications for both stroke recovery and recurrent stroke, few stroke survivors undergo screening, testing, or treatment for OSA. 10 Barriers to evaluation and treatment involve OSA awareness among stroke survivors and clinical providers, access to in-laboratory polysomnography (PSG) testing, and the lack of consensus among stroke providers on the ideal timing for sleep testing.Treatment with continuous positive airway pressure (CPAP) among patients diagnosed with OSA is associated with improved functional and motor outcome after stroke, 11 but trials are limited by poor CPAP tolerance and adherence. 12,13 Compared to the general OSA population, patients with acute stroke are typically older with more functional disability and may have more diffic...

show abstract

Section: Discussionmentioning

confidence: 98%

Section: R Esu Lt Smentioning

confidence: 99%

Effect of Continuous Positive Airway Pressure on Stroke Rehabilitation: A Pilot Randomized Sham-Controlled Trial

Khot

Davis

Crane

et al. 2016

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

show abstract

“…In addition, sleep apnea, neuroticism, and history of depression were included as they might influence the relationships between depression, apathy, and fatigue. Particularly, the role of sleep apnea is important, as it has been shown to be a risk factor for incident stroke [38], and is associated with worse cognitive and functional status [39]. Also in multiple sclerosis [40, 41], associations between sleep apnea and fatigue have been found.…”

Section: Discussionmentioning

confidence: 99%

Temporal Associations between Fatigue, Depression, and Apathy after Stroke: Results of the Cognition and Affect after Stroke, a Prospective Evaluation of Risks Study

et al. 2017

View full text Add to dashboard Cite

Background: Poststroke fatigue (PSF) is a form of pathological fatigue that can develop after stroke and has a negative impact on functional outcome. PSF is associated with poststroke depression (PSD), which in turn shows similarities with poststroke apathy (PSA). This study aimed at disentangling the temporal associations between PSF and PSD and between PSF and PSA. Methods: A total of 250 stroke patients were included, of which 243 completed the Fatigue Severity Scale, Montgomery-Åsberg Depression Rating Scale, and Apathy Evaluation Scale at 3 months poststroke, with follow-up measurements at 6 and 12 months after initial testing. Linear mixed models and linear regressions were performed to evaluate the temporal associations between PSF and PSD, and between PSF and PSA. Results: PSF was present in 119 patients (49%), of whom 62 patients also had PSD (26%), and 21 patients (9%) also had PSA. At baseline, PSF patients showed higher depression levels, which remained stable at follow-up. PSD patients had higher fatigue levels compared with no-PSD patients at baseline, which remained stable at follow-up. No association between apathy and fatigue was found at baseline and no interaction with time was found. Change in fatigue from baseline to 12-month follow-up was associated with change in depression and with change in apathy. Conclusions: Bidirectional associations were found between PSF and PSD. In treatment and rehabilitation programs, early focus on the presence of PSD and PSF is important, since these conditions tend to persist. As there are currently more treatment options for PSD, attention for PSD is important and might also have a beneficial effect on PSF.

show abstract

“…4 Obstructive sleep apnea (OSA) is common in patients with stroke, 5 and is a potential novel risk factor for stroke, but its relation to cognitive dysfunction poststroke has been less well studied. 6 The majority of studies have included stroke patients with varying severity who have not undergone comprehensive neuropsychological or imaging evaluation. Few studies have examined cognitive dysfunction after minor stroke or transient ischemic attack (TIA); however, mild cognitive impairment is not uncommon with 42% of patients meeting criteria for mild cognitive impairment at >1 year after their event with deficits mainly in executive function (EF) and processing speed (PS).…”

mentioning

confidence: 99%

Imaging and Baseline Predictors of Cognitive Performance in Minor Ischemic Stroke and Patients With Transient Ischemic Attack at 90 Days

Mandzia

Smith

Horton

et al. 2016

Stroke

View full text Add to dashboard Cite

Background and Purpose-Few studies have examined predictors of cognitive impairment after minor ischemic stroke and transient ischemic attack (TIA). We examined clinical and imaging features associated with worse cognitive performance at 90 days. Methods-TIA or patients with minor stroke underwent neuropsychological testing 90 days post event. Z scores were calculated for cognitive tests, and then grouped into domains of executive function (EF), psychomotor processing speed (PS), and memory. White matter hyperintensity and diffusion-weighted imaging volumes were measured on baseline magnetic resonance imaging. Ninety-day outcomes included modified Rankin Scale (mRS) and Centre for Epidemiological Studies Depression Scale (CES-D) score. Results-Ninety-two patients were included, 76% male, 54% TIA, and mean age 65.

show abstract

Obstructive Sleep Apnea is Related to Impaired Cognitive and Functional Status after Stroke

Cited by 94 publications

References 34 publications

Effect of Continuous Positive Airway Pressure on Stroke Rehabilitation: A Pilot Randomized Sham-Controlled Trial

Effect of Continuous Positive Airway Pressure on Stroke Rehabilitation: A Pilot Randomized Sham-Controlled Trial

Temporal Associations between Fatigue, Depression, and Apathy after Stroke: Results of the Cognition and Affect after Stroke, a Prospective Evaluation of Risks Study

Imaging and Baseline Predictors of Cognitive Performance in Minor Ischemic Stroke and Patients With Transient Ischemic Attack at 90 Days

Contact Info

Product

Resources

About