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

Abstract

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.

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

“…These data were further confirmed by a meta-analysis conducted by Hasan et al who evaluated the dynamic prevalence of sleep disorders after stroke or TIA [1 ••]. Recently, the SAS Care 1 study [35] evaluated longitudinally the progression of SDB in a large cohort patient with ischemic stroke or TIA by means of PSG: the authors observed a significant reduction of AHI (baseline: 21 events/h; at 3 months: 18 events/h) driven by a reduction of both the obstructive and central component. Nevertheless, the prevalence of SBD was similar at baseline (85.6%) and at 3 months (82.7%), and a reduction was observed exclusively for severe SBD (AHI > 30/h) and for CSA.…”

“…In a recent meta-analysis performed by Seiler et al [2] conducted on 86 studies for a total of 7096 patients, the prevalence of SA in patients with acute stroke or TIA ranged between 30% (with an AHI > 30/h, consistent with severe SDB) up to 71% (with an AHI > 5/h, consistent with mild SDB); only a slightly lower prevalence was observed in the chronic phase. However, most of the studies included in the meta-analysis evaluated the acute phase, while only few studies [32][33][34][35][36][37] evaluated the intra-individual evolution from acute to the chronic phase. Moreover, few studies [33][34][35][36]38] evaluated the evolution of SDB in stroke by means of polysomnography (PSG), the standard diagnostic test for SDB in stroke patients [39], reporting an improvement, but not a resolution, from acute to sub-acute/chronic phase, of the SDB.…”

“…However, most of the studies included in the meta-analysis evaluated the acute phase, while only few studies [32][33][34][35][36][37] evaluated the intra-individual evolution from acute to the chronic phase. Moreover, few studies [33][34][35][36]38] evaluated the evolution of SDB in stroke by means of polysomnography (PSG), the standard diagnostic test for SDB in stroke patients [39], reporting an improvement, but not a resolution, from acute to sub-acute/chronic phase, of the SDB. These data were further confirmed by a meta-analysis conducted by Hasan et al who evaluated the dynamic prevalence of sleep disorders after stroke or TIA [1 ••].…”

Effect of early sleep apnoea treatment with adaptive servo-ventilation in acute stroke patients on cerebral lesion evolution and neurological outcomes: study protocol for a multicentre, randomized controlled, rater-blinded, clinical trial (eSATIS: early Sleep Apnoea Treatment in Stroke)

“…Feasibility of the trial at each centre was evaluated based on the number of admitted stroke patients to a centre, availability of required infrastructure and qualified staff in the necessary disciplines to conduct the trial: neurology, pulmonary medicine and/or sleep medicine as well as neuroradiology. Feasibility of diagnosing and treating SDB in acute stroke patients was shown in former clinical studies of the Bernese study team (SAS CARE 1 & 2, [ 23 – 25 ]).…”

Obstructive Sleep Apnea: An Underdiagnosed Risk Factor for Stroke and Cardiovascular Disease

“…Stroke incidence in OSA-positive patients Results from three cohort studies reported by Dae Lim Koo (2018) [3] H. Lee Lau et al (2019) estimate a relative risk of independent association between SAS and stroke of 2.5 in a meta-analysis of 10 cohort studies [4] Sherma (2016) analysing the Sleep Heart Health Study and Wisconsin studies gives the respective results: HZ =2.86 and RR = 4.48 (ci: 1.31 -15.33) [5] Prevalence of OSA in stroke/TIA The results of a meta-analysis and systematic review of 89 studies involving 7,096 patients by Andreas Seiler (2019) are as follows: for AHI >5 events/hour, the prevalence is 71% of patients, for AHI>30 events/hour, the prevalence is 30% of patients [6]. The observational polysomnographic study by Sebastian R. Ott (2020) gives a prevalence of 80.5% for an AHI > 5 events/hour and 25.4% for an AHI > 30 events/hour [7].…”