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

Brunetti, Valerio; Rollo, Eleonora; Broccolini, Aldobrando; Frisullo, Giovanni; Scala, Irene; Marca, Giacomo Della

doi:10.1007/s11910-022-01234-2

Cited by 16 publications

(10 citation statements)

References 148 publications

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“…This results furtherly confirmed the influence of severe OSA on hypoperfusion. Multiple researches have reported a bidirectional relationship between OSA and stroke: on the one hand, it is a risk factor for stroke, on the other hand, it is also a consequence ( 26 , 27 ). The AHI was detected after the onset in the current study, it could not reflect the previous severity, and this made it difficult to determine the causal relationship between OSA and hypoperfusion.…”

Section: Discussionmentioning

confidence: 99%

Correlation between obstructive sleep apnea and hypoperfusion in patients with acute cerebral infarction

Zhou,

Jin,

Liu

et al. 2024

Front. Neurol.

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PurposeTo explore the relationship between obstructive sleep apnea (OSA) and hypoperfusion during ultra-early acute cerebral infarction.Patients and methodsData were retrospectively collected from patients admitted to our hospital with acute cerebral infarction between January 2020 and January 2022, who underwent comprehensive whole-brain computed tomography perfusion imaging and angiography examinations within 6 h of onset. The F-stroke software automatically assessed and obtained relevant data (Tmax). The patients underwent an initial screening for sleep apnea. Based on their Apnea-Hypopnea Index (AHI), patients were categorized into an AHI ≤15 (n = 22) or AHI >15 (n = 25) group. The pairwise difference of the time-to-maximum of the residue function (Tmax) > 6 s volume was compared, and the correlation between AHI, mean pulse oxygen saturation (SpO2), oxygen desaturation index (ODI), percentage of time with oxygen saturation < 90% (T90%), and the Tmax >6 s volume was analyzed.ResultsThe Tmax >6 s volume in the AHI > 15 group was significantly larger than that in the AHI ≤ 15 group [109 (62–157) vs. 59 (21–106) mL, p = 0.013]. Spearman’s correlation analysis revealed Tmax >6 s volume was significantly correlated with AHI, mean SpO2, ODI, and T90% in the AHI > 15 group, however, no significant correlations were observed in the AHI ≤ 15 group. Controlling for the site of occlusion and Multiphase CT angiography (mCTA) score, AHI (β = 0.919, p < 0.001), mean SpO2 (β = −0.460, p = 0.031), ODI (β = 0.467, p = 0.032), and T90% (β =0.478, p = 0.026) remained associated with early hypoperfusion in the AHI > 15 group.ConclusionIn patients with acute cerebral infarction and AHI > 15, AHI, mean SpO2, ODI and T90% were associated with early hypoperfusion. However, no such relationship exists among patients with AHI ≤ 15.

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Section: Discussionmentioning

confidence: 99%

Correlation between obstructive sleep apnea and hypoperfusion in patients with acute cerebral infarction

Zhou,

Jin,

Liu

et al. 2024

Front. Neurol.

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“…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 ]. The exclusion of central events in the count of O-AHI could have led to a lower prevalence of OSA in our population regarding patients who presented concomitant heart diseases and AF.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, it is possible that OSA is, at least in part, a reversible manifestation of AIS resulting from an altered respiratory pattern, pharyngeal muscular dysfunction, and prolonged immobilization [ 18 , 30 , 36 ]. In this view, AIS may exacerbate or precipitate pre-existing sleep-disordered breathing [ 18 ]. Current evidence suggests that OSA may be a pre-existing condition aggravated by stroke, while CSA may appear de novo as a symptom of the acute phase.…”

Section: Discussionmentioning

confidence: 99%

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

Brunetti

Testani

Losurdo³

et al. 2023

JPM

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Background: There is a growing body of evidence suggesting a link between obstructive sleep apnea (OSA) and atrial fibrillation (AF). The primary objective of this study is to evaluate the association between OSA and AF in acute ischemic stroke. The secondary objective is to describe the clinical features of patients with acute ischemic stroke and concomitant OSA. Methods: We enrolled consecutive patients with acute ischemic stroke. All patients underwent full-night cardiorespiratory polygraphy. To determine if there is an association between AF and OSA, we compared the observed frequency of this association with the expected frequency from a random co-occurrence of the two conditions. Subsequently, patients with and without OSA were compared. Results: A total of 174 patients were enrolled (mean age 67.3 ± 11.6 years; 95 males). OSA and AF were present in 89 and 55 patients, respectively. The association OSA + AF was observed in 33/174 cases, which was not statistically different compared to the expected co-occurrence of the two conditions. Patients with OSA showed a higher neck circumference and body mass index, a higher prevalence of hypertension and dysphagia, and a higher number of central apneas/hypoapneas. In the multivariate analysis, dysphagia and hypertension were independent predictors of OSA. A positive correlation was observed between OSA severity, BMI, and neck circumference. The number of central apneas/hypoapneas was positively correlated with stroke severity. Conclusions: Our data suggest that OSA and AF are highly prevalent but not associated in acute stroke. Our findings support the hypothesis that OSA acts as an independent risk factor for stroke.

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“…Sleep disorders (such as sleep apnea and also insomnia, narcolepsy, and restless leg syndrome) are more frequent in patients with spinal cord injury [27] and stroke [28] than in the general population and have been related to negative health outcomes such as cardiovascular risks and hypertension. Sleep deprivation and disorders have also been related to worsening of pain in patients with chronic pain and orthopedic issues [29].…”

Section: Discussionmentioning

confidence: 99%

Sleep Quality Should Be Assessed in Inpatient Rehabilitation Settings: A Preliminary Study

et al. 2023

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Objectives: In this preliminary, longitudinal study, our objective was to assess changes in sleep quality during an inpatient stay in a rehabilitation setting in the United States and to relate changes to patients’ demographic and clinical characteristics (i.e., age, gender, BMI, ethnicity, reason for hospitalization, pre-hospital living setting, prior diagnosis of sleep disorders, and mental health status). Methods: A total of 35 patients participated in this preliminary study (age = 61 ± 16 years old, 50% <65; BMI = 30 ± 7 kg/m2; 51% female; 51% Caucasian). The average length of hospitalization was 18 ± 8 days. Reasons for hospitalization included orthopedic-related issues (28%), spinal cord injury (28%), stroke (20%), and other (23%). In this sample, 23% had prior sleep disorders (mostly sleep apnea), and 60% came from an acute care unit. Patients’ sleep quality was assessed using the Pittsburgh sleep quality index (PSQI) at admission and before discharge. Demographic and medical data were collected. Patients’ mental health status was also assessed at the same intervals. Nighttime sound levels and the average number of sleep disturbances were also collected throughout the study (6 months). Results: Our data revealed that most patients had poor sleep (PSQI > 5) at admission (86%) and discharge (80%). Using a repeated ANOVA, a significant interaction was obtained between sleep quality and the presence of a diagnosed sleep disorder [F (1, 33) = 12.861, p = 0.001, η2p = 0.280]. The sleep quality of patients with sleep disorders improved over their stay, while the sleep of patients without such disorders did not. The mean nighttime sound collection level averages and peaks were 62.3 ± 5.1 dB and 86.1 ± 4.9 dB, respectively, and the average number of sleep disturbances was 2.6 ± 1.1. Conclusion: The improved sleep observed in patients with vs. without sleep disorders might be related to the care received for treating such disorders over the stay. Our findings call for the better detection and management of poor sleep in acute inpatient rehabilitation settings. Furthermore, if our findings are replicated in the future, studies on the implementation of quiet times for medical staff, patients, and family should be performed to improve sleep quality in the inpatient rehabilitation setting.

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

Cited by 16 publications

References 148 publications

Correlation between obstructive sleep apnea and hypoperfusion in patients with acute cerebral infarction

Correlation between obstructive sleep apnea and hypoperfusion in patients with acute cerebral infarction

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

Sleep Quality Should Be Assessed in Inpatient Rehabilitation Settings: A Preliminary Study

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