Sleep-Related Breathing Disorders and Rehabilitation Outcome of Stroke Patients

Abstract

Cherkassky T, Oksenberg A, Froom P, Ring H: Sleep-related breathing disorders and rehabilitation outcome of stroke patients: A prospective study. Am J Phys Med Rehabil 2003;82:452-455. Objective: Sleep-related breathing disorder (SRBD) is more prevalent in stroke patients than in age-and sex-matched controls, but the relationship between SRBD, functional levels at admission, and subsequent recovery is unclear. We evaluated patients after a first stroke to determine the prevalence of SRBD and the influence of SRBD on the recovery of discharge functional status after a rehabilitation program.Design: In a prospective study, 30 stroke patients were studied by continuous overnight pulse oximetry during sleep for the presence of desaturation events (fall of arterial saturation of Ͼ4% from the baseline). The Respiratory Disturbance Index was defined as number of desaturations per hour of sleep. Functional assessment was done at admission using the FIM™ instrument. The patients were asked about total hours of sleep and the presence or absence of habitual snoring before and after the stroke. The outcome measure at discharge was the FIM score.Results: On linear regression, after including the FIM score at admission, in the model, the Respiratory Disturbance Index score was negatively correlated with the FIM gain (coefficient, Ϫ0.635 Ϯ 0.27; P ϭ 0.025), and together, the variables explained 20.9% of the total variance (adjusted r 2 ). All patients with an admission FIM score of Ն70 (only mild functional impairment) had a good outcome (FIM score of Ͼ100 at discharge). However, only two of six of those with FIM scores of Ͻ70 with SRBD (defined as a Respiratory Disturbance Index score of Ͼ10) had significant improvement (Ն30 points), whereas this occurred in seven of nine of those without SRBD (prevalence ratio, 0.43; 95% confidence interval, 0.13-1.40; P ϭ 0.085) Conclusions: Even after adjusting for the admission functional status, the presence of hypoxic events during sleep predicts a poorer recovery, especially in stroke patients with poor function at admission.

Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

“…264,280 Sleep apnea has been associated with poor outcomes among patients with cerebrovascular disease, including higher mortality, [281][282][283][284] delirium, 261 depressed mood, 261 and worse functional status. 261,281,282,285,286 Sleep apnea can be treated with a variety of approaches, but the mainstay of therapy is CPAP. 267,271,287 Several RCTs and observational cohort studies have examined the effectiveness of CPAP in improving poststroke or post-TIA outcomes.…”

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

“…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.…”

Sleep Apnea and Stroke

“…Central sleep apneas predominate in the acute stroke phase, giving way to obstructive apneas in the chronic stages [46]; as the stroke condition evolves, sleep apnea may change in its intensity. Nonetheless, sleep apnea after stroke is associated with poor functional outcome, depressed mood, cognitive dysfunction, deteriorated ability to perform activities of daily living (ADL), as well as psychiatric and behavioral symptoms [47] and may be significantly and independently related to length of hospitalization [48,49].…”