Study of association of severity of sleep disordered breathing and functional outcome in stroke patients

Kumar, Rohit; Suri, Jagdish Chander; Manocha, Rajesh

doi:10.1016/j.sleep.2017.02.025

Cited by 24 publications

(21 citation statements)

References 33 publications

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“…Primary studies: Six additional primary studies of class II or III quality were identified [110][111][112][113][114][115].…”

Section: What Is the Frequency Of Sdb In Stroke Patients?mentioning

confidence: 99%

“…The frequencies for the different AHI cut-offs were found: AHI >5 in 70.4% (95% CI 62. [95,[110][111][112][113][114][115]. Most studies published did not find any relationship between topography of stroke and frequency/severity of SDB, although few reports suggested an association between central SDB and supratentorial, and obstructive SDB and infratentorial stroke [31].…”

Section: Overview Of the Evidencementioning

confidence: 99%

“…New studies, published after the most up-to-date systematic review, did not find an independent association between SDB and mortality [111,114,119]; however, three of them [113,114,118] found an association of SDB with a worse neurological outcome (e.g. modified Rankin Scale score, Bartel Index, early neurological deterioration) (table e14).…”

Section: Overview Of the Evidencementioning

confidence: 99%

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EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

et al. 2020

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@ERSpublicationsEvidence suggests a bidirectional relationship between sleep and stroke. However, the pathophysiological base of the associations and the possibilities of improving prevention and outcome through sleep-related interventions require further evaluation.ABSTRACT Sleep disorders are highly prevalent in the general population and may be linked in a bidirectional fashion to stroke, which is one of the leading causes of morbidity and mortality.Four major scientific societies established a task force of experts in neurology, stroke, respiratory medicine, sleep medicine and methodology, to critically evaluate the evidence regarding potential links and the impact of therapy. 13 research questions were evaluated in a systematic literature search using a stepwise hierarchical approach: first, systematic reviews and meta-analyses; second, primary studies postdating the systematic reviews/meta-analyses. A total of 445 studies were evaluated and 88 included. Statements were generated regarding current evidence and clinical practice.Severe obstructive sleep apnoea (OSA) doubles the risk for incident stroke, especially in young to middle-aged patients. Continuous positive airway pressure (CPAP) may reduce stroke risk, especially in treatment-compliant patients. The prevalence of OSA is high in stroke patients and can be assessed by polygraphy. Severe OSA is a risk factor for recurrence of stroke and may be associated with stroke mortality, while CPAP may improve stroke outcome. It is not clear if insomnia increases stroke risk, while pharmacotherapy of insomnia may increase it. Periodic limb movements in sleep (PLMS), but not restless limb syndrome (RLS), may be associated with an increased risk of stroke. Preliminary data suggest a high frequency of post-stroke insomnia and RLS and their association with a less favourable stroke outcome, while treatment data are scarce.Overall, the evidence base is best for OSA relationship with stroke and supports active diagnosis and therapy. Research gaps remain especially regarding insomnia and RLS/PLMS relationships with stroke. This article has an editorial commentary: https://doi.

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“…Primary studies: Six additional primary studies of class II or III quality were identified [110][111][112][113][114][115].…”

Section: What Is the Frequency Of Sdb In Stroke Patients?mentioning

confidence: 99%

Section: Overview Of the Evidencementioning

confidence: 99%

Section: Overview Of the Evidencementioning

confidence: 99%

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EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

et al. 2020

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“…Several subsequent studies have confirmed these and similar findings. 8,33,34 OSA has also been linked to depression, 35 which is common after stroke and may worsen outcomes. 36 The interaction between OSA, depression, and poststroke outcomes warrants further study.…”

Section: ■ Osa May Hinder Stroke Recovery Worsen Outcomesmentioning

confidence: 99%

A sleeping beast: Obstructive sleep apnea and stroke

McKee

Auckley

2019

CCJM

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Up to two-thirds of patients who have had a stroke have obstructive sleep apnea (OSA) afterward. These patients have worse outcomes than those without OSA in terms of short-term morbidity, functional and cognitive recovery, and mortality rates over the long term. Following a stroke, identifying OSA and treating it with positive airway pressure, if possible, are important clinical goals. KEY POINTS A low threshold for evaluating for OSA after a stroke is warranted: the prevalence is high in this population, and risk factors for OSA and its typical clinical picture may not be present. Questionnaires can help screen for the likelihood of OSA and the need for more definitive assessment with polysomnography or home sleep apnea testing, tests that pose additional challenges after stroke. Positive airway pressure (PAP) therapy remains the firstline treatment for OSA after stroke; it may improve recovery and reduce long-term sequelae of untreated OSA. Acceptance of and adherence to PAP therapy can be especially problematic in this population, and alternatives should be considered if needed.

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“…Increasing evidence shows that SDB can lead to worse functional outcome and quality of life in stroke patients. (40)(41)(42)(43)(44) Importantly, there could several mediating factors between SDB and worse functional outcomes in stroke. For example, cognitive impairment is described in four-out-of-five stroke patients, most commonly in the domain of attention and executive function.…”

Section: Introductionmentioning

confidence: 99%

Sleep and Stroke: New Updates on Epidemiology, Pathophysiology, Assessment, and Treatment

Lau

Rundek

Ramos

2019

Curr Sleep Medicine Rep

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Purpose of review-This review aims to discuss the most recent data on sleep disorders and stroke, highlighting relevant findings for the practicing neurologist or health providers who encounter patients with sleep disorders and stroke. Recent findings-Sleep apnea and abnormal sleep duration have the strongest association with stroke risk. Possible mechanisms include non-dipping of blood pressure during sleep, hypoxemia or reoxygenation leading to sympathetic activation, hypertension, atrial fibrillation and impaired cerebral hemodynamics. Treatment studies suggest that continuous positive airway pressure (CPAP) for sleep apnea could improve primary prevention of stroke, but data is equivocal for secondary prevention. However, CPAP could improve functional outcomes after stroke. Summary-Sleep disorders present an opportunity to improve stroke risk and functional outcomes. However, new strategies are needed to determine the patients at high-risk who would most likely benefit from targeted care. Novel methods for phenotyping sleep disorders could provide personalized stroke care to improve clinical outcomes and public health strategies.

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Study of association of severity of sleep disordered breathing and functional outcome in stroke patients

Cited by 24 publications

References 33 publications

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke

A sleeping beast: Obstructive sleep apnea and stroke

Sleep and Stroke: New Updates on Epidemiology, Pathophysiology, Assessment, and Treatment

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