Ann Rehabil Med.  2017 Aug;41(4):556-563. 10.5535/arm.2017.41.4.556.

Clinical Characteristics of Sleep-Disordered Breathing in Subacute Phase of Stroke

• Jeon H
• Sohn MK
• Jeon M
• Jee S

• KMID: 2389400
• DOI: http://doi.org/10.5535/arm.2017.41.4.556

Abstract

OBJECTIVE
To assess the frequency and severity of sleep-disordered breathing (SDB) in subacute stroke patients in Korea.
METHODS
We consecutively enrolled subacute stroke patients who were transferred to the Department of Rehabilitation Medicine from February 2016 to August 2016. The inclusion criteria were as follows: diagnosis of the first onset of cerebral infarction or hemorrhage in the brain by computed tomography or magnetic resonance imaging; patients between 18 and 80 years old; and patients admitted within 7 days to 6 months after stroke onset. We evaluated baseline clinical data on patients' admission to the Department of Rehabilitation Medicine. We assessed demographic data, stroke severity, neurologic impairment, cognition and quality of life. We used the Epworth Sleepiness Scale to assess quality of sleep. We used a portable polysomnography to detect SDB.
RESULTS
Of the 194 stroke patients, 76 patients enrolled in this study. We evaluated and included 46 patients in the outcome analysis. The mean apnea-hypopnea index (AHI) was 24.2±17.0 and 31 patients (67.4%) exhibited an AHI ≥15. Those in the SDB group showed a higher National Institutes of Health Stroke Scale, lower Functional Ambulation Category, lower Korean version of Modified Barthel Index, and lower EuroQol five dimensions questionnaire (EQ-5D) at admission. Prevalence and clinical characteristics of SDB did not show significant differences among stroke types or locations.
CONCLUSION
SDB is common in subacute stroke patients. SDB must be evaluated after a stroke, particularly in patients presenting severe neurologic impairment.

Keyword

Rehabilitation; Sleep; Sleep apnea syndromes; Stroke

MeSH Terms

Brain
Cerebral Infarction
Cognition
Diagnosis
Hemorrhage
Humans
Korea
Magnetic Resonance Imaging
National Institutes of Health (U.S.)
Polysomnography
Prevalence
Quality of Life
Rehabilitation
Sleep Apnea Syndromes*
Stroke*
Walking

Figure

• 

  Fig. 1 CONSORT diagram for patient inclusion and exclusion.

Reference

1. Ahn SH, Kim JH, Kim DU, Choo IS, Lee HJ, Kim HW. Interaction between sleep-disordered breathing and acute ischemic stroke. J Clin Neurol. 2013; 9:9–13. PMID: 23346154.

2. Klobucnikova K, Siarnik P, Carnicka Z, Kollar B, Turcani P. Causes of excessive daytime sleepiness in patients with acute stroke: a polysomnographic study. J Stroke Cerebrovasc Dis. 2016; 25:83–86. PMID: 26419529.

3. Aaronson JA, van Bennekom CA, Hofman WF, van Bezeij T, van den Aardweg JG, Groet E, et al. Obstructive sleep apnea is related to impaired cognitive and functional status after stroke. Sleep. 2015; 38:1431–1437. PMID: 25669178.

4. Mohsenin V, Valor R. Sleep apnea in patients with hemispheric stroke. Arch Phys Med Rehabil. 1995; 76:71–76. PMID: 7811179.

5. Martinez-Garcia MA, Galiano-Blancart R, Soler-Cataluna JJ, Cabero-Salt L, Roman-Sanchez P. Improvement in nocturnal disordered breathing after first-ever ischemic stroke: role of dysphagia. Chest. 2006; 129:238–245. PMID: 16478837.

6. Yan-fang S, Yu-ping W. Sleep-disordered breathing: impact on functional outcome of ischemic stroke patients. Sleep Med. 2009; 10:717–719. PMID: 19168390.

7. Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. 2015; 3:310–318. PMID: 25682233.

8. Kim J, In K, Kim J, You S, Kang K, Shim J, et al. Prevalence of sleep-disordered breathing in middle-aged Korean men and women. Am J Respir Crit Care Med. 2004; 170:1108–1113. PMID: 15347562.

9. Harbison J, Ford GA, James OF, Gibson GJ. Sleep-disordered breathing following acute stroke. QJM. 2002; 95:741–747. PMID: 12391386.

10. Bassetti CL, Milanova M, Gugger M. Sleep-disordered breathing and acute ischemic stroke: diagnosis, risk factors, treatment, evolution, and long-term clinical outcome. Stroke. 2006; 37:967–972. PMID: 16543515.

11. Camilo MR, Schnitman SV, Sander HH, Eckeli AL, Fernandes RM, Leite JP, et al. Sleep-disordered breathing among acute ischemic stroke patients in Brazil. Sleep Med. 2016; 19:8–12. PMID: 27198940.

12. Kaneko Y, Hajek VE, Zivanovic V, Raboud J, Bradley TD. Relationship of sleep apnea to functional capacity and length of hospitalization following stroke. Sleep. 2003; 26:293–297. PMID: 12749548.

13. Balfors EM, Franklin KA. Impairment of cerebral perfusion during obstructive sleep apneas. Am J Respir Crit Care Med. 1994; 150(6 Pt 1):1587–1591. PMID: 7952619.

14. Netzer N, Werner P, Jochums I, Lehmann M, Strohl KP. Blood flow of the middle cerebral artery with sleep-disordered breathing: correlation with obstructive hypopneas. Stroke. 1998; 29:87–93. PMID: 9445334.

15. Bradley TD, Floras JS. Obstructive sleep apnoea and its cardiovascular consequences. Lancet. 2009; 373:82–93. PMID: 19101028.

16. Arzt M, Young T, Finn L, Skatrud JB, Bradley TD. Association of sleep-disordered breathing and the occurrence of stroke. Am J Respir Crit Care Med. 2005; 172:1447–1451. PMID: 16141444.

17. Bassetti C, Aldrich MS. Sleep apnea in acute cerebrovascular diseases: final report on 128 patients. Sleep. 1999; 22:217–223. PMID: 10201066.

18. Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Nieto FJ, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001; 163:19–25. PMID: 11208620.

19. Bassetti C, Aldrich MS, Chervin RD, Quint D. Sleep apnea in patients with transient ischemic attack and stroke: a prospective study of 59 patients. Neurology. 1996; 47:1167–1173. PMID: 8909424.

20. Parra O, Arboix A, Bechich S, Garcia-Eroles L, Montserrat JM, Lopez JA, et al. Time course of sleep-related breathing disorders in first-ever stroke or transient ischemic attack. Am J Respir Crit Care Med. 2000; 161(2 Pt 1):375–380. PMID: 10673174.

21. Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009; 5:263–276. PMID: 19960649.

22. Kepplinger J, Barlinn K, Albright KC, Schrempf W, Boehme AK, Pallesen LP, et al. Early sleep apnea screening on a stroke unit is feasible in patients with acute cerebral ischemia. J Neurol. 2013; 260:1343–1350. PMID: 23263538.

23. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2012; 8:597–619. PMID: 23066376.

24. Collop NA, Anderson WM, Boehlecke B, Claman D, Goldberg R, Gottlieb DJ, et al. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients: Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2007; 3:737–747. PMID: 18198809.

25. Cho YW, Lee JH, Son HK, Lee SH, Shin C, Johns MW. The reliability and validity of the Korean version of the Epworth sleepiness scale. Sleep Breath. 2011; 15:377–384. PMID: 20358406.

26. Johns MW. Sleepiness in different situations measured by the Epworth Sleepiness Scale. Sleep. 1994; 17:703–710. PMID: 7701181.

27. Good DC, Henkle JQ, Gelber D, Welsh J, Verhulst S. Sleep-disordered breathing and poor functional outcome after stroke. Stroke. 1996; 27:252–259. PMID: 8571419.

28. Brown DL, McDermott M, Mowla A, De Lott L, Morgenstern LB, Kerber KA, et al. Brainstem infarction and sleep-disordered breathing in the BASIC sleep apnea study. Sleep Med. 2014; 15:887–891. PMID: 24916097.

29. Kim SM, Hwang SW, Oh EH, Kang JK. Determinants of the length of stay in stroke patients. Osong Public Health Res Perspect. 2013; 4:329–341. PMID: 24524022.