Влияние нарушений дыхания во сне на раннее функциональное восстановление при ишемическом инсульте

Abstract

The rehabilitation potential in ischemic stroke depends both on the localization and size of cerebral infarction and on many other factors ensuring the restoration of neuron function in the ischemic penumbra. Sleep-disordered breathing (SDB) appears as intermittent episodes of apnea and hypopnea, which are accompanied by hypoxemia and tissue hypoxia, and may slow early functional recovery in patients. Objective: to evaluate the impact of SDB on early neurological recovery in patients with ischemic stroke and to identify predictors of unfavorable functional outcome. Patients and methods. A total of 56 patients (24 men, 32 women; mean age 62±15 years) with ischemic stroke were examined. All the patients underwent brain magnetic resonance imaging. Neurological deficit was assessed using the National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) on admission and at 3 weeks. To identify SDB, cardiorespiratory monitoring was performed on 2–5 days after the onset of the disease. The total number of episodes of SDB, apnea, hypopnea, apnea-hypopnea index (AHI), hypoxemia index, and the total time with arterial oxygen saturation 123 is associated with the worst functional recovery. The results of the comparative analysis can be taken as the threshold value associated with unfavorable functional recovery in the early stages (AHI≥25/hr-1). It is precisely these patients that can be considered as candidates for early CPAP therapy (Continuous Positive Airway Pressure) in order to improve early functional recovery.