Cerebral oxymetry in patients with ischemic stroke and concomitant obstructive sleep apnea syndrome

Abstract

Cerebral stroke is an important medical and social problem of our time and the most common cause of permanent disability. In patients with brain damage due to ischemic stroke and concomitant obstructive sleep apnoea, numerous episodes of hypoventilation and apnoea cause significant «failures» in saturation and changes in cerebral perfusion, which negatively affects immediate and long-term treatment outcomes. Cerebral oximetry is widely used in clinical practice in various fields of surgery (cardiovascular, paediatric, neurosurgery, etc.), but its potential as a method of monitoring secondary brain damage and controlling treatment in patients with ischaemic cerebral stroke is poorly understood. Objective — to evaluate the effect of non-invasive CPAP support (Continuous Positive Airway Pressure — a method of non-invasive respiratory support in which positive pressure is created in the patient’s airways) on cerebral oximetry in the treatment of patients with ischaemic stroke and concomitant obstructive sleep apnoea syndrome. Materials and methods. Patients with verified mild to moderate ischaemic stroke underwent screening diagnostics to confirm the presence of obstructive sleep apnoea syndrome (SomnoChek micro, Weinman, Germany). We studied 60 patients with obstructive sleep apnoea in the setting of ischemic stroke, who were divided into two groups depending on the treatment method: control (n = 30), in which only conventional stroke treatment was used, and experimental (n = 30), in which the traditional treatment regimen and respiratory support (auto-SAPP) during night sleep with the ResMed Air Sencei apparatus (Australia) were used. To monitor the effectiveness of respiratory support, along with other methods of objective control, cerebral oximetry was used using the Masimo Root apparatus (Masimo, USA). The average rSO2 values on the side of the stroke-affected hemisphere were recorded at the following times: at the beginning of the study, on the 3rd, 5th and 7th day of treatment. The data obtained were processed statistically. Results. The initial average values of rSO2 of the affected by stroke hemisphere in patients of groups I and II were in the range of pathological values, and were (49.27 ± 4.98) and (50.60 ± 5.40) %, respectively, that is, the groups at the beginning of the study were compared to each other. It was found, that in group I patients statistically significant changes in rSO2 % in the intervals of the 1st and 3rd days, the 3rd and 5th days, and the 5th and 7th days — were not observed. Only during the 7th day of observation we’ve recorded statistically significant rSO2 growth at 15.6 % compared to the initial values up to the mark of (57.03 ± 7.01) %. Instead, the rSO2 changes in patients of group II (who were performed СРАР-support at night against the traditional treatment of a stroke), were dynamic and statistically probable: a controlled index during the 3rd day of observation has increased at 12.2 %, during the 5th day — at 26.5 %, during the 7th day — at 33.6 % compared to the initial values up to the level of (67.64 ± 3.02) % compared to the initial values. Conclusions. Standardized medicinal therapy and early rehabilitation of patients with ischemic stroke does not affect the course and severity of concomitant obstructive sleep apnea syndrome and requires a supplement with the methods of non-invasive respiratory support during night sleep. Patients with ischemic stroke against the background of autoCPAP-therapy, were recorded positive dynamics in terms of correction of obstructive sleep apnea syndrome and stable normalization of cerebral oxymetry.