Diagnosis and treatment of respiratory disturbances during sleep in patients with acute stroke

Abstract

The objective: to analyze the features of diagnosis and treatment of respiratory disturbances during sleep in patients with acute stroke (AS) with concomitant diabetes mellitus (DM).Materials and methods. The study involved 300 patients (180 men and 120 women) aged 46 to 82 years who were diagnosed with acute ischemic stroke with comorbid diabetes on admission.Results. When comparing the results of the use of various tracheotomy techniques in the Intensive Care Unit of the Kyiv Regional Clinical Hospital, it was established that percutaneous puncture-dilatational tracheotomy has several advantages over traditional tracheotomy. In particular, the peculiarities of the technique of performing the dilatational tracheotomy allow it to be performed in much shorter periods than the traditional one. Thus, the time for performing the manipulation in the main group of patients was 10.8 ± 3.6 min, whereas in the control group 1 49.7 ± 12.3 min (p <0.01).Conclusions. The study found that the risk of respiratory disorders in diabetic patients with acute stroke (AS) is high (63,3%). Risk factors include male gender, obesity, high NIHSS score (15). The effectiveness of detection of obstructive sleep apnea (OSA) with the help of the Epworth Sleepiness Scale in stroke patients is unsatisfactory and is only 5,9%. For the purpose of diagnosing disorders of breathing during sleep in these patients should be performed at admission screening diagnosis of OSA to determine the need for respiratory support and tactics. The tactics of respiratory support in these patients should be as follows. When detecting patients with "soft" OSA (IAH 5115), "position" therapy is performed to minimize the patient's stay in the position on the back. In patients with IAH>15, atechnique of early non-invasive ventilation correction using constant positive airway pressure (CPAP) should be used.