High Risk of Obstructive Sleep Apnea in Hemorrhagic Stroke Patient

Abstract

Background: Stroke is one of the biggest causes of mortality and morbidity in the world, about 10% - 20% are caused by hemorrhagic strokes. Obstructive Sleep Apnea (OSA) is a sleep disorder that is often found in 5-15% of the general population and has a high prevalence in patients with cerebrovascular disease. Case summary: A 51 year old female with a sudden loss of consciousness since 1 day ago, while working. The patient has a history of hypertension since 2014. On computerized tomography scan (CT scan) of the head without contrast shows bleeding. During hospitalization, it appears that the patient snoring, easily falls asleep during the day and there are periods of apnea when the patient sleeps. The blood gas analysis was normal. The patient's sleep score shows high risk of OSA. Discussion: Patient with a hemorrhagic stroke and high risk OSA. There are several risk factors that influence the emergence of OSA in this case, obesity and hypertension. The therapy is to prohibit positioning, sleep hygiene, and losing weight. Conclusion: We have reported a case of hemorrhagic stroke with a high risk of OSA that was experienced long before. The high risk of OSA in these patients can be a risk factor for hemorrhagic stroke. Polysomnography examination needs to be done in patients with a high risk of OSA, as the gold standard. Management of these patients apart from giving pharmacological therapy combined with behavioral and positional therapy to treat OSA symptoms. Mandibular enhancement devices and continuous positive airway pressure (CPAP) have not been given to this patient because polysomnography has not been performed and cost constraints. Keywords: hypertension; hemorrhagic stroke; obesity; OSA