Abstract
Presence of sleep-disordered breathing (SDB) affects negatively recovery from stroke. The aim of this study is to evaluate the relationships between sleep-disordered breathing (SDB) and outcome measures in Finnish stroke unit cohort: mRS, need of rehabilitation and hospitalization time. An observational longitudinal study consisted of 95 patients referred to the Stroke Unit of Satakunta Hospital District over a period of November 2013 to March 2016. Patients were tested for SDB within 72hr from the hospital admission because of ischemic stroke or TIA. The patients underwent polysomnography with NOX T3 wireless recorder. There are 37% (n=35) non-OSA patients, 20% (n=19) of patients have mild obstructive sleep apnea (OSA) and 39% (n=37) have moderate/severe OSA and 4% (n=4) have CSA. Patients with OSA have higher proportion of disability scores of mRS 3-5 (38%) compared to non-OSA (11%) and mild OSA (5%) patients on registration day (mRS0), and the same trend is seen at hospital discharge 35% versus 9% and 5%. (p=.009). Proportion of patients with OSA who needed rehabilitation is 65% (n=19) versus non-OSA patients 17.5% (n=4) and mild OSA patients 17.5% (n=4; p=.039). We observed longer duration of hospitalization (5-15days) in 29% of OSA patients compared to mild OSA patients 47% and OSA patients 54%. (p=.045). Ischemic stroke patients with OSA have higher disability, higher need of rehabilitation, and longer hospitalization length. Prescreening tools for recognizing these stroke patients in acute phase could be valuable. That could result in earlier initiation of treatment and might prevent worse recovery from stroke.
Highlights
Sleep-disordered breathing (SDB) is frequent among ischemic stroke and TIA patients and several studies have estimated the prevalence between 50% and 70% depending on the definition (Bassetti &Aldrich, 1999; Bassetti, Aldrich, Chervin, & Quint, 1996; Hermann & Bassetti, 2009, 2016; Sahlin et al, 2008)
Our observations in a Finnish stroke unit cohort are comparable with previous studies even in mainly mild stroke and TIA patients tested in acute phase
sleep-disordered breathing (SDB) and especially obstructive sleep apnea (OSA) is common in stroke and TIA patients
Summary
Sleep-disordered breathing (SDB) is frequent among ischemic stroke and TIA patients and several studies have estimated the prevalence between 50% and 70% depending on the definition (Bassetti &Aldrich, 1999; Bassetti, Aldrich, Chervin, & Quint, 1996; Hermann & Bassetti, 2009, 2016; Sahlin et al, 2008). Sleep-disordered breathing (SDB) is frequent among ischemic stroke and TIA patients and several studies have estimated the prevalence between 50% and 70% depending on the definition SDB and especially the most common condition, obstructive sleep apnea (OSA) is preceding condition and a known risk factor for ischemic stroke (European Stroke Organisation (ESO) Executive Committee and. Higher rate of recurrent cardiovascular events and mortality have observed in patients with SDB in several studies (Hermann & Bassetti, 2016; Parra et al, 2004; Sahlin et al, 2008; Young et al, 2002). According to ESOC guideline, SDB and moderate to severe OSA is recommended to be treated with continuous positive airway pressure (CPAP; European Stroke Organisation (ESO) Executive Committee and ESO Writing Committee, 2008). In the updated AHA/ASA guideline, it is proposed that the treatment with CPAP might be considered for improved outcomes for stroke and TIA patients (Kernan et al, 2014)
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