Sleep disordered breathing in patients with acute unilateral dorsolateral medullary infarction – preliminary results of a prospective study

Abstract

Background Acute unilateral dorsolateral medullary infarction (aUMI) is related to respiratory failure in 2−5% of patients. However, sleep disordered breathing (SDB) in these patients has not yet been systematically studied. Aims and objectives To identify and characterize SDB in patients with aUMI. Methods We prospectively followed 13 (9 male) patients (median age 53 years, range (49−66)) with aUMI. Polysomnography (PSG) was performed 1−3 times during hospitalization and at 3 months after the event. In patients that underwent more than one PSG recording the highest apnea-hypopnea index (AHI) was analysed. Data are presented as median (25th−75th percentile). Results During hospitalization, AHI≥10/h was detected at least once in 8 patients (62%) with highest AHI of 17 (7−19)/h, central AHI (CAHI) 17(7−18)/h and obstructive AHI (OAHI) 0.0(0−0.5)/h. Periodic breathing (PB) was recorded at least once in 12 (92%) patients, and 6 (46%) patients had PB ≥5% per total recording time. Intra-patient SDB severity varied between timely separated PSG recordings and its peak was at various times during hospitalization. At follow up, AHI and CAHI decreased to 6 (4−8)/h and 6 (3−8)/h (p=0.04 for each value), respectively, the changes in OAHI were not statistically significant (p=0.46), however. Conclusions Our preliminary results indicate high transient predisposition of patients with aUMI to central sleep apneas. Due to the risk of respiratory failure or even sudden death, PSG is warranted in all patients with aUMI early after the event. Since the time peak of SDB is variable it is reasonable to perform PSG repeatedly.