Sleep Apnea In Stroke Patients Research Articles

Risk of obstructive sleep apnea in stroke patients in tertiary-level hospitals in the province of Luanda, 2021

Risk of obstructive sleep apnea in stroke patients in tertiary-level hospitals in the province of Luanda, 2021

Risk of obstructive sleep apnea in stroke patients in tertiary-level hospitals in Luanda, Angola 2021

Risk of obstructive sleep apnea in stroke patients in tertiary-level hospitals in Luanda, Angola 2021

Fatty Acid Levels and Their Inflammatory Metabolites Are Associated with the Nondipping Status and Risk of Obstructive Sleep Apnea Syndrome in Stroke Patients.

Background: This paper discusses the role of inflammation in the pathogenesis of nondipping blood pressure and its role in the pathogenesis of obstructive sleep apnea syndrome. The aim of the study was to assess the impact of free fatty acids (FAs) and their inflammatory metabolites on the nondipping phenomenon and the risk of sleep apnea in stroke patients. Methods: Sixty-four ischemic stroke patients were included in the prospective study. Group I consisted of 33 patients with a preserved physiological dipping effect (DIP), while group II included 31 patients with the nondipping phenomenon (NDIP). All subjects had FA gas chromatography and inflammatory metabolite measurements performed with the use of liquid chromatography, their 24 h blood pressure was recorded, and they were assessed with the Epworth sleepiness scale (ESS). Results: In the nondipping group a higher level of C16:0 palmitic acid was observed, while lower levels were observed in regard to C20:0 arachidic acid, C22:0 behenic acid and C24:1 nervonic acid. A decreased leukotriene B4 level was recorded in the nondipping group. None of the FAs and derivatives correlated with the ESS scale in the group of patients after stroke. Correlations were observed after dividing into the DIP and NDIP groups. In the DIP group, a higher score of ESS was correlated with numerous FAs and derivatives. Inflammation of a lower degree and a higher level of anti-inflammatory mediators from EPA and DHA acids favored the occurrence of the DIP. A high level of C18: 3n6 gamma linoleic acid indicating advanced inflammation, intensified the NDIP effect. Conclusions: We demonstrated potential novel associations between the FA levels and eicosanoids in the pathogenesis of the nondipping phenomenon. There are common connections between fatty acids, their metabolites, inflammation, obstructive sleep apnea syndrome and nondipping in stroke patients.

Home Sleep Apnea Testing is a Feasible and Accurate Method to Diagnose Obstructive Sleep Apnea in Stroke Patients During In-Hospital Rehabilitation

To study the feasibility and accuracy of home sleep apnea testing (HSAT) in the diagnosis of obstructive sleep apnea (OSA) in a stroke rehabilitation unit. Stroke patients referred to a neurorehabilitation center underwent OSA screening by means of HSAT within the Home Polygraphic Recording with Telemedicine Monitoring for Diagnosis and Treatment of Sleep Apnea in Stroke, or HOPES study (ClinicalTrials.gov identifier: NCT02748681). Feasibility was determined by evaluating the acceptability of recording quality. Patients in whom moderate OSA was diagnosed subsequently underwent unattended polysomnography (PSG) confirmation. Accuracy was studied by comparing the respiratory event index (REI)/monitoring time (MT) of screening HSAT with the apnea-hypopnea index (AHI)/total sleep time (TST) obtained during subsequent PSG with Bland-Altman plots. The influence of PSG-evaluated wake time and arousals on OSA classification was studied by comparing the AHI and REI of the same night. A total of 265 patients (58 ± 9 years, 70% male) were screened. A total of 92% of HSAT studies were performed with acceptable recording quality. In total, 33 patients (63 ± 5 years, 58% male) with moderate OSA (REI ≥ 15 to < 30 events/h) were included in the HSAT/PSG comparison. The Bland-Altman plot shows acceptable limits of agreement from -19.5 to +16.4, with a mean difference of -1.33. The REI detected in the PSG night demonstrated no significant differences to the AHI and a high correlation (r = .97; P < .001). The 95% confidence interval of the Bland-Altman plots varied from -7.61 to +4.80. These findings confirm a good feasibility and sufficient accuracy of HSAT attached in a stroke rehabilitation unit. Therefore, the authors suggest that American Academy of Sleep Medicine recommendations for HSAT should include stroke patients.

An inpatient program for diagnosing and treating sleep apnea in patients with stroke

Background and Purpose:Sleep apnea (SA) is highly prevalent in the stroke population. Testing and treating SA in stroke patients is challenging due to inaccessibility to testing and impaired mobili...

In-hospital diagnosis of sleep apnea in stroke patients using a portable acoustic device.

Sleep apnea (SA) is highly prevalent in post-stroke patients. Due to physical disability and relative inaccessibility of polysomnography (PSG) to test for SA, patients with stroke frequently remain undiagnosed and untreated. Portable SA monitoring can facilitate at-home or in-hospital testing for SA. However, portable SA monitoring is not recommended in those with complex medical conditions, such as stroke, due to the lack of validation of portable monitoring in such patients. The objective of our study was to test the accuracy and feasibility of a portable single-channel acoustic device, BresoDx™ for quantifying the apnea-hypopnea index (AHI) and diagnosing SA in a post-stroke population. Patients who recently suffered a stroke and were undergoing rehabilitation in a stroke rehabilitation unit (SRU) underwent testing with BresoDx both simultaneously during attended PSG and unattended on the SRU. We studied 23 stroke patients of whom 78% had SA (defined by AHI ≥15) on PSG. All of the patients tolerated the BresoDx. Using cutoff AHI of ≥15 by PSG to diagnose SA, BresoDx had sensitivity of 90.0%, specificity of 84.6%, and overall accuracy of 87.0% in the laboratory. This study demonstrates that BresoDx is well tolerated and feasible to use in the post-stroke population where it was found to have excellent positive and negative predictive values for the diagnosis of SA.

Subjective Evaluation of Sleep Apnea Is Not Sufficient in Stroke Rehabilitation

Objective: Sleep apnea (SA) is common in stroke patients and is associated with poor functional outcome. Therefore, we studied the clinical value of the Berlin Questionnaire (BQ), a subjective screening method to detect stroke patients with SA in a neurorehabilitation care unit, and compared it with respirographic sleep studies. Another aim was to explore the association of SA with functional status in the subacute phase after stroke. Methods: Sixty-eight stroke patients were subjected to respirographic sleep studies to determine their apnea-hypopnea index (AHI). Subjective evaluation was performed by means of the BQ. Functional outcome was assessed by the Barthel Index (BI). Sensitivity and specificity of the BQ for detecting SA in stroke patients were calculated. Results: Respirographic sleep studies showed a high prevalence of moderate and severe sleep apnea in 56% of stroke patients. Sensitivity and specificity of the BQ for SA (AHI > 15) were 0.69 and 0.15, respectively. The area under the receiver operating characteristics (ROC) curve for detection of SA was 0.58. The AHI correlated significantly with the BI (r = -0.57, P ≤ .001). Conclusion: As the BQ demonstrated low diagnostic utility in stroke rehabilitation, screening for SA should not be based solely on clinical interviews. SA is linked to poor functional status in the subacute phase post stroke.

Sleep Apnea in Stroke Patients: Hard to Diagnose, Even Harder to Treat

This article summarizes the current knowledge regarding sleep apnea in stroke patients. There are two major problems with sleep apnea in stroke patients. First, awareness of this disease is low in both the affected people and the medical professionals who treat them. Second, once sleep apnea has been diagnosed, it is difficult to treat since 80–90% of stroke patients refuse continuous positive airway pressure therapy, which is the most effective treatment. However, the 10–20% of patients who tolerate continuous positive airway pressure therapy may recover more rapidly, have less disability and are less likely to suffer from a new cardiovascular event than the majority of patients who cannot be treated. Unfortunately, treatment alternatives are scarce; surgery as well as oral appliances are usually not an option. One could consider drug treatment but, at present, there are no convincing data that stroke patients may profit from that kind of medication.

Screening for Obstructive Sleep Apnea in Stroke Patients

Obstructive sleep apnea (OSA) is common after acute ischemic stroke and predicts poor stroke recovery, but whether screening for OSA and treatment by continuous positive airway pressure (CPAP) improves neurological outcome is unknown. We used a cost-effectiveness model to estimate the magnitude of benefit that would be necessary to make polysomnography (PSG) and OSA treatment cost-effective in stroke patients. A decision tree modeled 2 alternative strategies: PSG followed by 3 months of CPAP for those found to have OSA versus no screening. The primary outcome was the utility gained through OSA screening and treatment in relation to 2 common willingness-to-pay thresholds of $50,000 and $100,000 per quality-adjusted life year (QALY). Screening resulted in an incremental cost-effectiveness ratio of $49,421 per QALY. Screening is cost-effective as long as the treatment of stroke patients with OSA by CPAP improves patient utilities by >0.2 for a willingness-to-pay of $50,000 per QALY and 0.1 for a willingness-to-pay of $100,000 per QALY. A clinical trial assessing the effectiveness of CPAP in improving stroke outcome is warranted from a cost-effectiveness standpoint.

Sleep apnea, delirium, depressed mood, cognition, and ADL ability after stroke.

The incidence of sleep apnea and stroke increases with age. The aim of this study was to investigate the presence of sleep apnea after stroke and its relationship to delirium, depressed mood, cognitive functioning, ability to perform activities of daily living (ADLs), and psychiatric and behavior symptoms. Cross-sectional study. Geriatric stroke rehabilitation unit. 133 patients (78 women and 55 men, mean age 77.1 +/- 7.7 years) consecutively admitted to a geriatric stroke rehabilitation unit. All patients underwent overnight respiratory sleep recordings at 23 +/- 7 days (range 11 to 41 days) after suffering a stroke. The patients were assessed using the Organic Brain Syndrome Scale, Montgomery-Asberg-Depression-Rating Scale, Mini-Mental State Examination (MMSE), and Barthel-ADL Index. Sleep apnea was defined as an apnea-hypopnea index (AHI) of 10 or more. The median of the AHI for the studied sample (N = 133) was 13 (range 0-79; interquartile range 6-28). Fifty-nine percent fulfilled the criteria for sleep apnea; 52% with first-ever stroke had sleep apnea. More patients with sleep apnea than without were delirious, depressed, or more ADL-dependent. Sleep apnea patients also had a higher frequency of ischemic heart disease and had more often suffered from an earlier cerebral infarction. Multivariate analysis showed that obesity, low ADL scores, ischemic heart disease, and depressed mood were independently associated with sleep apnea. Low ADL scores, apnea-related hypoxemia, body mass index < or = 27, and impaired vision were independently associated with delirium. The presence of sleep apnea was not associated with any specific type of stroke or location of the brain lesion. Sleep apnea is common in stroke patients and is associated with delirium, depressed mood, latency in reaction and in response to verbal stimuli, and impaired ADL ability. We suggest a trial investigating whether delirium, depressed mood, and ADL ability improve with nasal continuous positive airway pressure treatment of sleep apnea in stroke patients.