Sleep-disordered breathing in the acute phase of ischemic stroke

Objective. Sleep-disordered breathing (SDB) is a common cardiovascular risk factor. The aim of our study was to assess the occurrence and features of SDB in patients with acute supratentorial ischemic stroke. Design and methods. Patients 18-89 years of age with acute ischemic stroke admitted to the stroke intensive care unit within 24 hours after the symptom onset underwent respiratory monitoring during the first day of hospitalization. 1616 patients were screened between 2018 and 2021 years, respiratory monitoring was performed in 583 patients, and data from 281 patients [mean age 67 (30; 89) years, 146 males (52 %)] were included in the final analysis. Results. The mean respiratory disturbance index was 11,8 (0; 88)/h. SDB was detected in 182 patients (69,2 %), with mild severity in 28,6 %, moderate in 24,2 %, and severe in 47,2 %. Prevalent obstructive apnea type was observed in 71,1 %, central type in 14,2 %, and mixed type in 14,7 %. The TOAST stroke subtype distribution was the following: unspecified etiology was diagnosed in 52 %, cardioembolic in 26 %, atherothrombotic in 11 %, lacunar in 9 %, and other established etiology in 2 %. The majority of patients had mild stroke severity (89,4 %), moderate and severe stroke was diagnosed in 10,5 %. No significant differences in the main indices of the type and severity of sleep apnea were found in the groups based on severity and pathogenetic type of stroke. Conclusions. Our results correlate with the worldwide prevalence of SDB in patients with ischemic stroke (69,2 % and 71,1 %). Further analysis with inclusion of more patients with moderate and severe stroke is required, as well as a prospective study to assess the prognostic impact of SDB.

1. Neurology: a national guide. Edited by EI Gusev, AN Konovalov, VI Skvortsova. 2nd ed., reprint and additional M.: GEOTAR-Media, 2018. Series “National Guides”.

2. Khokhrina A, Andreeva E, Degryse JM. The prevalence of sleep-disordered breathing in Northwest Russia: The ARKHsleep study. Chron Respir Dis. 2020;17:1479973120928103. doi:10.1177/1479973120928103

3. Bassetti CLA, Randerath W, Vignatelli L, Ferini-Strambi L, Brill AK, Bonsignore MR et al. EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke. Eur Respir J. 2020;55(4):1901104. doi:10.1183/13993003.01104-2019

4. Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353(19): 2034-2041. doi:10.1056/NEJMoa043104

5. Bassetti CL, Milanova M, Gugger M. Sleep-disordered breathing and acute ischemic stroke: diagnosis, risk factors, treatment, evolution, and long-term clinical outcome. Stroke. 2006;37(4):967-972. doi:10.1161/01.STR.0000208215.49243.c3

6. Berry RB, Brooks R, Gamaldo C, Harding SM, Lloyd RM, Quan SF et al. AASM scoring manual updates for 2017 (Version 2.4). J Clin Sleep Med. 2017;13(5):665-666. doi:10.5664/jcsm.6576

7. Brott T, Adams HP, Olinger CP, Marler JR, Barsan WG, Biller J et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989;20(7):864-870. doi:10.1161/01.str.20.7.864

8. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in acute stroke treatment. Stroke. 1993;24(1):35-41. doi:10.1161/01.str.24.1.35

9. Seiler A, Camilo M, Korostovtseva L, Haynes AG, Brill AK, Horvath T et al. Prevalence of sleep-disordered breathing after stroke and TIA: a meta-analysis. Neurology. 2019;92(7):e648-e654. doi:10.1212/WNL.0000000000006904

10. Poluektov MG, Bakhrevsky IE, Koshelev IY, Eligulashvili TS, Vein AM. Sleep-disordered breathing in neurological pathology. J Neurol Psych S. S. Korsakov (Stroke Appendix). 2002;102(5): 22-26. In Russian.

11. Fonyakin AV, Geraskina LA, Maksimova MYu, Lutokhin GM. Prevalence and character of sleep-disordered breathing in ischemic stroke. Kardiosomatika = Cardiosomatics. 2018;9(2):12-16. doi:10.26442/2221-7185_2018.2.12-16. In Russian.

12. Liu X, Lam DCL, Chan KPF, Chan HY, Ip MSM, Lau KK. Prevalence and determinants of sleep apnea in patients with stroke: a meta-analysis. J Stroke Cerebrovasc Dis. 2021;30(12):106129. doi:10.1016/j.jstrokecerebrovasdis.2021.106129

13. Dziewas R, Ritter M, Usta N, Boentert M, Hor H, Dittrich R et al. Atherosclerosis and obstructive sleep apnea in patients with ischemic stroke. Cerebrovasc Dis. 2007;24(1):122-126. doi:10.1159/000103611

14. Lutohin GM, Geraskina LA, Fonyakin AV. Sleep-disordered breathing syndrome in acute ischemic stroke. J Neurol Psych S. S. Korsakov. 2016;116(12-2):14-20. doi:10.17116/jnevro201611612214-20. In Russian.