12. Nocturnal cerebral hemodynamics in acute stroke patients during sleep disordered breathing: A near infra-red spectroscopy study

Introduction: In patients with acute stroke, part of the acute management entails identifying the risk factors; modifiable or non modifiable. Early recognition of these factors is essential for optimizing therapeutic procedures, especially those with a known effective treatment. In this sense, Sleep Disordered Breathing (SDB) has also been suggested as a modifiable and independent risk factor for stroke as defined by international guidelines and some studies have demonstrated that patients with stroke and particularly Obstructive Sleep Apnea (OSA) have an increased risk of death or new vascular events. Pathogenesis of ischemic stroke in SDB is probably related to worsening of existing cardiovascular risk factors such as hypertension and hypoxia driven cardiac arrhythmia leading to higher prevalence of ischemic stroke in patients with sleep disordered breathing disease. Despite strong evidence linking SDB to ischemic stroke, evaluation for SDB is rarely performed in patients presenting with an acute ischemic stroke. Hypothesis: Evaluation of SDB is rarely performed in patients presenting with acute ischemic stroke. Methods: We performed a retrospective review of all patients above the age of 18 who were admitted to the acute stroke service at University Hospital July 2014 to December 2014. Demographic data, etiology of stroke as identified per TOAST criteria, modifiable risk factors, presenting NIHSS and frequency of testing for SDB and their results were collected. The data was consolidated and tabulated by using STATA version 14. Results: Total of 240 patients satisfied our inclusion criteria. Only 24 patients ie 10% of those who satisfied our inclusion criteria received evaluation for SDB. Out of those evaluated, 62.5% ie 15 patients out of 24 patients had findings concerning for significant desaturation. Only 2 providers out of 8 stroke physicians ie 25% tested for SDB in more than 5 patients. Conclusions: Our observations highlight the paucity in evaluation for SDB in acute ischemic stroke in a tertiary care setting. Being a modifiable risk factor, greater emphasis must be placed on evaluation for SDB in patients in patients with acute stroke. Education must be provided to all patients and providers regarding identification of these factors.

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Sleep-disordered breathing assessed by Holter-monitoring is associated to worsened one-year clinical outcomes in ischemic stroke patients: a cardiopulmonary coupling analysis

Sleep Medicine ◽

10.1016/j.sleep.2019.11.756 ◽

2019 ◽

Vol 64 ◽

pp. S271

Author(s):

J.O. Na ◽

D.O. Kang ◽

C.K. Kim ◽

Y. Park ◽

W.Y. Jang ◽

...

Keyword(s):

Ischemic Stroke ◽

Clinical Outcomes ◽

Sleep Disordered Breathing ◽

Holter Monitoring ◽

Stroke Patients ◽

Coupling Analysis ◽

Cardiopulmonary Coupling ◽

One Year ◽

Disordered Breathing

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White matter disease and sleep-disordered breathing after acute stroke

Neurology ◽

10.1212/01.wnl.0000086818.57992.b8 ◽

2003 ◽

Vol 61 (7) ◽

pp. 959-963 ◽

Cited By ~ 40

Author(s):

J. Harbison ◽

G. J. Gibson ◽

D. Birchall ◽

I. Zammit-Maempel ◽

G. A. Ford

Keyword(s):

White Matter ◽

Acute Stroke ◽

Sleep Disordered Breathing ◽

White Matter Disease ◽

Disordered Breathing

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Sleep disordered breathing in stroke patients

Consilium Medicum ◽

10.26442/2075-1753_19.9.8-11 ◽

2017 ◽

Vol 19 (9) ◽

pp. 8-11

Keyword(s):

Sleep Disordered Breathing ◽

Stroke Patients ◽

Disordered Breathing

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Abstract TP208: Medullary Infarction is Associated with Severe Sleep Disordered Breathing

Stroke ◽

10.1161/str.44.suppl_1.atp208 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Shuichi Fujii ◽

Kensaku Shibazaki ◽

Kenichiro Sakai ◽

Junya Aoki ◽

Junichi Uemura ◽

...

Keyword(s):

Ischemic Stroke ◽

Multivariate Regression ◽

Sleep Disordered Breathing ◽

Multivariate Regression Analysis ◽

Stroke Patients ◽

Sleep Study ◽

Respiratory Disturbance ◽

The Relationship ◽

Medullary Infarction ◽

Disordered Breathing

Background and Purpose: A relationship between presence or severity of sleep disordered breathing (SDB) and site of lesion in ischemic stroke patients has been unclear. Our aim of the present study was to investigate the relationship between presence or severity of SDB and site of ischemic lesions in stroke patients. Subjects and Methods: Between April 2010 and March 2012, consecutive ischemic stroke patients within 24 hours of onset were prospectively enrolled. Ischemic lesions were identified by MRI on admission. Patient underwent sleep study to evaluate the presence and severity of SDB within 7 days after admission. SDB was defined as a respiratory disturbance index (RDI; apnea/hypopnea events per hour) ≥ 5, and severe SDB was defined as a RDI ≥ 40. We investigated the relationship between presence or severity of SDB and clinical characteristics including site of ischemic lesions. Results: A total of 214 patients (mean age 71.3, male 132) were enrolled. Supratentrial lesion was observed in 166 (77.6%) patients and right side lesion in 101 (47.2%) patients. Sites of ischemic lesions were as follows; cortex (n=11), subcortex (n=35), cortex plus subcortex (n=75), basal ganglia (n=57), thalamus (n=13), midbrain (n=3), pons (n=27), medulla (n=11), and cerebellum (n=22). Sleep study was performed at 4 days (median). The median RDI (IQR) was 20 (10-34). SDB patients were found in 187 (87%) patients. There were no significant differences in frequency of each site of lesions between SDB and non-SDB patients. Severe SDB was observed in 42 (19.6%) patients. Age (75 (70-83) vs. 72 (64-78), p=0.047), NIHSS score on admission (3 (1-10) vs. 7 (2-12), p=0.047), the frequency of atrial fibrillation (41% vs. 22%, p=0.012) and medullary lesions (12% vs. 4%, p=0.027) were significantly higher in severe SDB patients than non-severe SDB. Multivariate regression analysis demonstrated that medullary lesions (OR 5.5, 95%CI 1.41-21.8, p=0.014) was independently associated with severe SDB. Conclusions: Medullary lesion in stroke patients should be associated with severe SDB.

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Abstract 2457: Atrial Fibrillation is Associated with Severe Sleep Disordered Breathing TIA and Stroke Patients

Stroke ◽

10.1161/str.43.suppl_1.a2457 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Kensaku Shibazaki ◽

Kazumi Kimura ◽

Junichi Uemura ◽

Kenichiro Sakai ◽

Shuichi Fuii

Keyword(s):

Atrial Fibrillation ◽

Regression Analysis ◽

Multivariate Regression ◽

Sleep Disordered Breathing ◽

Japanese Patients ◽

Multivariate Regression Analysis ◽

Stroke Patients ◽

Sleep Study ◽

Factors Associated ◽

Disordered Breathing

Background and Purpose Sleep disordered breathing (SBD) was reported to be a risk factor for cerebrovascular disease. We investigated the frequency of SDB in Japanese patients with acute transient ischemic attack (TIA) and stroke and the factors associated with severe SDB in Japan. Methods Between May 2010 and April 2011, we prospectively enrolled TIA and stroke patients within 24 hours of onset and performed sleep study up to 7 days after admission. SBD was defined as respiratory disturbance index (RDI: apnea or hypopnea event per hour) ≥5. Patients were divided into 2 groups according to the RDI value as follows: ≥30(severe) and <30(none or non-severe). We demonstrated the frequency of SDB and the factors associated with severe SDB were investigated by multivariate regression analysis. Results A total of 150 patients (92 males; mean age, 72.8 years) were enrolled in this study; 28 had TIA and 122 had stroke. The mean time from admission to sleep study was 4 days. Mean RDI was 22.2±17.6. SDB was observed in 126(84%) patients. Frequencies of SDB were as follows: 21(75%) patients in TIA, 105(86%) in stroke [8/10(80%) in large artery atherosclerosis, 14/14(100%) in small vessel occlusion, 37/41(90%) in cardioembolism, 46/57(81%) in other cause of stroke/undetermined]. Severe SDB was observed in 44 (29%) patients; 21% in TIA and 31% in stroke. Frequencies of male (75% for the severe SDB group vs. 56% for the non-severe SDB group, p=0.027), atrial fibrillation (39% vs. 23%, p=0.045), body mass index (23.8±3.8 vs. 22.3±3.8, p=0.043), and neck circumference (37.8±4.3 vs. 35.8±4.2, p=0.012) were significantly higher in the severe SDB than in the non-severe SDB. Metabolic syndrome (36% vs. 21%, p=0.057) and waist circumference (88.9±9.8 vs. 85.5±9.3, p=0.080) showed a tendency toward higher in the severe SDB group than in the non-severe SDB group. There were no significant differences in age, prior stroke, vascular risk factors, Glasgow Coma Scale, and NIHSS score on admission. On multivariate regression analysis, atrial fibrillation (odds ratio, 2.5; 95% confidence interval, 1.079-5.836, p=0.0326) was found to be independently associated with severe SDB. Conclusions Most Japanese patients with acute TIA and stroke had SDB, and the presence of atrial fibrillation was associated with severe SDB.

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Wake-Up Sleepyhead: Unilateral Diencephalic Stroke Presenting with Excessive Sleepiness

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_258_18 ◽

2019 ◽

Vol 10 (01) ◽

pp. 145-147 ◽

Cited By ~ 1

Author(s):

R. Pradeep ◽

Dhananjay Gupta ◽

Anish Mehta ◽

R. Srinivasa ◽

Mahendra Javali ◽

...

Keyword(s):

Ischemic Stroke ◽

Sleep Disordered Breathing ◽

Reciprocal Relationship ◽

Sleep Architecture ◽

Periodic Limb Movements ◽

Limb Movements ◽

Stroke Patients ◽

Excessive Sleepiness ◽

Sleep Abnormalities ◽

Disordered Breathing

ABSTRACTAltered sleep architecture and stroke share a reciprocal relationship. More than half of the stroke patients display sleep abnormalities including hypersomnia, insomnia, parasomnia, periodic limb movements, or sleep-disordered breathing. Conversely, one of the major causes of severe organic hypersomnia is acute brainstem strokes, involving thalamic infarctions, which may be reversible over 6–12 months. Here, we report a patient with increased lethargy and drowsiness who was diagnosed to have a right thalamic and hypothalamic ischemic stroke.

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