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

Abstract Background Sleep-disorder breathing (SDB) using polysomnography is closely associated to poor functional and clinical outcomes in ischemic stroke patients. The cardiopulmonary coupling analysis using Holter-monitoring (CPC-Holter analysis) is an emerging feasible modality to investigate SDB. Purpose We investigated the association between SDB defined by CPC-Holter analysis and one-year clinical outcome in patients with acute ischemic stroke. Methods Total 666 patients with acute ischemic stroke who underwent Holter-monitoring were enrolled. The CPC-Holter analysis was conducted and SDB was defined as the presence of narrow-band (NB) coupling during sleep time. Primary outcome was recurrent ischemic stroke, and secondary outcome was major adverse cerebrovascular event (MACE), a composite of recurrent ischemic stroke, transient ischemic attack, and all-cause mortality within one year since discharge. Result The NB coupling was present in 205 (30.8%) of 666 patients with mean age of 64.1±12.8 years. The NB group showed significantly higher incidence of both recurrent ischemic stroke (8.3% vs. 1.4%, p<0.001) and MACE (14.9% vs. 3.0%, p<0.001) within one-year. In multivariate analysis, presence of NB coupling remained as an independent predictor of both recurrent ischemic stroke and MACE (HR: 4.81; 95% CI: 1.73–13.4; p=0.003; and HR 4.17; 95% CI: 1.74–10.0; p<0.001, respectively). The results were consistent after propensity-score matched analysis with 164 patient pairs (C-statistics=0.757). One-year clinical outcomes Overall population (n=666) PSM population (n=328) no NB (=461) NB (n=205) Log-rank p-value OR (95% CI) no NB (n=164) NB (n=164) Log-rank p-value OR (95% CI) Recurrent ischemic stroke 6 (1.4) 14 (8.3) <0.001 5.73 (2.20–14.9) 3 (2.0) 11 (8.1) 0.026 3.85 (1.07–13.8) Transient ischemic attack 3 (0.7) 3 (1.7) 0.275 2 (1.3) 3 (2.1) 0.633 Hemorrhagic stroke 0 (0.0) 2 (1.2) 0.027 0 (0.0) 2 (1.5) 0.148 Total death 3 (0.7) 9 (4.8) 0.001 2 (1.3) 3 (1.9) 0.641 MACEs 12 (3.0) 25 (14.9) <0.001 4.63 (2.06–10.4) 7 (5.2) 17 (13.1) 0.030 2.95 (1.06–8.21) Data are expressed as n (%). CI = confidence interval; MACE = major adverse cardiovascular event; NB = narrow-band; OR = odds ratio. One-year clinical outcomes Conclusion SDB assessed by CPC-Holter analysis at early phase of ischemic stroke is a powerful prognostic marker for predicting one-year adverse clinical outcomes. The CPC analysis using Holter-monitoring is a useful modality and could be easily applied to predict clinical outcomes in acute ischemic stroke patients.

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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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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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Automatic classification of sleep-disordered breathing using cardiopulmonary coupling analysis

Sleep Medicine ◽

10.1016/j.sleep.2015.02.1495 ◽

2015 ◽

Vol 16 ◽

pp. S232

Author(s):

J. Park ◽

U. Erdenebayar ◽

P. Jeong ◽

K. Lee

Keyword(s):

Sleep Disordered Breathing ◽

Automatic Classification ◽

Coupling Analysis ◽

Cardiopulmonary Coupling ◽

Disordered Breathing

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Sleep-disordered breathing among acute ischemic stroke patients in Brazil

Sleep Medicine ◽

10.1016/j.sleep.2015.11.008 ◽

2016 ◽

Vol 19 ◽

pp. 8-12 ◽

Cited By ~ 17

Author(s):

Millene R. Camilo ◽

Saul V. Schnitman ◽

Heidi H. Sander ◽

Alan L. Eckeli ◽

Regina M.F. Fernandes ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Sleep Disordered Breathing ◽

Stroke Patients ◽

Disordered Breathing

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P3715Impact of sleep-disordered breathing on short-term functional outcomes in ischemic stroke patients: a cardiopulmonary coupling analysis using holter-monitoring

European Heart Journal ◽

10.1093/eurheartj/ehz745.0569 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

D O Kang ◽

C K Kim ◽

Y Park ◽

W Y Jang ◽

W Kim ◽

...

Keyword(s):

Ischemic Stroke ◽

Propensity Score ◽

Acute Ischemic Stroke ◽

Sleep Disordered Breathing ◽

Functional Disability ◽

Narrow Band ◽

Holter Monitoring ◽

P Value ◽

Prognostic Impact ◽

Cardiopulmonary Coupling

Abstract Background Sleep-disordered breathing (SDB) assessed by conventional polysomnography is reported to have close association with worsened clinical outcomes in patients with ischemic stroke. The cardiopulmonary coupling (CPC) analysis using Holter-monitoring is an easily assessable method to evaluate SDB. However, its prognostic impact needs to be investigated. Purpose The present study investigated the prognostic impact of SDB defined by CPC analysis using Holter-monitoring at early stage of ischemic stroke on the functional disability at 3-month follow-up. Methods Total 692 patients with acute ischemic stroke who underwent Holter-monitoring were enrolled. The CPC analysis was conducted and SDB was defined as the presence of narrow-band (NB) coupling during sleep time. We investigated the association between SDB and functional disability at 3-month measured by modified Rankin scale (mRS). Result The NB coupling was present in 216 (31.2%) of 692 patients with mean age of 64.2±12.8 years. The NB group showed significantly higher proportion of severe functional disability (mRS ≥3; 45.3% vs. 12.3%, p<0.001) and persistent disability (ΔmRS≤0; 42.6% vs. 56.4%, p<0.001) after 3-month. In multivariate analysis, the presence of NB coupling was an independent predictor of higher risk of both severe and persistent functional disability (HR: 3.97; 95% CI: 2.37–6.64; p<0.001; and HR 1.92; 95% CI: 1.34–2.77; p<0.001, respectively). The results were consistent after propensity-score matched analysis with 175 patient pairs (C-statistics=0.759). Parameters of functional disability Overall population (n=692) PSM population (n=350) no NB (n=476) NB (n=216) OR (95% CI) p-value no NB (n=175) NB (n=175) OR (95% CI) p-value Initial NIHSS ≥5 89 (18.6) 81 (37.5) <0.001 52 (29.7) 52 (29.7) >0.999 Discharge mRS ≥3 146 (30.6) 126 (58.3) <0.001 90 (51.4) 89 (50.8) 0.915 3-month mRS ≥3 59 (12.3) 98 (45.3) 5.86 (4.00–8.60) <0.001 38 (21.7) 72 (41.1) 2.52 (1.57–4.02) <0.001 3-month ΔmRS ≤0 (persisent disability) 203 (42.6) 122 (56.4) 1.74 (1.26–2.41) 0.001 77 (44.0) 100 (57.1) 1.69 (1.11–2.58) 0.014 Data are expressed as n (%). mRS = modified Rankin's scale; NB = narrow-band; NIHSS = National Institutes of Health Stroke Scale; OR = odds ratio; PSM = propensity-score matched. Functional disabilities after 3-month Conclusion SDB assessed by CPC analysis at early phase of ischemic stroke was able to predict both greater and persistent functional disability at 3-month. The CPC analysis using Holter-monitoring is a useful modality for predicting functional disabilities in acute ischemic stroke.

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