scholarly journals Sleep for Stroke Management and Recovery Trial (Sleep SMART): Rationale and methods

2020 ◽  
Vol 15 (8) ◽  
pp. 923-929 ◽  
Author(s):  
Devin L Brown ◽  
Valerie Durkalski ◽  
Jeffrey S Durmer ◽  
Joseph P Broderick ◽  
Darin B Zahuranec ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Ischemic Stroke ◽  
Sleep Apnea ◽  
Acute Ischemic Stroke ◽  
Functional Recovery ◽  
Transient Ischemic Attack ◽  
Stroke Management ◽  
Vascular Events ◽  
Obstructive Sleep ◽  
Ischemic Attack

Rationale Obstructive sleep apnea is common among patients with acute ischemic stroke and is associated with reduced functional recovery and an increased risk for recurrent vascular events. Aims and/or hypothesis The Sleep for Stroke Management and Recovery Trial (Sleep SMART) aims to determine whether automatically adjusting continuous positive airway pressure (aCPAP) treatment for obstructive sleep apnea improves clinical outcomes after acute ischemic stroke or high-risk transient ischemic attack. Sample size estimate A total of 3062 randomized subjects for the prevention of recurrent serious vascular events, and among these, 1362 stroke survivors for the recovery outcome. Methods and design Sleep SMART is a phase III, multicenter, prospective randomized, open, blinded outcome event assessed controlled trial. Adults with recent acute ischemic stroke/transient ischemic attack and no contraindication to aCPAP are screened for obstructive sleep apnea with a portable sleep apnea test. Subjects with confirmed obstructive sleep apnea but without predominant central sleep apnea proceed to a run-in night of aCPAP. Subjects with use (≥4 h) of aCPAP and without development of significant central apneas are randomized to aCPAP plus usual care or care-as-usual for six months. Telemedicine is used to monitor and facilitate aCPAP adherence remotely. Study outcomes Two separate primary outcomes: (1) the composite of recurrent acute ischemic stroke, acute coronary syndrome, and all-cause mortality (prevention) and (2) the modified Rankin scale scores (recovery) at six- and three-month post-randomization, respectively. Discussion Sleep SMART represents the first large trial to test whether aCPAP for obstructive sleep apnea after stroke/transient ischemic attack reduces recurrent vascular events or death, and improves functional recovery.

scholarly journals Acute stroke and TIA patients have specific polygraphic features of obstructive sleep apnea

2020 ◽  
Vol 24 (4) ◽  
pp. 1495-1505 ◽  
Author(s):  
Akseli Leino ◽  
Susanna Westeren-Punnonen ◽  
Juha Töyräs ◽  
Sami Myllymaa ◽  
Timo Leppänen ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Ischemic Stroke ◽  
Sleep Apnea ◽  
Transient Ischemic Attack ◽  
Sleep Disordered Breathing ◽  
Apnea Hypopnea Index ◽  
Stroke Patients ◽  
Respiratory Events ◽  
Obstructive Sleep ◽  
Ischemic Attack

Abstract Purpose Obstructive sleep apnea (OSA) is associated with increased risk for stroke, which is known to further impair respiratory functions. However, it is unknown whether the type and severity of respiratory events are linked to stroke or transient ischemic attack (TIA). Thus, we investigate whether the characteristics of individual respiratory events differ between patients experiencing TIA or acute ischemic stroke and matched patients with clinically suspected sleep-disordered breathing. Methods Polygraphic data of 77 in-patients with acute ischemic stroke (n = 49) or TIA (n = 28) were compared to age, gender, and BMI-matched patients with suspected sleep-disordered breathing and no cerebrovascular disease. Along with conventional diagnostic parameters (e.g., apnea-hypopnea index), durations and severities of individual apneas, hypopneas and desaturations were compared between the groups separately for ischemic stroke and TIA patients. Results Stroke and TIA patients had significantly shorter apneas and hypopneas (p < 0.001) compared to matched reference patients. Furthermore, stroke patients had more central apnea events (p = 0.007) and a trend for higher apnea/hypopnea number ratios (p = 0.091). The prevalence of OSA (apnea-hypopnea index ≥ 5) was 90% in acute stroke patients and 79% in transient ischemic attack patients. Conclusion Stroke patients had different characteristics of respiratory events, i.e., their polygraphic phenotype of OSA differs compared to matched reference patients. The observed differences in polygraphic features might indicate that stroke and TIA patients suffer from OSA phenotype recently associated with increased cardiovascular mortality. Therefore, optimal diagnostics and treatment require routine OSA screening in patients with acute cerebrovascular disease, even without previous suspicion of OSA.

scholarly journals “Wakeup” to Reality!

2019 ◽  
pp. 488-500
Author(s):  
Madeleine Grigg-Damberger
Keyword(s):  
Older Adults ◽  
Obstructive Sleep Apnea ◽  
Ischemic Stroke ◽  
Sleep Apnea ◽  
Transient Ischemic Attack ◽  
Epworth Sleepiness Scale ◽  
Severe Obstructive Sleep Apnea ◽  
Younger Adults ◽  
Obstructive Sleep ◽  
Ischemic Attack

A small-vessel left paramedian pontine ischemic infarction on awakening from sleep in a 74-year-old woman with hypercholesterolemia triggered an evaluation for untreated severe obstructive sleep apnea (OSA). This case illustrates how the clinical presentation of OSA is different in older and younger adults. Older adults with OSA are more likely to report not feeling well rested in the morning, to have higher scores on the Epworth Sleepiness Scale, and to have greater frequency of nocturia. It is important to consider untreated OSA in patients who have ischemic stroke on awakening from sleep. Most strokes occur between 6 a.m. and noon, but strokes during sleep warrant consideration of untreated OSA. OSA is highly prevalent in patients after stroke or transient ischemic attack. OSA is associated with poorer outcomes after ischemic strokes.

scholarly journals Effect of Obstructive Sleep Apnea on the Functional Outcome of Acute Ischemic Stroke

2019 ◽  
Vol 16 (2) ◽  
pp. 88-94
Author(s):  
Su-Hyun Han ◽  
Kwang-Yeol Park ◽  
Yong Sung Kim ◽  
Jeong-Min Kim ◽  
Seo-Young Lee
Keyword(s):  
Obstructive Sleep Apnea ◽  
Ischemic Stroke ◽  
Sleep Apnea ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Obstructive Sleep

scholarly journals Hemoglobin Concentration and Clinical Outcomes After Acute Ischemic Stroke or Transient Ischemic Attack

2021 ◽  
Author(s):  
Runhua Zhang ◽  
Qin Xu ◽  
Anxin Wang ◽  
Yong Jiang ◽  
Xia Meng ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Clinical Outcomes ◽  
Transient Ischemic Attack ◽  
Stroke Recurrence ◽  
Vascular Events ◽  
Poor Functional Outcome ◽  
Ischemic Attack ◽  
The Relationship

Background Anemia or low hemoglobin can increase the risk of stroke. However, the association between hemoglobin and outcomes after stroke is uncertain. In this study, we aimed to investigate the association between hemoglobin and clinical outcomes, including mortality, poor functional outcome, stroke recurrence, and composite vascular events at 1 year. Methods and Results We included the patients diagnosed with acute ischemic stroke or transient ischemic attack from the Third China National Stroke Registry. We used the Cox model for mortality, stroke recurrence, and composite vascular events and the logistic model for the poor functional outcome to examine the relationship between hemoglobin and clinical outcomes. In addition, we used the restricted cubic spline to evaluate the nonlinear relationship. This study included 14 159 patients with acute ischemic stroke or transient ischemic attack. After adjusted for potential cofounders, both anemia and high hemoglobin were associated with the higher risk of mortality (hazard ratio [HR], 1.73; 95% CI, 1.39–2.15; HR, 2.71; 95% CI, 1.95–3.76) and poor functional outcome (odds ratio [OR], 1.36; 95% CI, 1.18–1.57; OR, 1.42; 95% CI, 1.07–1.87). High hemoglobin, but not anemia, increased the risk of stroke recurrence (HR, 1.37; 95% CI, 1.05–1.79) and composite vascular events (HR, 1.41; 95% CI, 1.08–1.83). There was a U‐shaped relationship between hemoglobin and mortality and poor functional outcome. Conclusions Abnormal hemoglobin was associated with a higher risk of all‐cause mortality, poor functional outcome, stroke recurrence, and composite vascular events. More well‐designed clinical studies are needed to confirm the relationship between hemoglobin and clinical outcomes after stroke.

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