The syndrome of respiratory failure in acute stroke: new diagnostic approaches

2020 ◽  
Vol 30 (4) ◽  
pp. 485-492
Author(s):  
A. G. Chuchalin ◽  
T. G. Кim ◽  
L. V. Shogenova ◽  
M. Yu. Martynov ◽  
E. I. Gusev
Keyword(s):  
Respiratory Failure ◽  
Acute Stroke ◽  
Clinical Features ◽  
Sleep Disordered Breathing ◽  
Diagnostic Methods ◽  
Neurological Injury ◽  
Neurogenic Pulmonary Edema ◽  
Arterial Blood ◽  
Obstructive Sleep ◽  
Disordered Breathing

The article presents an overview of the problem of respiratory failure in patients with acute stroke, its prevalence, leading pathophysiological factors, clinical features, and diagnostic methods. Stroke is the third leading cause of death worldwide. Stroke survivors often experience medical complications that may be the direct cause of mortality. The syndrome of respiratory failure and respiratory complication are common after stroke. The syndrome of respiratory failure syndrome of varying severity is following after stroke in 44 – 90%, often remains undervalued, undiagnosed, due to the clinical features of this category of patients. The nature of these disorders depends on the severity and site of neurological injury. Abnormality of breathing control, respiratory mechanics, and breathing pattern are common and may lead to gas exchange abnormalities or the need for respiratory support. The leading symptom is hypoxemia, which is often hidden, and may be detected by examining of arterial blood gasses (PaO2, PCO2). Stroke can lead to sleep disordered breathing such as central or obstructive sleep apnea. Sleep disordered breathing may also play a role in the pathogenesis of cerebral infarction. Venous thromboembolism, swallowing abnormalities, aspiration, and pneumonia are among the most common respiratory complications of stroke. Neurogenic pulmonary edema occurs less often but may be very dramatic. Therefore, early diagnosis, prevention and treatment are important in reducing mortality and improving functional rehabilitation.

scholarly journals Energy Conversion Monitoring in Skin Tissue: A More Sensitive Measure of Hypoxia Occurring With Sleep Disordered Breathing Than Pulse Oximetry

2019 ◽  
Author(s):  
Guy M. Hatch ◽  
Liza Ashbrook ◽  
Aric A. Prather ◽  
Andrew D. Krystal
Keyword(s):  
Pulse Oximetry ◽  
Energy Conversion ◽  
Sleep Disordered Breathing ◽  
Skin Tissue ◽  
Current Standard ◽  
Blood Oxygen Saturation ◽  
Primary Snoring ◽  
Arterial Blood ◽  
Obstructive Sleep ◽  
Disordered Breathing

Pulse oximetry is the current standard for detecting drops in arterial blood oxygen saturation (SpO2) associated with obstructive sleep apnea and hypopnea events in polysomnographic (PSG) testing. In cases of hypoxic challenge, such as occurs during apneic events, regulatory mechanisms restrict blood flow to the skin to preferentially maintain SpO2 for more vital organs. As a result, a measure related to skin tissue oxygenation is likely to be more sensitive to inadequate breathing during sleep than pulse oximetry. Energy Conversion Monitoring (ECM) provides a method for measuring skin tissue oxygen-dependent energy conversion and, as such, is promising for more sensitively detecting sleep disordered breathing (SDB) events compared to pulse oximetry. We hypothesized that ECM would detect hypoxia occurring with SDB events associated with drops in SpO2 but also would detect hypoxic challenge occurring with SDB events not associated with drops in SpO2 (hypopneas defined by a drop in nasal pressure occurring in conjunction with an arousal, respiratory-related arousals, and primary snoring). Primary snoring is of particular interest with respect to the potential of ECM because it is statistically associated with co-morbidities of SDB, such as hypertension, but is not considered pathological because of the lack of a proximal measure of pathology occurring with PSG. In this article we review ECM technology and methodology, present preliminary data indicating that it detects hypoxia occurring in the skin during SDB events that is not detected as blood desaturation by pulse oximetry, and make the case that it is a promising tool for identifying pathology occurring at the mild end of the SDB spectrum.

scholarly journals Obesity hypoventilation syndrome

2019 ◽  
Vol 28 (151) ◽  
pp. 180097 ◽  
Author(s):  
Juan F. Masa ◽  
Jean-Louis Pépin ◽  
Jean-Christian Borel ◽  
Babak Mokhlesi ◽  
Patrick B. Murphy ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Obstructive Sleep Apnoea ◽  
Sleep Disordered Breathing ◽  
Sleep Apnoea ◽  
Obesity Hypoventilation Syndrome ◽  
Hypercapnic Respiratory Failure ◽  
Obstructive Sleep ◽  
Hypoventilation Syndrome ◽  
Obesity Hypoventilation ◽  
Disordered Breathing

Obesity hypoventilation syndrome (OHS) is defined as a combination of obesity (body mass index ≥30 kg·m−2), daytime hypercapnia (arterial carbon dioxide tension ≥45 mmHg) and sleep disordered breathing, after ruling out other disorders that may cause alveolar hypoventilation. OHS prevalence has been estimated to be ∼0.4% of the adult population. OHS is typically diagnosed during an episode of acute-on-chronic hypercapnic respiratory failure or when symptoms lead to pulmonary or sleep consultation in stable conditions. The diagnosis is firmly established after arterial blood gases and a sleep study. The presence of daytime hypercapnia is explained by several co-existing mechanisms such as obesity-related changes in the respiratory system, alterations in respiratory drive and breathing abnormalities during sleep. The most frequent comorbidities are metabolic and cardiovascular, mainly heart failure, coronary disease and pulmonary hypertension. Both continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) improve clinical symptoms, quality of life, gas exchange, and sleep disordered breathing. CPAP is considered the first-line treatment modality for OHS phenotype with concomitant severe obstructive sleep apnoea, whereas NIV is preferred in the minority of OHS patients with hypoventilation during sleep with no or milder forms of obstructive sleep apnoea (approximately <30% of OHS patients). Acute-on-chronic hypercapnic respiratory failure is habitually treated with NIV. Appropriate management of comorbidities including medications and rehabilitation programmes are key issues for improving prognosis.

Sleep-Disordered Breathing in Patients with Motor Neurone Disease: One Size Does Not Fit all

2021 ◽  
pp. 1-8
Author(s):  
Vinod Aiyappan ◽  
Peter Catcheside ◽  
Nick Antic ◽  
Graham Keighley-James ◽  
Jeremy Mercer ◽  
...  
Keyword(s):  
Muscle Weakness ◽  
Sleep Disordered Breathing ◽  
Pulmonary Function Tests ◽  
Upper Airway ◽  
Blood Gases ◽  
Motor Neurone ◽  
Motor Neurone Disease ◽  
Arterial Blood ◽  
Obstructive Sleep ◽  
Disordered Breathing

Introduction: Sleep-disordered breathing (SDB) in patients with motor neurone disease (MND) is normally attributed to hypoventilation due to muscle weakness. However, we have observed different patterns of SDB among MND patients referred for non-invasive ventilation, which do not appear to be explained by respiratory muscle weakness alone. Aim: The aim of this study was to examine the characteristics of SDB in MND. Methods: This is a retrospective analysis of sleep studies (using polysomnography [PSG]), pulmonary function tests, and arterial blood gases in MND patients referred to a tertiary sleep medicine service for clinical review. Sleep apnoeas were characterised as obstructive or central, and to further characterise the nature of SDB, hypopnoeas were classified as obstructive versus central. Results: Among 13 MND patients who had a diagnostic PSG, the mean ± SD age was 68.9 ± 9.8 years, BMI 23.0 ± 4.3 kg/m2, forced vital capacity 55.7 ± 20.9% predicted, and partial pressure of CO2 (arterial blood) 52.7 ± 12.1 mm Hg. A total of 38% of patients (5/13) showed evidence of sleep hypoventilation. The total apnoea/hypopnoea index (AHI) was (median [interquartile range]) 44.4(36.2–56.4)/h, with 92% (12/13) showing an AHI >10/h, predominantly due to obstructive events, although 8% (1/13) also showed frequent central apnoea/hypopnoeas. Conclusions: Patients with MND exhibit a wide variety of SDB. The prevalence of obstructive sleep apnoea (OSA) is surprising considering the normal BMI in most patients. A dystonic tongue and increased upper-airway collapsibility might predispose these patients to OSA. The wide variety of SDB demonstrated might have implications for ventilator settings and patients’ outcomes.

scholarly journals O012 A prospective evaluation of the nature and time course of sleep disordered breathing and respiratory failure in patients with motor neurone disease (MND): the BreatheMND-1 study

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A5-A6
Author(s):  
V Aiyappan ◽  
P Catcheside ◽  
N Antic ◽  
N Grivell ◽  
C Hansen ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Sleep Disordered Breathing ◽  
Time Course ◽  
Sleep Time ◽  
Prospective Evaluation ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Roc Area ◽  
Disordered Breathing

Abstract Introduction Sleep disordered breathing (SDB) is a well-recognised but heterogeneous complication in MND and may herald the onset of respiratory failure. This study examined the nature and time course of SDB, sleep disruption and respiratory failure in MND patients. Methods The BreatheMND-1 study recruited MND patients for prospective evaluation of muscle strength,supine and prone dyspnea, quality of life, pulmonary function, arterial blood gas and polysomnographic sleep measurements at baseline and, where possible, 3, 6 and 12 months for exploratory analyses. Results 35 MND patients completed baseline and 25 at least one follow-up visit (median [IQR] follow-up time 8.7 [7.1–10.2] months). At baseline, patients were aged 64 [55–70] years, 16/35 (46%) female, with reduced FVC (77[59–92] %predicted) but relatively normal BMI (26.2[23.7–27.7] kg/m²) and PaCO2 (38.8[37.0–42.1] mmHg). At baseline and last follow-up, the prevalence of respiratory failure (PaCO2&gt;45 mmHg or HCO3&gt;27 mmol/l) was 9/33 (27%) and 12/27 (44%) respectively (p=0.186). Total sleep time and sleep efficiency were poor at baseline (5.2[4.6–5.9] h and 67.6[63.0–78.8]%) and declined at follow-up (by 1[0.3–1.9] h, p=0.020 and 7.9[-2.3–14.2]%, p=0.017 respectively). AHI was 7.2[2.8–14.6] /h and remained unchanged. In regression model,sleep time and efficiency were not predictive of respiratory failure, but the percentage of deep and REM sleep at last follow-up were (ROC area under curve 0.73±0.11, p=0.048 and 0.84±0.09, p=0.001). Discussion Sleep quality in MND is remarkably poor, irrespective of SDB, and could reflect and/or impact MND progression. Thus, further strategies to monitor & improve sleep are clearly warranted in patients with MND.

scholarly journals SAS Care 1: sleep-disordered breathing in acute stroke an transient ischaemic attack – prevalence, evolution and association with functional outcome at 3 months, a prospective observational polysomnography study

2020 ◽  
Vol 6 (2) ◽  
pp. 00334-2019 ◽  
Author(s):  
Sebastian R. Ott ◽  
Francesco Fanfulla ◽  
Silvia Miano ◽  
Thomas Horvath ◽  
Andrea Seiler ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Functional Outcome ◽  
Obstructive Sleep Apnoea ◽  
Sleep Disordered Breathing ◽  
Chronic Phase ◽  
Sleep Apnoea ◽  
Cross Sectional ◽  
Central Sleep Apnoea ◽  
Obstructive Sleep ◽  
Disordered Breathing

Sleep-disordered breathing (SDB) is frequent in patients with acute stroke. Little is known, however about the evolution of SDB after stroke. Most of our knowledge stems from smaller cohort studies applying limited cardiopulmonary sleep recordings or from cross-sectional data collected in different populations.This study aims to determine prevalence, type and intra-individual evolution of SDB based on full-night polysomnography (PSG) in acute stroke and 3 months thereafter. Furthermore, we aimed to identify predictors of SDB in the acute and chronic phase and to evaluate associations between SDB and functional outcome at 3 months (M3).A total of 166 patients with acute cerebrovascular events were evaluated by full PSG at baseline and 105 again at M3. The baseline prevalence of SDB (apnoea–hypopnoea index (AHI)>5·h−1) was 80.5% and 25.4% of the patients had severe SDB (AHI>30·h−1). Obstructive sleep apnoea was more prevalent than central sleep apnoea (83.8% versus 13%). Mean±SD AHI was 21.4±17.6·h−1and decreased significantly at M3 (18±16.4·h−1; p=0.018). At M3, 91% of all patients with baseline SDB still had an AHI>5·h−1 and in 68.1% the predominant type of SDB remained unchanged (78.9% in obstructive sleep apnoea and 44.4% in central sleep apnoea). The only predictors of SDB at baseline were higher age and body mass index and in the chronic phase additionally baseline AHI. Baseline AHI was associated with functional outcome (modified Rankin score >3) at M3.The high prevalence of SDB in acute stroke, its persistence after 3 months, and the association with functional outcome supports the recommendation for a rapid SDB screening in stroke patients.

scholarly journals Long-term Impact of Adenotonsillectomy on the Quality of Life of Children with Sleep-disordered breathing

2020 ◽  
Author(s):  
Juliana Alves Sousa Caixeta ◽  
Jessica Caixeta Silva Sampaio ◽  
Vanessa Vaz Costa ◽  
Isadora Milhomem Bruno da Silveira ◽  
Carolina Ribeiro Fernandes de Oliveira ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Disordered Breathing ◽  
Long Term Effects ◽  
Obstructive Sleep ◽  
Long Term Impact ◽  
Disordered Breathing

Abstract Introduction Adenotonsillectomy is the first-line treatment for obstructive sleep apnea secondary to adenotonsillar hypertrophy in children. The physical benefits of this surgery are well known as well as its impact on the quality of life (QoL), mainly according to short-term evaluations. However, the long-term effects of this surgery are still unclear. Objective To evaluate the long-term impact of adenotonsillectomy on the QoL of children with sleep-disordered breathing (SDB). Method This was a prospective non-controlled study. Children between 3 and 13 years of age with symptoms of SDB for whom adenotonsillectomy had been indicated were included. Children with comorbities were excluded. Quality of life was evaluated using the obstructive sleep apnea questionnaire (OSA-18), which was completed prior to, 10 days, 6 months, 12 months and, at least, 18 months after the procedure. For statistical analysis, p-values lower than 0.05 were defined as statistically significant. Results A total of 31 patients were enrolled in the study. The average age was 5.2 years, and 16 patients were male. The OSA-18 scores improved after the procedure in all domains, and this result was maintained until the last evaluation, done 22 ± 3 months after the procedure. Improvement in each domain was not superior to achieved in other domains. No correlation was found between tonsil or adenoid size and OSA-18 scores. Conclusion This is the largest prospective study that evaluated the long-term effects of the surgery on the QoL of children with SDB using the OSA-18. Our results show adenotonsillectomy has a positive impact in children's QoL.

scholarly journals Apnoea–hypopnoea indices determined via continuous positive airway pressure (AHI-CPAPflow) versus those determined by polysomnography (AHI-PSGgold): a protocol for a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e044499
Author(s):  
Fanny Bertelli ◽  
Carey Meredith Suehs ◽  
Jean Pierre Mallet ◽  
Marie Caroline Rotty ◽  
Jean Louis Pepin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Sleep Disordered Breathing ◽  
Positive Airway Pressure ◽  
Meta Analysis ◽  
Sleep Apnoea ◽  
Obstructive Sleep ◽  
The Impact ◽  
Disordered Breathing

Introduction To date, continuous positive airway pressure (CPAP) remains the cornerstone of obstructive sleep apnoea treatment. CPAP data describing residual sleep-disordered breathing events (ie, the CPAP-measured apnoea–hypopnoea indices (AHI-CPAPflow)) is difficult to interpret because it is an entirely different metric than the polysomnography (PSG) measured AHI gold standard (AHI-PSGgold). Moreover, manufacturer definitions for apnoea and hypopnoea are not only different from those recommended for PSG scoring, but also different between manufacturers. In the context of CPAP initiation and widespread telemedicine at home to facilitate sleep apnoea care, there is a need for concrete evidence that AHI-CPAPflow can be used as a surrogate for AHI-PSGgold. Methods and analysis No published systematic review and meta-analysis (SRMA) has compared the accuracy of AHI-CPAPflow against AHI-PSGgold and the primary objective of this study is therefore to do so using published data. The secondary objectives are to similarly evaluate other sleep disordered breathing indices and to perform subgroup analyses focusing on the inclusion/exclusion of central apnoea patients, body mass index levels, CPAP device brands, pressure titration modes, use of a predetermined and fixed pressure level or not, and the impact of a 4% PSG desaturation criteria versus 3% PSG on accuracy. The Preferred Reporting Items for SRMA protocols statement guided study design. Randomised controlled trials and observational studies of adult patients (≥18 years old) treated by a CPAP device will be included. The CPAP intervention and PSG comparator must be performed synchronously. PSGs must be scored manually and follow the American Academy of Sleep Medicine guidelines (2007 AASM criteria or more recent). To assess the risk of bias in each study, the Quality Assessment of Diagnostic Accuracy Studies 2 tool will be used. Ethics and dissemination This protocol received ethics committee approval on 16 July 2020 (IRB_MTP_2020_07_2020000404) and results will be disseminated via peer-reviewed publications. PROSPERO/Trial registration numbers CRD42020159914/NCT04526366; Pre-results

569 Correlation between age and initial findings of sleep disordered breathing in children with achondroplasia

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A224-A225
Author(s):  
Fayruz Araji ◽  
Cephas Mujuruki ◽  
Brian Ku ◽  
Elisa Basora-Rovira ◽  
Anna Wani
Keyword(s):  
Sleep Apnea ◽  
Primary Care Physicians ◽  
Sleep Disordered Breathing ◽  
Upper Airway ◽  
Sleep Study ◽  
Surgical Interventions ◽  
Screening Guidelines ◽  
Obstructive Sleep ◽  
Children’S Sleep ◽  
Disordered Breathing

Abstract Introduction Achondroplasia (ACH) occurs approximately 1 in 20,000–30,000 live births. They are prone to sleep disordered breathing specifically due to the upper airway stenosis, enlarged head circumference, combined with hypotonia and limited chest wall size associated with scoliosis at times. The co-occurrence of sleep apnea is well established and can aide in the decision for surgical intervention, however it is unclear at what age children should be evaluated for sleep apnea. Screening is often delayed as during the daytime there is no obvious gas exchange abnormalities. Due to the rareness of this disease, large studies are not available, limiting the data for discussion and analysis to develop guidelines on ideal screening age for sleep disordered breathing in children with ACH. Methods The primary aim of this study is to ascertain the presence of sleep disorder breathing and demographics of children with ACH at time of first polysomnogram (PSG) completed at one of the largest pediatric sleep lab in the country. The secondary aim of the study is to identify whether subsequent polysomnograms were completed if surgical interventions occurred and how the studies differed over time with and without intervention. Retrospective review of the PSGs from patients with ACH, completed from 2017–2019 at the Children’s Sleep Disorders Center in Dallas, TX. Clinical data, demographics, PSG findings and occurrence of interventions were collected. Results Twenty-seven patients with the diagnosis of ACH met criteria. The average age at the time of their first diagnostic PSG was at 31.6 months of age (2.7 years), of those patients 85% had obstructive sleep apnea (OSA),51% had hypoxemia and 18% had hypercapnia by their first diagnostic sleep study. Of those with OSA, 50% were severe. Majority were females, 55%. Most of our patients were Hispanic (14%), Caucasian (9%), Asian (2%), Other (2%), Black (0%). Each patient had an average of 1.9 PSGs completed. Conclusion Our findings can help create a foundation for discussion of screening guidelines. These guidelines will serve to guide primary care physicians to direct these patients to an early diagnosis and treatment of sleep disordered breathing. Support (if any):

Rural Barriers to Surgical Care for Children With Sleep-Disordered Breathing

2021 ◽  
pp. 019459982199338
Author(s):  
Flora Yan ◽  
Dylan A. Levy ◽  
Chun-Che Wen ◽  
Cathy L. Melvin ◽  
Marvella E. Ford ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Sleep Disordered Breathing ◽  
Healthy Children ◽  
Loss To Follow Up ◽  
Cox Regression Analysis ◽  
Obstructive Sleep ◽  
The Impact ◽  
Disordered Breathing

Objective To assess the impact of rural-urban residence on children with obstructive sleep-disordered breathing (SDB) who were candidates for tonsillectomy with or without adenoidectomy (TA). Study Design Retrospective cohort study. Setting Tertiary children’s hospital. Methods A cohort of otherwise healthy children aged 2 to 18 years with a diagnosis of obstructive SDB between April 2016 and December 2018 who were recommended TA were included. Rural-urban designation was defined by ZIP code approximation of rural-urban commuting area codes. The main outcome was association of rurality with time to TA and loss to follow-up using Cox and logistic regression analyses. Results In total, 213 patients were included (mean age 6 ± 2.9 years, 117 [55%] male, 69 [32%] rural dwelling). Rural-dwelling children were more often insured by Medicaid than private insurance ( P < .001) and had a median driving distance of 74.8 vs 16.8 miles ( P < .001) compared to urban-dwelling patients. The majority (94.9%) eventually underwent recommended TA once evaluated by an otolaryngologist. Multivariable logistic regression analysis did not reveal any significant predictors for loss to follow-up in receiving TA. Cox regression analysis that adjusted for age, sex, insurance, and race showed that rural-dwelling patients had a 30% reduction in receipt of TA over time as compared to urban-dwelling patients (hazard ratio, 0.7; 95% CI, 0.50-0.99). Conclusion Rural-dwelling patients experienced longer wait times and driving distance to TA. This study suggests that rurality should be considered a potential barrier to surgical intervention and highlights the need to further investigate geographic access as an important determinant of care in pediatric SDB.

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