Sleep-disordered breathing in patients with acute supra- and infratentorial strokes - A prospective study of 39 patients

Background and Purpose Although recent studies suggest a high prevalence of obstructive sleep apnea (OSA) in patients with acute stroke, a systematic characterization of sleep-disordered breathing based on the severity and topography of stroke has not been performed. Methods We prospectively studied 39 noncomatose adult subjects (15 women, 24 men; mean age, 57 years) with a first acute stroke. Sleep history, cardiovascular risk factors, stroke severity as estimated by the Scandinavian Stroke Scale, and extent of stroke demonstrated on a computed tomographic or magnetic resonance imaging scan of the brain were assessed. Polysomnography was performed a mean of 10 days (range, 1 to 49 days) after stroke onset. Monitoring of breathing during wakefulness, non-rapid eye movement sleep, and rapid eye movement sleep included measurements of nasal/oral airflow, respiratory effort, and oxygen saturation. Results Breathing was abnormal during wakefulness in 7 (18%) subjects and during sleep in 26 (67%). Obstructive sleep apnea (apnea-hypopnea index >10) was found in 14 subjects, Cheyne-Stokes-like breathing was observed in 4, and a combination of obstructive sleep apnea and Cheyne-Stokes-like breathing was observed in 7. Sustained tachypnea and ataxic breathing were rare. No significant differences were found in age, body mass index, history of snoring or hypersomnia, or stroke topography or severity between subjects with and without sleep-disordered breathing. Prevalence and severity of breathing disturbances were also similar between patients with supratentorial stroke (n=28) and those with infratentorial (n=11) stroke. Conclusions Sleep-disordered breathing is frequent in patients with acute stroke, rarely has localizing value, and can also be found in patients with mild neurological deficits. Respiratory disturbances in stroke victims can be explained only in part by topography and extension of acute brain damage.