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Sleep-disordered breathing following acute stroke

Lookup NU author(s): Dr Joseph Harbison, Professor Gary Ford, Emeritus Professor Oliver James, Emeritus Professor John Gibson

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Abstract

Background: The reported prevalence of sleep apnoea following stroke varies between 44% and 72%, but its course and relations are unclear. Aim: To determine the prevalence and course of sleep-disordered breathing in acute stroke in-patients, and its relation to age, stroke subtype, pre-stroke handicap and post-stroke outcome. Design: Prospective uncontrolled observational study. Methods: Paired respiratory sleep studies were performed at week 2 and week 6-9 following stroke. Pre- and post-stroke handicap (modified Rankin Score) and week 2 and week 6-9 disability (Barthel Score) and impairment (Scandinavian Neurological Stroke Score) were assessed. Pre-stroke sleepiness was determined by Epworth Score. Results: There were 68 patients in the week 2 study, and 50 in the week 6-8 study. Mean week 2 Apnoea Hypopnoea Index (AHI) was 30; 64 patients (94%) had an AHI greater than or equal to10. Mean AHI was higher in subjects with lacunar vs. cortical strokes (44 vs. 28, p<0.05), in subjects aged greater than or equal to65 years (32 vs. 21, p<0.05) and in those with greater pre-stroke handicap (modified Rankin Score 2 vs. <2) (41 vs. 27, p<0.05). In 50 paired studies, mean AHI fell from 31 to 24 (p<0.01) and the proportion with AHI greater than or equal to10 fell from 96% to 72%. Pre-stroke sleepiness was associated with post-stroke neurological impairment (r=-0.325, p<0.05) and disability (r=-0.377, p<0.05). Discussion: Sleep-disordered breathing improves in the first 6-9 weeks following stroke, but remains highly prevalent. Worse sleep-disordered breathing was observed following lacunar stroke, and in older subjects or those with pre-stroke handicap.

Publication metadata

Author(s): James OFW; Harbison J; Gibson GJ; Ford GA

Publication type: Article

Publication status: Published

Journal: QJM

Year: 2002

Volume: 95

Issue: 11

Pages: 741-747

ISSN (print): 1460-2725

ISSN (electronic): 1460-2393

Publisher: Oxford University Press

URL: http://dx.doi.org/10.1093/qjmed/95.11.741

DOI: 10.1093/qjmed/95.11.741

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