Sleep Disordered Breathing after Stroke: Clinical Profile of Patients with
Obstructive- as Opposed to Central-Sleep Apnea
|Maria Luisa Sacchetti1*, Maria Teresa Di Mascio1, Giacomo Della Marca2, Antonio Minni3, Silvia Ottaviani1, Danilo Toni1 and Marco Fiorelli1
|1Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
|2Sleep Unit, Institute of Neurology, Catholic University, A. Gemelli, Rome, Italy
|3Department of Sensory Organs, Sapienza University of Rome, Rome, Italy
|Corresponding Author :
||Maria Luisa Sacchetti
Department of Neurology and Psychiatry
Sapienza University, Rome, Italy
Tel: +39 06 4453610
E-mail: [email protected]
|Received April 01, 2013; Accepted April 20, 2013; Published April 25, 2013
|Citation: Sacchetti ML, Di Mascio MT, Marca GD, Minni A, Ottaviani S, et al. (2013) Sleep Disordered Breathing after Stroke: Clinical Profile of Patients with Obstructive- as Opposed to Central-Sleep Apnea. J Sleep Disord Ther 2:113. doi:10.4172/2167-0277.1000113
|Copyright: © 2013 Sacchetti ML, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Aim: In order to define the clinical and instrumental profile of patients with Obstructive Sleep Apnea/Hypopnea
(OSAH) and to compare them with that of cases with Central Sleep Apnea/Hypopnea (CSAH), a series of stable
strokes were studied.
Methods: Thirty four patients were submitted to both clinical and polisomnographyc study (PSG) after 4 months
as affected by predominantly OSAH (pOSAH), predominantly CSAH (pCSAH), or normal patients. Comparisons
were made among the groups and correlation analyses were done in each group. Significance was set at p<0.005.
Results: Thirty-four ischemic strokes
were enrolled (55% embolic, 6% large artery, 32% lacunar, 9% with
undetermined cause). The 76% of them had a SDB ( pOSAH=61%; pCSAH=39%). Nearly the 47% of cases had an
obstruction of the upper airways alone or combined with an increase in pharyngeal tissue. No significant differences
were found between pOSAH and pCSAH. In pOSAH cases, 8 cases (50%) had an obstruction of the upper airways;
in 4 of them it was combined with an increase in pharyngeal tissue; the time interval from stroke to PSG (Δ t), was
inversely related to both TST (p 0.017) and TSP (p 0.039); the NIH-SS at entry was directly related to the number of
arousals /h of sleep (p 0.044); the more severe AHI the higher is ODI (p 0.000). In the pCSAH group, 4 cases (40%)
had an obstruction of the upper airways combined with an increase in pharyngeal tissue; two of these 4 cases had
also a BMI>30. In CSAH, Δt was inversely related to SE Index (p 0.021), and directly related to both the number of
arrhythmias/h sleep (p 0.016) and ODI (p 0.033). No correlations were found between the number of arrhythmias
sleep and causes of stroke both in pOSAH and in pCSAH groups.
Conclusions: Our data suggest a direct effect of stroke on the peripheral breathing system with subsequent
alteration of loop gain and CSAH phenotype, at least in a subgroup of cases. To confirm this hypothesis multicenter
clinical sleep studied are needed.