Post stroke sleep apnea hypopnea syndrome: a series of 12 consecutive stable stroke cases

M.L. Sacchetti, M.T. Di Mascio*, M. Fiorelli, D. Toni*, R. Roukos**, A. Minni**, M. Saponara**

Department of Neurology and Psychiatry, *Emergency Department, Stroke Unit, and **Department of Neurology and Otolaryngology; Sapienza University, Rome, Italy. marialuisa.sacchetti@uniroma1.it

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• Neurology

OBJECTIVES: Sleep Disordered Breathing (SDB) is a negative prognostic factor for stroke patients. In order to reveal: (1) the frequency of Sleep Apnea-Hypopnea Syndrome (SAHS) in the stable phase of the illness; (2) the type of SAHS, either obstructive (OSAHS) or central (CSAHS); (3) the possible association between SAHS and daily sleepiness, cardiac arrhythmias, stroke / TIA recurrence and location of the brain lesion, an observational study is on-going at Sapienza University of Rome. We report here the results of cases included in the feasibility study.

PATIENTS AND METHODS: Clinical evaluations, brain images and polisomnographic study were performed at discharge and after 4 and 9 months of stroke.

RESULTS: Eleven out of the 12 patients included (91.6%) had an Apnea/Hypopnea Index-AHI >= 5. In 5 cases, the majority of total respiratory events were purely central in origin. In 3 of these 5 cases, a concomitant obstruction of the upper airways was revealed; the 2 remaining had risk factors for OSAHS (smoke, hypertension, BMI > 25). A significant association was found between central apnea/hypopnea events and cardiac arrhythmias (p value 0.017).

CONCLUSIONS: These findings confirm the high prevalence of SDB, either obstructive or/and central, even in the stable phase of the illness, which – in those patients who had accumulated risk factors for OSAHS – result in Complex-sleep apnea/hypopnea syndrome (CompSAHS). As patients with CompSAHS are left with very disrupted breathing on continuous positive airway pressure, in order to select cases with stable stroke who benefit from continuos-positive airway pressure (C-PAP) treatment, further and more detailed clinical studies are needed to better distinguish CompSAHS from mixed SAHS.

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