Sleep-related breathing disorders and stroke
- Antonio Culebras, MD
Antonio Culebras, MD
- Professor of Neurology
- Upstate Medical University
Sleep-related breathing disorders, including obstructive sleep apnea (OSA), central sleep apnea (CSA), and Cheyne-Stokes breathing, are common in patients with stroke or transient ischemic attack and have been associated with adverse outcomes both in the general population and in patients with stroke. In addition, OSA may itself be an independent risk factor for stroke.
OSA is characterized by the intermittent cessation or reduction of airflow during sleep due to complete or partial upper airway obstruction, while CSA is characterized by the intermittent absence of airflow and ventilatory effort. Cheyne-Stokes breathing refers to cyclic crescendo-decrescendo airflow and respiratory effort during wakefulness or sleep, without upper airway obstruction. Cheyne-Stokes breathing is considered a type of CSA when the decrescendo effort is accompanied by apnea during sleep. (See "Polysomnography in the evaluation of sleep-disordered breathing in adults".)
Clinical signs and symptoms of sleep-related breathing disorders are not reliable in patients with stroke, and diagnostic sleep testing with polysomnography or home sleep apnea testing is required to make the diagnosis. While clinical trials in the general population have demonstrated that treatment of OSA with continuous positive airway pressure (CPAP) or other therapies significantly reduces apneas and oxygen desaturation during sleep and other outcomes, data in stroke patients are more limited.
The association between OSA and stroke as well as the epidemiology, clinical features, diagnosis, and management of sleep-related breathing disorders following stroke or transient ischemic attack are discussed here. Other cardiovascular complications of OSA and other respiratory abnormalities that can occur after a stroke are described separately. (See "Obstructive sleep apnea and cardiovascular disease in adults" and "Stroke-related pulmonary complications and abnormal respiratory patterns", section on 'Abnormal respiratory patterns'.)
SLEEP APNEA AS A RISK FACTOR FOR STROKE
Obstructive sleep apnea (OSA) has been associated with an increased risk for ischemic stroke, independent of vascular risk factors . The risk of stroke in patients with other sleep-related breathing disorders, including central sleep apnea syndrome, is not well studied.
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- SLEEP APNEA AS A RISK FACTOR FOR STROKE
- Clinical evidence
- Effect of treatment
- PREVALENCE AFTER STROKE
- CONTRIBUTING FACTORS
- CLINICAL FEATURES
- Screening in post-stroke patients
- Timing and modality of diagnostic testing
- SUMMARY AND RECOMMENDATIONS