Interaction between Sleep-Disordered Breathing and Acute Ischemic Stroke
2
조회
0
다운로드
4
인용
0
참고문헌
키워드
초록
Background and Purpose Sleep-disordered breathing (SDB) is suggested to be strongly associated with ischemic strokes. Risk factors, stroke subtypes, stroke lesion distribution, and the outcome of SDB in stroke patients remain unclear in Korea. Methods We prospectively studied 293 patients (159 men, 134 women; age 68.4±10.5) with acute ischemic stroke. Cardiovascular risk factors, stroke severity, sleep-related stroke onset,distribution of stroke lesions, and 3-month score on the modified Rankin Scale (mRS) were assessed. Stroke severity was assessed by the US National Institutes of Health Stroke Scale (NIHSS) and the mRS. The apnea-hypopnea index (AHI) was determined 6.3±2.2 days after stroke onset with the Apnea Link portable sleep apnea monitoring device. Results The prevalence of SDB (defined as an AHI of ≥10) was 63.1% (111 men, 74 women). Those in the SDB group were older, had higher NIHSS and mRS scores, greater bulbar weakness, and a higher incidence of sleep-associated stroke onset. Among risk-factor profiles,alcohol consumption and atrial fibrillation were significantly related to SDB. The stroke outcome was worse in patients with SDB than in those without SDB. The lesion location and specific stroke syndrome were not correlated with SDB. Conclusions SDB is very common in acute cerebral infarction. Different risk-factor profiles and sleep-related stroke onsets suggest SDB as a cause of ischemic stroke. The higher NIHSS score and greater bulbar involvement in the SDB group seem to show the influence of ischemic stroke on the increased SDB prevalence.
Abstract
Background and Purpose Sleep-disordered breathing (SDB) is suggested to be strongly associated with ischemic strokes. Risk factors, stroke subtypes, stroke lesion distribution, and the outcome of SDB in stroke patients remain unclear in Korea. Methods We prospectively studied 293 patients (159 men, 134 women; age 68.4±10.5) with acute ischemic stroke. Cardiovascular risk factors, stroke severity, sleep-related stroke onset,distribution of stroke lesions, and 3-month score on the modified Rankin Scale (mRS) were assessed. Stroke severity was assessed by the US National Institutes of Health Stroke Scale (NIHSS) and the mRS. The apnea-hypopnea index (AHI) was determined 6.3±2.2 days after stroke onset with the Apnea Link portable sleep apnea monitoring device. Results The prevalence of SDB (defined as an AHI of ≥10) was 63.1% (111 men, 74 women). Those in the SDB group were older, had higher NIHSS and mRS scores, greater bulbar weakness, and a higher incidence of sleep-associated stroke onset. Among risk-factor profiles,alcohol consumption and atrial fibrillation were significantly related to SDB. The stroke outcome was worse in patients with SDB than in those without SDB. The lesion location and specific stroke syndrome were not correlated with SDB. Conclusions SDB is very common in acute cerebral infarction. Different risk-factor profiles and sleep-related stroke onsets suggest SDB as a cause of ischemic stroke. The higher NIHSS score and greater bulbar involvement in the SDB group seem to show the influence of ischemic stroke on the increased SDB prevalence.
참고문헌 (31)
- Yaggi H, "Obstructive sleep apnoea and stroke", The Lancet Neurology, 3, pp.333~342 (2004)
- Bassetti C, "Sleep apnea in patients with transient ischemic attack and stroke: a prospective study of 59 patients", Neurology, 47, pp.1167~1173 (1996)
- Parra O, "Time course of sleep-related breathing disorders in first-ever stroke or transient ischemic attack", American Journal of Respiratory and Critical Care Medicine, 161, pp.375~380 (2000)
- Bassetti CL, "Sleep-disordered breathing and acute ischemic stroke: diagnosis, risk factors, treatment, evolution, and long-term clinical outcome", Stroke, 37, pp.967~972 (2006)
- Dyken ME, "Investigating the relationship between stroke and obstructive sleep apnea", Stroke, 27, pp.401~407 (1996)
- Yaggi HK, "Obstructive sleep apnea as a risk factor for stroke and death", The New England Journal of Medicine, 353, pp.2034~2041 (2005)
- Dziewas R, "Increased prevalence of sleep apnea in patients with recurring ischemic stroke compared with first stroke victims", Journal of Neurology, 252, pp.1394~1398 (2005)
- Bassetti C, "Sleep apnea in acute cerebrovascular diseases: final report on 128 patients", Sleep, 22, pp.217~223 (1999)
- Wessendorf TE, "Sleep-disordered breathing among patients with first-ever stroke", Journal of Neurology, 247, pp.41~47 (2000)
- Turkington PM, "Prevalence and predictors of upper airway obstruction in the first 24 hours after acute stroke", Stroke, 33, pp.2037~2042 (2002)
- Hui DS, "Prevalence of sleep-disordered breathing and continuous positive airway pressure compliance: results in Chinese patients with first-ever ischemic stroke", Chest, 122, pp.852~860 (2002)
- Rola R, "Sleep related breathing disorders in patients with ischemic stroke and transient ischemic attacks: respiratory and clinical correlations", Journal of Physiology and Pharmacology, 58(Suppl 5), pp.575~582 (2007)
- Yan-fang S, "Sleep-disordered breathing: impact on functional outcome of ischemic stroke patients", Sleep Medicine, 10, pp.717~719 (2009)
- Broadley SA, "Early investigation and treatment of obstructive sleep apnoea after acute stroke", Journal of Clinical Neuroscience, 14, pp.328~333 (2007)
- McArdle N, "Sleep-disordered breathing as a risk factor for cerebrovascular disease: a case-control study in patients with transient ischemic attacks", Stroke, 34, pp.2916~2921 (2003)
- Iranzo A, "Prevalence and clinical importance of sleep apnea in the first night after cerebral infarction", Neurology, 58, pp.911~916 (2002)
- Siccoli MM, "Central periodic breathing during sleep in 74 patients with acute ischemic stroke - neurogenic and cardiogenic factors", Journal of Neurology, 255, pp.1687~1692 (2008)
- Nopmaneejumruslers C, "Cheyne-Stokes respiration in stroke: relationship to hypocapnia and occult cardiac dysfunction", American Journal of Respiratory and Critical Care Medicine, 171, pp.1048~1052 (2005)
- Harbison J, "Sleep-disordered breathing following acute stroke", QJM, 95, pp.741~747 (2002)
- Szücs A, "Pathological sleep apnoea frequency remains permanent in ischaemic stroke and it is transient in haemorrhagic stroke", European Neurology, 47, pp.15~19 (2002)
- Joo BE, "Prevalence of sleep-disordered breathing in acute ischemic stroke as determined using a portable sleep apnea monitoring device in Korean subjects", Sleep And Breathing, 15, pp.77~82 (2011)
- Adams HP Jr, "Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment", Stroke, 24, pp.35~41 (1993)
- Martínez-García MA, "Improvement in nocturnal disordered brea-thing after first-ever ischemic stroke: role of dysphagia", Chest, 129, pp.238~245 (2006)
- Marin JM, "Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study", The Lancet, 365, pp.1046~1053 (2005)
- Arzt M, "Association of sleep-disordered breathing and the occurrence of stroke", American Journal of Respiratory and Critical Care Medicine, 172, pp.1447~1451 (2005)
- Munoz R, "Severe sleep apnea and risk of ischemic stroke in the elderly", Stroke, 37, pp.2317~2321 (2006)
- Valham F, "Increased risk of stroke in patients with coronary artery disease and sleep apnea: a 10-year follow-up", Circulation, 118, pp.955~960 (2008)
- Erman MK, "Validation of the ApneaLink for the screening of sleep apnea: a novel and simple single-channel recording device", Journal of Clinical Sleep Medicine, 3, pp.387~392 (2007)
- Ng SS, "Validation of a portable recording device (ApneaLink) for identifying patients with suspected obstructive sleep apnoea syndrome", Internal Medicine Journal, 39, pp.757~762 (2009)
- Gami AS, "Association of atrial fibrillation and obstructive sleep apnea", Circulation, 110, pp.364~367 (2004)
- Kaneko Y, "Relationship of sleep apnea to functional capacity and length of hospitalization following stroke", Sleep, 26, pp.293~297 (2003)