TY - JOUR

T1 - Sleep-disordered breathing and cerebral small vessel disease—acute and 6 months after ischemic stroke

AU - Simonsen, Sofie Amalie

AU - Andersen, Adam Vittrup

AU - West, Anders Sode

AU - Wolfram, Frauke

AU - Jennum, Poul

AU - Iversen, Helle K.

N1 - Funding Information: This study was funded by the Clinical Stroke Research Unit, Department of Neurology, Rigshospitalet, Glostrup; the Grosser L. F. Foghts Foundation; and the Hoerslev Foundation. Publisher Copyright: © 2021, The Author(s), under exclusive licence to Springer Nature Switzerland AG.

PY - 2022

Y1 - 2022

N2 - Purpose: Sleep-disordered breathing (SDB) occurs frequently after stroke and is associated with poor functional outcome and increased mortality. The purpose of this study was to detect changes in SDB over time after acute ischemic stroke and investigate relationships between SDB and stroke etiologies with focus on cerebral small vessel disease. Methods: From May 2015 to August 2016, we conducted an observational study of 99 patients with mild to moderate stroke (median age: 68 years, range 36–88; 56% men). Polysomnography was performed within 7 days of stroke onset (n = 91) and after 6 months (n = 52). The strokes were classified using the etiological TOAST classification. Total small vessel disease (SVD) scores were calculated based on MRIs. Results: SDB, defined as an apnea–hypopnea index (AHI) ≥ 15, was found in 56% of patients in the acute state and in 44% at follow-up. AHI decreased over time (median change 4.7, 95% confidence interval [95% CI] 0.5–8.9; p = 0.03). Patients with AHI ≥ 15 in both the acute state and at follow-up had higher SVD score at follow-up (p = 0.003). AHI was not associated with ischemic stroke subgroups according to the TOAST classification. Discussion: In conclusion, 6 months after stroke, AHI decreased, but 44% still had AHI ≥ 15. Persistent SDB in both the acute state and at follow-up was associated with a higher SVD score, but not to the TOAST subgroups. SDB evaluation should be offered to stroke patients, and the effect of SDB on cerebral small vessel disease needs to be further investigated using the well-defined SVD score. Trial registration: clinicaltrials.gov NCT02111408, April 11, 2014

AB - Purpose: Sleep-disordered breathing (SDB) occurs frequently after stroke and is associated with poor functional outcome and increased mortality. The purpose of this study was to detect changes in SDB over time after acute ischemic stroke and investigate relationships between SDB and stroke etiologies with focus on cerebral small vessel disease. Methods: From May 2015 to August 2016, we conducted an observational study of 99 patients with mild to moderate stroke (median age: 68 years, range 36–88; 56% men). Polysomnography was performed within 7 days of stroke onset (n = 91) and after 6 months (n = 52). The strokes were classified using the etiological TOAST classification. Total small vessel disease (SVD) scores were calculated based on MRIs. Results: SDB, defined as an apnea–hypopnea index (AHI) ≥ 15, was found in 56% of patients in the acute state and in 44% at follow-up. AHI decreased over time (median change 4.7, 95% confidence interval [95% CI] 0.5–8.9; p = 0.03). Patients with AHI ≥ 15 in both the acute state and at follow-up had higher SVD score at follow-up (p = 0.003). AHI was not associated with ischemic stroke subgroups according to the TOAST classification. Discussion: In conclusion, 6 months after stroke, AHI decreased, but 44% still had AHI ≥ 15. Persistent SDB in both the acute state and at follow-up was associated with a higher SVD score, but not to the TOAST subgroups. SDB evaluation should be offered to stroke patients, and the effect of SDB on cerebral small vessel disease needs to be further investigated using the well-defined SVD score. Trial registration: clinicaltrials.gov NCT02111408, April 11, 2014

KW - Cerebral small vessel disease

KW - Ischemic stroke

KW - Sleep apnea

KW - Sleep-disordered breathing

U2 - 10.1007/s11325-021-02482-1

DO - 10.1007/s11325-021-02482-1

M3 - Journal article

C2 - 34476728

AN - SCOPUS:85114088795

VL - 26

SP - 1107

EP - 1113

JO - Sleep and Breathing

JF - Sleep and Breathing

SN - 1520-9512

ER -