Improvement in nocturnal disordered breathing after first-ever ischemic stroke: role of dysphagia.

STUDY OBJECTIVE The aim of this study was to analyze the role of dysphagia as a model of pharyngeal muscle dysfunction in the time course of nocturnal disordered breathing (NDB) in patients who experienced a first-ever ischemic stroke. DESIGN Prospective study. PATIENTS AND INTERVENTIONS Fifty-nine consecutive patients (mean age, 73.2 years; SD, 12.8 years) were studied. Clinical sleep and neurologic data and vascular risk factors were recorded. Two nocturnal studies using a portable autotitration device (AutoSet Portable Plus II system; ResMed; Sydney, NSW, Australia) were performed in both the acute phase (mean duration, 1.23 days; SD, 0.7 day) and the stable phase (mean duration 65.9 days; SD, 12.5 days) of the neurologic event in all patients. RESULTS The mean total apnea-hypopnea index (AHI) measured with the autotitration device in the acute phase was 34.9 (SD, 25.2) vs 20.1 (SD, 21.7) in the stable phase, both with predominance of obstructive apnea. Patients with dysphagia (n = 30) showed the largest number of obstructive apneic episodes (OAIs) in the acute phase (AHI, 40 episodes; OAI, 30.4 episodes), with a significant reduction in this type of apnea during the stable phase of stroke (AHI, 24.7 episodes; OAI, 17.7 episodes), coinciding with the recovery of pharyngeal muscle function. In contrast, nondysphagic patients (n = 29) showed no significant changes in NDB from the acute to the stable phase of stroke. Logistic regression analysis found dysphagia to be the best independent predictor of AHI reduction of > 50% from baseline (odds ratio, 13.4; 95% confidence interval, 3.3 to 39.6; p = 0.001). CONCLUSION The present study shows significant improvement in the number obstructive apneic events occurring in the stable phase of a first-ever ischemic stroke in patients with transient pharyngeal muscle alterations secondary to the neurologic lesion.

[1]  J. Harbison,et al.  Sleep-disordered breathing following acute stroke. , 2002, QJM : monthly journal of the Association of Physicians.

[2]  J. Woo,et al.  Prevalence of sleep-disordered breathing and continuous positive airway pressure compliance: results in chinese patients with first-ever ischemic stroke. , 2002, Chest.

[3]  P. Wanklyn,et al.  Prevalence and Predictors of Upper Airway Obstruction in the First 24 Hours After Acute Stroke , 2002, Stroke.

[4]  Jan Hedner,et al.  Increased incidence of cardiovascular disease in middle-aged men with obstructive sleep apnea: a 7-year follow-up. , 2002, American journal of respiratory and critical care medicine.

[5]  C. Janson,et al.  Prevalence of sleep apnoea and snoring in hypertensive men: a population based study. , 2002, Thorax.

[6]  T. Bradley,et al.  Sleep Apnea and Cardiovascular Disease , 2001 .

[7]  V. Mohsenin,et al.  Sleep-Related Breathing Disorders and Risk of Stroke , 2001, Stroke.

[8]  J. Harbison,et al.  Snoring, sleep apnoea and stroke: chicken or scrambled egg? , 2000, QJM : monthly journal of the Association of Physicians.

[9]  W. McNicholas,et al.  Cardiovascular risk factors in patients with obstructive sleep apnoea syndrome. , 2000, The European respiratory journal.

[10]  Erry,et al.  Prospective study of the association between sleep-disordered breathing and hypertension. , 2000, The New England journal of medicine.

[11]  Bonnie K. Lind,et al.  Association of Sleep-Disordered Breathing, Sleep Apnea, and Hypertension in a Large Community-Based Study , 2000 .

[12]  J. Montserrat,et al.  Time course of sleep-related breathing disorders in first-ever stroke or transient ischemic attack. , 2000, American journal of respiratory and critical care medicine.

[13]  J. M. Arriero,et al.  Validación de la versión española del test de somnolencia Epworth en pacientes con síndrome de apnea de sueño , 1999 .

[14]  M. Aldrich,et al.  Sleep apnea in acute cerebrovascular diseases: final report on 128 patients. , 1999, Sleep.

[15]  P. Lévy,et al.  Simultaneous laboratory-based comparison of ResMed Autoset with polysomnography in the diagnosis of sleep apnoea/hypopnoea syndrome. , 1998, The European respiratory journal.

[16]  M. Gugger.  Comparison of ResMed AutoSet (version 3.03) with polysomnography in the diagnosis of the sleep apnoea/hypopnoea syndrome. , 1997, The European respiratory journal.

[17]  W. McNicholas,et al.  Comparison of a limited computerized diagnostic system (ResCare Autoset) with polysomnography in the diagnosis of obstructive sleep apnoea syndrome. , 1996, The European respiratory journal.

[18]  V. Somers,et al.  Investigating the relationship between stroke and obstructive sleep apnea. , 1996, Stroke.

[19]  V Hachinski,et al.  The Canadian Neurological Scale , 1989, Neurology.

[20]  D H Barer,et al.  The natural history and functional consequences of dysphagia after hemispheric stroke. , 1989, Journal of neurology, neurosurgery, and psychiatry.

[21]  D. Wade,et al.  Dysphagia in acute stroke. , 1987, British medical journal.

[22]  Mahoney Fi,et al.  FUNCTIONAL EVALUATION: THE BARTHEL INDEX. , 1965 .

[23]  M. C. M. García,et al.  Prevalencia de trastornos respiratorios durante el sueño en pacientes con ictus isquémico agudo. Influencia del momento de aparición del ictus , 2004 .

[24]  C W Whitney,et al.  Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. , 2001, American journal of respiratory and critical care medicine.

[25]  K. Clark,et al.  Association of Sleep-Disordered Breathing, Sleep Apnea, and Hypertension in a Large Community- Based Study , 2000 .

[26]  Bruce Neal,et al.  1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension. Guidelines Subcommittee. , 1999, Journal of hypertension.