Sleep-disordered breathing and acute ischemic stroke - Diagnosis, risk factors, treatment, evolution, and long-term clinical outcome

Background and Purpose - Sleep-disordered breathing (SDB) is frequent in stroke patients. Risk factors, treatment response, short-term and long-term outcome of SDB in stroke patients are poorly known. Methods - We prospectively studied 152 patients ( mean age 56 +/- 13 years) with acute ischemic stroke. Cardiovascular risk factors, Epworth sleepiness score (ESS), stroke severity/etiology, and time of stroke onset were assessed. The apnea-hypopnea index (AHI) was determined 3 +/- 2 days after stroke onset and 6 months later ( subacute phase). Continuous positive airway pressure ( CPAP) treatment was started acutely in patients with SDB ( AHI >= 15 or AHI >= 10 + ESS > 10). CPAP compliance, incidence of vascular events, and stroke outcome were assessed 60 +/- 16 months later ( chronic phase). Results - Initial AHI was 18 +/- 16 ( >= 10 in 58%, >= 30 in 17% of patients) and decreased in the subacute phase ( P < 0.001). Age, diabetes, and nighttime stroke onset were independent predictors of AHI (r(2) = 0.34). In patients with AHI >= 30, age, male gender, body mass index, diabetes, hypertension, coronary heart disease, ESS, and macroangiopathic etiology of stroke were significantly higher/more common than in patients with AHI < 10. Long-term incidence of vascular events and stroke outcome were similar in both groups. CPAP was started in 51% and continued chronically in 15% of SDB pts. Long-term stroke mortality was associated with initial AHI, age, hypertension, diabetes, and coronary heart disease. Conclusions - SDB is common particularly in elderly stroke male patients with diabetes, nighttime stroke onset, and macroangiopathy as cause of stroke; it improves after the acute phase, is associated with an increased poststroke mortality, and can be treated with CPAP in a small percentage of patients.