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Vol. 40. Issue 5.
Pages 196-202 (May 2004)
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Vol. 40. Issue 5.
Pages 196-202 (May 2004)
Original Articles
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Prevalence of Sleep-Disordered Breathing in Patients With Acute Ischemic Stroke: Influence of Onset Time of Stroke
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M.A. Martínez Garcíaa,
Corresponding author
med013413@nacom.es

Correspondence: Dr. M.A. Martínez García. Unidad de Neumología. Servicio de Medicina Interna. Hospital General de Requena. Paraje Casablanca, s/n. 46340 Requena. Valencia. España
, R. Galiano Blancartb, L. Cabero Saltc, J.J. Soler Cataluñaa, T. Escamillac, P. Román Sánchezc
a Unidad de Neumología, Hospital General de Requena, Requena, Valencia, Spain
b Unidad de Neurología, Hospital General de Requena, Requena, Valencia, Spain
c Servicio de Medicina Interna, Hospital General de Requena, Requena. Valencia, Spain
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Objective

TO analyze the prevalence of sleep-disordered breathing in patients with acute ischemic stroke and the influence of the characteristics of the stroke and time of onset.

Patients and Methods

Polysomnography was performed with an Autoset Portable Plus II in 139 patients within 72 hours of the onset of symptoms. Standard polysomnographic data, signs and symptoms related with sleep apnea-hypopnea syndrome (SAHS) prior to ischemic stroke, vascular risk factors, and characteristics and onset time (day/night) of ischemic stroke were recorded. The polysomnographic data were compared with results published for subjects of a similar age in the general population.

Results

The mean age was 73.6 (SD 11.1) years (59% of the patients were men). Prior to the stroke, 64.7% of the patients snored, 21.6% presented repetitive sleep apneas, and 35.6% had daytime sleepiness. The mean apnea-hypopnea index (AHI) was 29.1 (17.9) episodes/hour, the obstructive component of which was 20.1 (15.7) episodes/hour. Five patients presented Cheyne-Stokes breathing. The AHI (for all cut-points from 5 to 50), chronic snoring, and daytime sleepiness were significantly greater than those published for the general population. The stroke characteristics showed no significant differences between daytime and nighttime onset. Nighttime stroke (60.4%) was associated with a significantly higher AHI (33.3 compared to 24.7 episodes/hour) mainly because of obstructive apneas. Nighttime stroke was also associated with a greater nighttime desaturation and a greater probability of SAHS symptoms prior to stroke (odds ratio, 2.62). In contrast, there were no differences in vascular risk factors between daytime and nighttime stroke onset.

Conclusion

The prevalences of sleep-disordered breathing with clinical signs and symptoms of SAHS were high in this population of patients with acute ischemic stroke. Patients with nighttime stroke had more obstructive sleep-disordered breathing and a higher clinical probability of obstructive SAHS before stroke. These findings support the hypothesis that obstructive SAHS is a risk factor for ischemic stroke, particularly for strokes presenting at night.

Key words:
Prevalence
Sleep apnea-hypopnea syndrome
Nighttime stroke
Ischemic stroke
Objetivo

Analizar la prevalencia de trastornos respiratorios durante el sueño en pacientes con accidente cerebro-vascular isquémico agudo (ACVI) y la influencia de las ca-racterísticas y el momento de aparición del ictus.

Pacientes y métodos

Se realizó una poligrafía respiratoria (Autoset Portable Plus II) en 139 pacientes con ACVI en las primeras 72 h desde el inicio de los síntomas. Se recogieron los datos poligráficos habituales, síntomas y signos relacionados con el síndrome de apnea-hipopneas del sueño (SAHS) previos al ACVI, factores de riesgo vascular y características y momento de aparición (diurno/nocturno) del ACVI. Los resultados poligráficos se compararon con los publicados para individuos de edad semejante de la población general.

Resultados

La edad media (± desviación estándar) fue de 73,6 ± 11,1 años (el 59% eran varones). Antes del ictus, el 64,7% de los pacientes eran roncadores, el 21,6% presentaba apneas nocturnas repetidas y el 35,6%, somnolencia diurna. El índice medio de apneas-hipopneas fue de 29,1 ± 17,9, con un índice de apneas obstructivas de 20,1 ± 15,7. Cinco pacientes presentaron patrón de Cheyne-Stokes. El índice de apneas-hipopneas (para todos los puntos de corte estudiados; de 5 a 50), la roncopatía crónica y la hipersomnia diurna fueron significativamente mayores que los encontrados en población general. No hubo diferencias significativas según las características del ACVI. Los ACVI nocturnos (60,4%) mostraron de forma significativa un mayor índice de apneas-hipopneas (33,3 frente a 24,7) a cargo fundamentalmente de las apneas de carácter obstructivo, así como una mayor desaturación nocturna y una mayor probabilidad clínica de presencia de SAHS antes del ictus (odds ratio de 2,62). No hubo, sin embargo, diferencias con res-pecto a los factores de riesgo vascular estudiados.

Conclusión

En nuestra serie hubo una alta prevalencia de trastornos respiratorios durante el sueño y de clínica relacionada con SAHS en pacientes con ACVI agudo. Los ictus nocturnos presentaron un mayor número de trastornos respiratorios del sueño de carácter obstructivo y una mayor probabilidad clínica de SAHS previo. Nuestro estudio apoya la hipótesis de un SAHS obstructivo previo al ictus que podría funcionar como factor de riesgo, sobre todo en las formas de aparición nocturna.

Palabras clave:
Prevalencia
Síndrome de apneas-hipopneas durante el sueño
Ictus nocturno
Ictus isquémico
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Copyright © 2004. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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