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The impact of sleep-disordered breathing on early functional recovery in ischemic stroke

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The rehabilitation potential in ischemic stroke depends both on the localization and size of cerebral infarction and on many other factors ensuring the restoration of neuron function in the ischemic penumbra. Sleep-disordered breathing (SDB) appears as intermittent episodes of apnea and hypopnea, which are accompanied by hypoxemia and tissue hypoxia, and may slow early functional recovery in patients.

Objective: to evaluate the impact of SDB on early neurological recovery in patients with ischemic stroke and to identify predictors of unfavorable functional outcome.

Patients and methods. A total of 56 patients (24 men, 32 women; mean age 62±15 years) with ischemic stroke were examined. All the patients underwent brain magnetic resonance imaging. Neurological deficit was assessed using the National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) on admission and at 3 weeks. To identify SDB, cardiorespiratory monitoring was performed on 2–5 days after the onset of the disease. The total number of episodes of SDB, apnea, hypopnea, apnea-hypopnea index (AHI), hypoxemia index, and the total time with arterial oxygen saturation < 90% (desaturation time < 90%) were recorded.


Results and discussion. At baseline, the median NIHSS score was 6 (range 4–10) and the median mRS score was 3 (range 2–5). After 3 weeks, the median NIHSS score was 3 (range 1.5–5) and the median mRS score was 1 (range 0–3). According to the degree of achieved functional independence, the patients were divided into 2 groups: 1) 40 functionally independent patients (a mRS score of ≤2; 2) 16 patients in need of assistance/care (a mRS score of ≥3). The groups were matched for age, sex, localization of cerebral infarction, degree of cerebral atherosclerosis, and incidence of cardiac pathology. At the same time, at baseline Group 2 had a more severity of neurological deficit (p=0.001) and respiratory disorders (p<0.04) and more frequently large and medium-sized foci (p=0.01). Discriminant analysis with a model including the characteristics of patients who had a difference in the two groups was carried out to confirm the role of the factors considered as predictors for poor functional prognosis and to identify their specific contribution to outcome. The investigation showed the predictive value of the studied model as a whole with relation to early functional recovery in the patients. As this took place, the number of apnea episodes demonstrated the proper importance as a predictor of poor prognosis.

Conclusion. It is established that the number of nocturnal apnea episodes >123 is associated with the worst functional recovery. The results of the comparative analysis can be taken as the threshold value associated with unfavorable functional recovery in the early stages (AHI≥25/hr-1). It is precisely these patients that can be considered as candidates for early CPAP therapy (Continuous Positive Airway Pressure) in order to improve early functional recovery.

About the Authors

G. M. Lutokhin
Neurology Research Institute, Moscow Russia
Russian Federation
80, Volokolamskoe Shosse, Moscow 125367

L. A. Geraskina
Neurology Research Institute, Moscow Russia
Russian Federation
80, Volokolamskoe Shosse, Moscow 125367

A. V. Fonyakin
Neurology Research Institute, Moscow Russia
Russian Federation
80, Volokolamskoe Shosse, Moscow 125367

M. Yu. Maksimova
Neurology Research Institute, Moscow Russia
Russian Federation
80, Volokolamskoe Shosse, Moscow 125367


1. Кадыков АС, Черникова ЛА, Шахпаронова НВ. Реабилитация неврологических больных. Москва: МедПресс-Информ; 2014. 560 с. [Kadykov AS, Chernikova LA, Shakhparonova NV. Reabilitatsiya nevrologicheskikh bol'nykh. [Rehabilitation of neurologic patients]. Moscow: MedPress-Inform; 2014. 560 p. (In Russ.)].

2. Гудкова ВВ, Стаховская ЛВ, Кирильченко ТД и др. Ранняя реабилитация после перенесенного инсульта. Consilium medicum 2005;(8):692-6. [Gudkova VV, Stakhovskaya LV, Kiril'chenko TD, et al. Early rehabilitation after stroke. Consilium medicum 2005;(8):692-6. (In Russ.)].

3. Пирадов МА, Реброва ОЮ, Максимова МЮ. Нейросетевой алгоритм диагностики патогенетических подтипов ишемического инсульта. Журнал неврологии и психиатрии им. С.С. Корсакова. 2004;104(S12):23-8. [Piradov MA, Rebrova OYu, Maximova MYu. Neural network algorithm for the diagnosis of pathogenic subtypes of ischemic stroke. Zhurnal Nevrologii i Psykhiatrii im. S.S. Korsakova. 2004;104(S12):23-8. (In Russ.)].

4. Saposnik G, Kapral MK, Liu Y, et al., Investigators of the Registry of the Canadian Stroke Network, Stroke Outcomes Research Canada (SORCan) Working Group SO. Circulation. 2011 Feb 22;123(7):739-49. doi: 10.1161/CIRCULATIONAHA.110.983353. Epub 2011 Feb 7.

5. Hermann DM, Bassetti CL. Sleep-related breathing and sleep-wake disturbances in ischemic stroke. Neurology. 2009 Oct 20; 73(16):1313-22. doi: 10.1212/WNL.0b013e3181bd137c.

6. Shahar E, Whitney CW, Redline S, et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001 Jan;163(1):19-25.

7. Yaggi HK, Concato J, Kernan WN, et al. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005 Nov 10;353(19):2034-41.

8. Good DC, Henkle JQ, Gelber D, et al. Sleep-Disordered Breathing and Poor Functional Outcome After Stroke. Stroke. 1996 Feb;27(2):252-9.

9. Bassetti CL, Milanova M, Gugger M. Sleep-Disordered Breathing and Acute Ischemic Stroke. Diagnosis, Risk Factors, Treatment, Evolution, and Long-Term Clinical Outcome. Stroke. 2006 Apr;37(4):967-72. Epub 2006 Mar 16.

10. Bravata DM, Concato J, Fried T, et al. Continuous Positive Airway Pressure: Evaluation of a Novel Therapy for Patients with Acute Ischemic Stroke. Sleep. 2011 Sep 1;34(9):1271-7. doi: 10.5665/SLEEP.1254.

11. Parra O, Sanchez-Armengol A, Bonnin M, et al. Early treatment of obstructive apnoea and stroke outcome: a randomized controlled trial. Eur Respir J. 2011 May;37(5):1128-36. doi: 10.1183/09031936.00034410. Epub 2010 Sep 16.

12. Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack. A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke. 2014 Jul;45(7):2160-236. doi: 10.1161/STR.0000000000000024. Epub 2014 May 1.

13. Национальные рекомендации ВНОК И ОССН по диагностике и лечению ХСН (третий пересмотр). Сердечная недостаточность. 2010;(1):3-62. [National guidelines for the diagnosis and treatment of chronic heart failure (third revision). Serdechnaya nedostatochnost. 2010;1:3-62. (In Russ.)].

14. Ворлоу ЧП, Деннис МС, ван Гейн Ж и др. Инсульт. Практическое руководство для ведения больных. Санкт-Петербург: Политехника; 1998. 629 с. [Warlow CP, Dennis MS, van Gein J, et al. Stroke. Insul't. Prakticheskoe rukovodstvo dlya vedeniya bol'nykh [A practical guide for the patients management]. Saint-Petersburg: Politekhnika; 1998. 629 p.]

15. Верещагин НВ, Брагина ЛК, Вавилов СБ, Левина ГЯ. Компьютерная томография головного мозга. Москва: Медицина; 1986. 251 с. [Vereshchagin NV, Bragina LK, Vavilov SB, Levina GYa. Komp'yuternaya tomografiya golovnogo mozga [Computer tomography of the brain]. Moscow: Meditsina; 1986. 251 p.]

16. Tsara V, Amfilochiou A, Papagrigorakis JM, et al. Guidelines for Diagnosing and Treating Sleep related Breathing Disorders in Adults and Children. Hippokratia. 2010 Jan;14(1):57-62.

17. Реброва ОЮ. Статистический анализ медицинских данных. Москва: Медиа Сфера; 2002. 312 с. [Rebrova OYu. Statisticheskii analiz meditsinskikh dannykh [Statistical analysis of medical data]. Moscow: Media Sfera; 2002. 312 p.]

18. Кистенев БА, Фонякин АВ, Гераскина ЛА, Петрова ЕА. Преходящий синдром слабости синусового узла как проявление цереброкардиального синдрома у больного в остром периоде инсульта. Неврологический журнал. 2003;(2):16-20. [Kistenev BA, Fonyakin AV, Geraskina LA, Petrova EA. Transient sick sinus syndrome as a manifestation of cerebrocardiac syndrome in a patient with acute stroke. Nevrologicheskii Zhurnal. 2003; (2):16-20. (In Russ.)].

19. Суслина ЗА, Фонякин АВ, Гераскина ЛА и др. Кардионеврология. Справочное руководство с обзором клинических исследований. Москва: ИМА-ПРЕСС; 2011. 264 с. [Suslina ZA, Fonyakin AV, Geraskina LA, et al. Kardionevrologiya. Spravochnoe rukovodstvo s obzorom klinicheskikh issledovanii [Cardioneurology. Reference manual and the review of clinical research]. Moscow: IMA-PRESS; 2011. 264 p.]

20. Stahl SM, Yaggi HK, Taylor S, et al. Infarct location and sleep apnea: evaluating the potential association in acute ischemic stroke. Sleep Med. 2015 Oct;16(10):1198-203. doi: 10.1016/j.sleep.2015.07.003. Epub 2015 Jul 17.

21. Garvey JF, Pengo MF, Drakatos P, Kent BD. Epidemiological aspects of obstructive sleep apnea. J Thorac Dis. 2015 May;7(5):920-9. doi: 10.3978/j.issn.2072-1439.2015.04.52.

22. Бельченко ЛА. Адаптация человека и животных к гипоксии разного происхождения. Соросовский образовательный журнал. 2001;(7):33–9. [Bel’chenko LA. A Human and animal Adaptation in hypoxia of different origin. Sorosovskii obrazovatel'nyi zhurnal. 2001; (7):33–9. (In Russ)].

23. Солкин АА, Белявский НН, Кузнецов ВИ, Николаева АГ. Основные механизмы формирования защиты головного мозга при адаптации к гипоксии. Вестник ВГМУ. 2012;(1):6–14. [Solkin AA, Belyavskii NN, Kuznetsov VI, Nikolaeva AG. The main mechanisms of cerebral protection in hypoxia adaptation. Vestnik VGMU. 2012;(1):6–14. (In Russ.)].

24. Lavie P, Lavie L. Unexpected survival advantage in elderly people with moderate sleep apnoea. J Sleep Res. 2009 Dec;18(4):397-403. doi: 10.1111/j.1365-2869.2009.00754.x. Epub 2009 Aug 3.

25. Garvey JF, Taylor CT, McNicholas WT. Cardiovascular disease in obstructive sleep apnoea syndrome: the role of intermittent hypoxia and inflammation. Eur Respir J. 2009 May;33(5):1195-205. doi: 10.1183/09031936.00111208.

26. Cereda CW, Tamisier R, Manconi M, et al. Endothelial dysfunction and arterial stiffness in ischemic stroke the role of sleep-disordered breathing. Stroke. 2013 Apr;44(4):1175-8. doi: 10.1161/STROKEAHA.111.000112. Epub 2013 Mar 7.

27. Meyer JS, Ishikawa Y, Hata T, Karacan I. Cerebral blood flow in normal and abnormal sleep and dreaming. Brain Cogn. 1987 Jul;6(3):266-94.

28. Daly JA, Giombetti R, Miller B, Garrett K. Impaired awake cerebral perfusion in sleep apnea. Am Rev Respir Dis. 1990;141:A376.

29. Fisher AQ, Chaudhary BA, Taormina MA, Akhtar B. Intracranial hemodynamics in sleep apnea. Chest. 1992 Nov;102(5):1402-6.

30. Hudgel DW, Devadatta P, Quadri M, et al. Mechanism of sleep-induced periodic breathing in convalescing stroke patients and healthy elderly subjects. Chest. 1993 Nov;104(5):1503-10.

31. Shapard JW. Hypertension, cardiac arrhythmias, myocardial infarction, and stroke in relation to obstructive sleep apnea. Clin Chest Med. 1992 Sep;13(3):437-58.

For citation:

Lutokhin G.M., Geraskina L.A., Fonyakin A.V., Maksimova M.Yu. The impact of sleep-disordered breathing on early functional recovery in ischemic stroke. Neurology, Neuropsychiatry, Psychosomatics. 2017;9(1):20-26. (In Russ.)

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