Objective: To assess the prevalence of sleep-disordered breathing (SDB), continuous positive airway pressure (CPAP) acceptance, and CPAP compliance in patients who have experienced ischemic stroke.
Design: A case-controlled study.
Setting: A university hospital.
Measurements and results: We recruited 23 women and 28 men, who were admitted to the hospital within 4 days of stroke onset, with a mean (+/- SD) age of 64.2 +/- 13.0 years and a body mass index (BMI) of 24.3 +/- 4.4 kg/m(2) for this study. Twenty-seven patients (53%) and 9 patients (17.6%), respectively, reported a history of snoring and severe daytime sleepiness prior to experiencing a stroke, while the mean Epworth sleepiness scale score was 6.8 +/- 3.6. Polysomnography revealed 34 patients (67%) with an apnea-hypopnea index (AHI) of > or = 10 events per hour, 31 patients (61%) with an AHI of > or = 15 events per hour, and 25 patients (49%) with an AHI of > or = 20 events per hour. Significant obstructive SDB, defined as an AHI of > or = 20/h, was more prevalent in ischemic stroke patients than in control subjects (49% vs 24%, respectively; p = 0.04) and was associated with a higher BMI (p = 0.046). Among the 34 patients with an AHI of > or = 10/h, CPAP titration was tolerated by 16 patients, but only 4 patients who had typical sleep apnea features proceeded to home CPAP treatment with objective compliance over a period of 3 months of 2.5 +/- 0.6 h per night. A subgroup of 20 patients not receiving CPAP showed partial spontaneous improvement of SDB at 1 month (baseline AHI, 32.3 +/- 17.6 events per hour; AHI at 1 month, 23.0 +/- 18.8 events per hour; p = 0.01) with a trend toward improvement for the obstructive but no significant change for the central events, whereas no improvement in AHI was noted for the four patients receiving CPAP.
Conclusion: There is a high prevalence of obstructive SDB in patients who have experienced acute ischemic stroke, which, in many cases, is different from classic obstructive sleep apnea syndrome, and this is reflected by the lack of significant sleepiness, poor CPAP acceptance, and partial spontaneous improvement at 1 month.