on January 25, 2007
Published online before print January 25, 2007, doi: 10.1161/01.STR.0000258105.58221.9a
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Submitted on September 28, 2006
From the Department of Neurology, University Hospital Zurich (D.M.H., M.S., P.K., C.L.B.) and Division of Pneumology, Inselspital Berne (M.G.), Switzerland. * To whom correspondence should be addressed. E-mail: claudio.bassetti{at}usz.ch.
Background and Purpose--It has been suggested that central periodic breathing during sleep (CPBS) may develop in unilateral supratentorial stroke without cardiopulmonary disease and disturbed consciousness. Not many data existed about such patients. Methods--Of 31 patients with first-ever stroke, we report 3 patients with CPBS in the absence of cardiopulmonary and vigilance disturbances. Patient assessments included polysomnography, MRI and echocardiography. Nocturnal breathing was reassessed after 1 to 3 months. Results--The patients had ischemic strokes in the left cingulate cortex, left insula and right paramedian thalamus. They were fully conscious when submitted to sleep recordings and lacked overt cardiovascular dysfunctions (ejection fractions=67%, 48%, 65%). CPBS was present during 18% to 24% of sleep. In all patients, breathing improved during stroke recovery. Conclusions--CPBS may be present in strokes involving autonomic (insula) and volitional (cingulate cortex, thalamus) respiratory networks. As such, CPBS partly resolves within weeks.
Accepted on October 4, 2006
Central Periodic Breathing During Sleep in Acute Ischemic Stroke
Dirk M. Hermann MD;
Key words: acute stroke • Cheyne-Stokes breathing • pathobiology • sleep • sleep apnea • sleep-disordered breathing • stroke