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(Stroke. 1995;26:2361-2365.)
© 1995 American Heart Association, Inc.

Articles

Transient Ischemic Attacks and Minor Stroke During Sleep

Relationship to Obstructive Sleep Apnea Syndrome

M.R. Pressman, PhD; W.R. Schetman, MD; W.G. Figueroa, MD; B. Van Uitert, MD; H.J. Caplan, MD D.D. Peterson, MD

From the Sleep Disorders Center, Section of Sleep Medicine, Division of Pulmonary and Critical Care Medicine (M.R.P., W.G.F., D.D.P.), and Divisions of General Internal Medicine (W.R.S.) and Neurology (H.J.C.), Department of Medicine, The Lankenau Hospital and Medical Research Center, Wynnewood; Department of Medicine, Jefferson Medical College, Philadelphia; and Department of Medicine (B. Van U.), Presbyterian Medical Center of Philadelphia (Pa).

Correspondence to Mark R. Pressman, PhD, Sleep Disorders Center, The Lankenau Hospital and Medical Research Center, 100 Lancaster Ave, Wynnewood, PA 19096-3498.

Background It is reported that 13% to 44% of all cerebrovascular accidents (CVAs) occur during sleep. In addition to other well-known risk factors, snoring, sleep apnea, obesity, and daytime sleepiness have been shown to significantly increase the risk of stroke. We describe two cases that support the statistical relationship between snoring, sleep apnea, and CVA during sleep.

Case Descriptions In the first case, motor aphasia was noted in a 64-year-old, 5-ft, 1-in, 218-lb woman when she awakened from sleep at approximately 4 AM. This completely resolved within 3 hours. During her subsequent hospitalization she was found to have severe obstructive sleep apnea that responded well to treatment with nasal continuous positive airway pressure. There has been no recurrence of symptoms in this patient. The second patient was a 59-year-old, 5-ft, 6-in, 260-lb woman who presented to the Sleep Disorders Center with signs and symptoms of severe sleep apnea. In addition, she had awakened from sleep approximately 6 months earlier with numbness and weakness on her right side. Although these symptoms had greatly improved, she continued to complain about residual weakness that was worse on awakening from sleep. Sleep studies confirmed severe obstructive sleep apnea that responded very well to treatment with nasal continuous positive airway pressure.

Conclusions Snoring and obstructive sleep apnea not only increase the statistical risk of CVA but could be the proximal trigger that precipitates these events during sleep. These two cases provide clinical support for this relationship. Successful diagnosis and treatment of obstructive sleep apnea in the patient with transient ischemic attacks and minor stroke may be an important tool for preventing recurrence.

Key Words: cerebral ischemia, transient • risk factors • sleep apnea syndromes

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