This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Turkington, P.M. Articles by Elliott, M.W. Search for Related Content PubMed PubMed Citation Articles by Turkington, P.M. Articles by Elliott, M.W. Related Collections Acute Stroke Syndromes Pathology of Stroke Risk Factors for Stroke

(Stroke. 2002;33:2037.)
© 2002 American Heart Association, Inc.

Original Contributions

Prevalence and Predictors of Upper Airway Obstruction in the First 24 Hours After Acute Stroke

P.M. Turkington, MB, ChB; J. Bamford, MD; P. Wanklyn, MB, ChB(Hon) M.W. Elliott, MD

From the Departments of Respiratory Medicine (P.M.T., M.W.E.), Neurology (J.B.), and Elderly Medicine (P.W.), The Leeds Teaching Hospitals National Health Service Trust, St James’s University Hospital, Leeds, UK.

Correspondence to Dr M.W. Elliott, Department of Respiratory Medicine, St James’s University Hospital, Beckett St, Leeds LS9 7TF, UK. E-mail Mark.Elliott{at}gw.sjsuh.northy.nhs.uk

Background and Purpose— The prevalence of sleep-disordered breathing after stroke has been reported to be between 32% and 71%. However, the first 24-hour period, when upper airway obstruction may have a critical effect on the cerebral circulation because of hemodynamic fluctuations and repetitive hypoxia, has not been studied. Furthermore, data on prediction of upper airway obstruction after stroke are limited. This study sought to assess the prevalence of upper airway obstruction in the first 24 hours of stroke and to ascertain whether its occurrence could be predicted.

Methods— One hundred twenty patients with acute stroke underwent a respiratory variable-only sleep study, started within 24 hours of onset of neurological symptoms. Sleep history and stroke characteristics were recorded on admission.

Results— We found that 79%, 61%, and 45% of the patients had a respiratory disturbance index greater than 5, 10, and 15 events per hour, respectively. Patients had a significantly higher respiratory disturbance index when nursed in the supine (29 events per hour), supine left (29 events per hour), and supine right (24 events per hour) positions than in any other position (P<0.0001). On logistic regression analysis, BMI (P=0.025), neck circumference (P=0.026), and limb weakness (P=0.025) independently predicted the occurrence of upper airway obstruction in the first 24 hours after acute stroke.

Conclusions— Upper airway obstruction is common in the first 24 hours after stroke, especially if patients are nursed in the supine position, and typical obstructive sleep apnea risk factors (body mass index and neck circumference) appear to be the best predictors of its occurrence. Stroke characteristics (severity, clinical subtype, and clinically assessed pharyngeal function) are not independently associated with upper airway obstruction after stroke.

Key Words: prevalence • sleep apnea syndromes • stroke, acute

This article has been cited by other articles:

				V. K. Somers, D. P. White, R. Amin, W. T. Abraham, F. Costa, A. Culebras, S. Daniels, J. S. Floras, C. E. Hunt, L. J. Olson, et al. Sleep Apnea and Cardiovascular Disease: An American Heart Association/American College of Cardiology Foundation Scientific Statement From the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing In Collaboration With the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health) Circulation, September 2, 2008; 118(10): 1080 - 1111. [Full Text] [PDF]

				D. L. Brown, L. D. Lisabeth, M. J. Zupancic, M. Concannon, C. Martin, and R. D. Chervin High Prevalence of Supine Sleep in Ischemic Stroke Patients Stroke, September 1, 2008; 39(9): 2511 - 2514. [Abstract] [Full Text] [PDF]

				V. K. Somers, D. P. White, R. Amin, W. T. Abraham, F. Costa, A. Culebras, S. Daniels, J. S. Floras, C. E. Hunt, L. J. Olson, et al. Sleep Apnea and Cardiovascular Disease: An American Heart Association/American College of Cardiology Foundation Scientific Statement From the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing In Collaboration With the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health) J. Am. Coll. Cardiol., August 19, 2008; 52(8): 686 - 717. [Full Text] [PDF]

				B. Buyse and the participants of working group 2 Treatment effects of sleep apnoea: where are we now? Eur. Respir. Rev., December 1, 2007; 16(106): 146 - 168. [Abstract] [Full Text] [PDF]

				M. A. Martinez-Garcia, R. Galiano-Blancart, J.-J. Soler-Cataluna, L. Cabero-Salt, and P. Roman-Sanchez Improvement in nocturnal disordered breathing after first-ever ischemic stroke: role of Dysphagia. Chest, February 1, 2006; 129(2): 238 - 245. [Abstract] [Full Text] [PDF]

				D. L. Brown, R. D. Chervin, S. L. Hickenbottom, K. M. Langa, and L. B. Morgenstern Screening for Obstructive Sleep Apnea in Stroke Patients: A Cost-Effectiveness Analysis Stroke, June 1, 2005; 36(6): 1291 - 1293. [Abstract] [Full Text] [PDF]

				G J Gibson Sleep disordered breathing and the outcome of stroke Thorax, May 1, 2004; 59(5): 361 - 363. [Full Text] [PDF]

				P M Turkington, V Allgar, J Bamford, P Wanklyn, and M W Elliott Effect of upper airway obstruction in acute stroke on functional outcome at 6 months Thorax, May 1, 2004; 59(5): 367 - 371. [Abstract] [Full Text] [PDF]