Published Online
on March 16, 2006

A more recent version of this article appeared on April 1, 2006

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Submitted on November 14, 2005
Accepted on November 16, 2005

Sleep-Disordered Breathing and Acute Ischemic Stroke. Diagnosis, Risk Factors, Treatment, Evolution, and Long-Term Clinical Outcome

Claudio L. Bassetti MD^*; Milena Milanova MD; and Matthias Gugger MD

From the Departments of Neurology (C.L.B., M.M.) and Pulmonary Medicine (M.G.), University Hospital, Bern and Zürich, Switzerland.

^* To whom correspondence should be addressed. E-mail: claudio.bassetti{at}usz.ch.

Background and Purpose--Sleep-disordered breathing (SDB) is frequent in stroke patients. Risk factors, treatment response, short-term and long-term outcome of SDB in stroke patients are poorly known.

Methods--We prospectively studied 152 patients (mean age 56±13 years) with acute ischemic stroke. Cardiovascular risk factors, Epworth sleepiness score (ESS), stroke severity/etiology, and time of stroke onset were assessed. The apnea-hypopnea index (AHI) was determined 3±2 days after stroke onset and 6 months later (subacute phase). Continuous positive airway pressure (CPAP) treatment was started acutely in patients with SDB (AHI 15 or AHI 10+ESS >10). CPAP compliance, incidence of vascular events, and stroke outcome were assessed 60±16 months later (chronic phase).

Results--Initial AHI was 18±16 (10 in 58%, 30 in 17% of patients) and decreased in the subacute phase (P<0.001). Age, diabetes, and nighttime stroke onset were independent predictors of AHI (r²=0.34). In patients with AHI 30, age, male gender, body mass index, diabetes, hypertension, coronary heart disease, ESS, and macroangiopathic etiology of stroke were significantly higher/more common than in patients with AHI <10. Long-term incidence of vascular events and stroke outcome were similar in both groups. CPAP was started in 51% and continued chronically in 15% of SDB pts. Long-term stroke mortality was associated with initial AHI, age, hypertension, diabetes, and coronary heart disease.

Conclusions--SDB is common particularly in elderly stroke male patients with diabetes, nighttime stroke onset, and macroangiopathy as cause of stroke; it improves after the acute phase, is associated with an increased poststroke mortality, and can be treated with CPAP in a small percentage of patients.

Key words: diabetes mellitus • hypertension • outcome • sleep apnea syndromes • stroke

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