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The incidence of sleep apnea in patients with stroke or transient ischemic attack

80%
Disorders of breathing during sleep are defined as cessation or reduction of air flow thorough the upper airway, accompanied by a decrease of oxygen saturation. The results of many studies underline the association between sleep-disordered breathing (SDB) and cerebrovascular disorders. SDB, mostly obstructive sleep apnea syndrome (OSAS), is believed to be an independent risk factor of stroke and is related to poor outcome and increased long-term stroke mortality. The present study evaluated the frequency of SDB in patients with stroke or transient ischemic attack transient ischemic attack. We studied 43 patients (mean age 68.5 ±11.0), which included 35 males and 8 females, with acute stroke (n=37) and transient ischemic attack (n=6). The assessment included body mass index (BMI), age, cardiovascular risk factors, and localization of stroke. All patients underwent all-night screening for SDB with a portable 8-channel recorder. The apnea/hypopnea index (AHI) for the whole group was 13.3 ±15.2. AHI <5 was found in 16 patients. Overall, SDB was present in 27 (62.8%) patients with stroke and transient ischemic attack, stratified into those with AHI 5-10, (10 patients), 10-20 (8 patients), and AHI>20 (9 patients). In 15 patients, there was an increase in AHI 5 on assuming the supine position. The patients’ mean BMI was 27.8 ±4.7. The analysis of BMI, age, and localization of stroke was not sufficient to identify patients with high risk for SDB. We submit that overnight screening for SDB should be routinely performed in every patient after stroke and transient ischemic attack and it should become a diagnostic tool in neurological departments.
The aim of our study was to characterize the dynamics of heart rate variability (HRV) during sleep in healthy subjects and in patients with obstructive sleep apnea syndrome (OSAS). Present results were compared with earlier data obtained in healthy subjects (1) performing intermittent voluntary apneas. Power spectra in low (LF) and high (HF) frequency band and non linear indices: correlation dimension (CD) and recurrence plots were computed. New indices were applied: a beat-to beat control (BBC) for the assessment of cardiovascular regulatory mechanisms as cardiac, vascular or mixed type control and COT for quantification of relative contribution of cardiac and vascular component in blood pressure variability. During Wake stage in OSAS patients mean LF component was augmented (0.035 s2/Hz) comparing to healthy subjects (0.012 s2/Hz). Nonlinear indices suggest reduced HRV dynamics complexity in OSAS patients. Similar pattern could be observed when comparing LF component, CD and recurrence parameters during spontaneous breathing and in consecutive voluntary apneas. The results correlate with 20% increase in BBC vascular control type and COT inversion form +0.08 to - 0.12. Changes in BBC and COT along with power spectra and nonlinear dynamics indices appear to signal risk and/or initiation of arterial hypertension in OSAS patients.
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