Brainstem strokes are associated with increased obstructive apnea index during sleep acutely after stroke

Sleep-disordered breathing (SDB) and ischemic stroke are intertwined pathologies. Stroke topography may influence SDB presentation. We investigated the association of stroke topography with obstructive (OAI) and central apnea indices (CAI) in acute and subacute stroke.The prospective multicentre SAS-CARE study included 204 stroke patients. Demographic, anthropometric and stroke characteristics were recorded at admission. Stroke topography (left- and right-sided, supra- and infratentorial, cortical, subcortical, insular, brainstem, cerebellar) was visually scored on the MRI at admission and binary coded. Polysomnography was performed at admission (n=102) and at 3 months post-stroke (n=72).In a linear regression model adjusted for age and sex, brainstem stroke (n=9) was associated with higher OAI acutely after stroke (beta=9.91/h, p<0.01). This association was not detected at subacute stroke. Both patients with brainstem and non-brainstem strokes showed a decrease of OAI from acute to subacute stroke (p=0.01 and p=0.04, respectively; Figure 1A), but this decrease was larger in brainstem compared to non-brainstem stroke group (p<0.01; Figure 1B). CAI was not related to any stroke topography in acute and subacute stroke.These results suggest the possible involvement of brainstem lesions in the pathogenesis of obstructive SDB in acute stroke. Further studies could clarify the mechanism of this association.
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Sleep and control of breathing Source Type: research