اختلالات خواب در بیماران مبتلا به سکته مغزی هموراژیک یا ایسکمیک حاد
Abstract
Introduction
Methods
Results
Discussion
Conclusions
References
Abstract
Background
Ments were examined in the acute period of stroke. 33 (50%) patients had at least one or more new or exacerbated sleep complaiore than half of stroke patients present with a sleep-related breathing disorder including both central and obstructive forms of sleep apnoea. A cerebral infarction in different brain areas can disrupt sleep regulating pathways and cause insomnia, hypersomnia, circadian rhythm disturbances and other sleep disorders. Therefore, there is a need of objective data about various sleep disorders arising after ischemic or haemorrhagic stroke in order to implement practical recommendations how to suspect, diagnose and treat these conditions. Our medical hypothesis is that non-breathing sleep disorders are common among patients with acute ischemic or haemorrhagic stroke.
Objective
To investigate the subjective and objective sleep parameters in the patients with an acute ischemic or haemorrhagic stroke.
Methods
In the acute period (from 3 to 10 days after the first symptoms) of stroke all the patients completed questionnaires about sleep complaints and symptoms experienced before and after stroke, Epworth Sleepiness Scale (ESS), National Institute of Health Stroke Scale, Hospital Anxiety and Depression Scale and Modified Rankin Scale. Patients were included for further polysomnography (PSG) and sleep electroencephalography according to these criteria: (1) patients expressing severe sleep related complaints and/or symptoms that are new or have exacerbated after the stroke; and/or (2) patients having the ESS score equal or >10.
Results
66 patints and/or symptoms, mostly related to obstructive sleep apnoea (OSA) and insomnia. Finally, 13 (19.7% of the whole sample) patients were selected for performing PSG. 12 of 13 patients were diagnosed with sleep disorder: 1 patient got the diagnosis of mild OSA, 1 - central sleep apnoea (CSA), 2 - combination of OSA and CSA, 1 - combination of mild OSA, periodic limb movement disorder (PLMD) and REM sleep behaviour disorder (RBD), 1 - combination of mild OSA and PLMD, 3 - combination of PLMD and insomnia, 3 - insomnia. There were no significant relations between type, location or treatment of stroke and various PSG measures, as well as type of a diagnosed sleep disorder.
Conclusions
Half of our acute stroke patients had at least one or more new or exacerbated sleep complaints and/or symptoms, mainly related to OSA or insomnia. In the selected PSG group almost all patients were diagnosed with a sleep disorder, half of them having non-breathing sleep disorder, such as PLMD, RBD and insomnia.
Introduction
Sleep is recognized to be considerable for health and well-being in all persons, but increasingly so in those recovering from brain damage [1]. It is known that sleep disorders are a frequent complication in patients with acute ischemic or haemorrhagic stroke, approximately 20–40% of stroke patients experience various sleep-wake disorders, such as insomnia, hypersomnia, REM sleep behavior disorder (RBD), periodic limb movement disorder (PLMD). Even more, about 50–70% stroke patients present with a sleep-related breathing disorder including both central and obstructive forms of sleep apnoea [2,3]. Despite that, the majority of physicians do not screen stroke patients for sleep-disordered breathing [4]. Patients with stroke and OSA have a higher risk for repeated stroke and significantly increased mortality in one year after the stroke in comparison with the patients without apnoea [5,6]. Studies showed a significant reduction in stroke recurrence and mortality as well as improved neurological recovery among the patients treated with continuous positive airway pressure therapy (CPAP), consequently, CPAP treatment may reduce the risk of stroke in patients with OSA [7]. A cerebral infarction in subcortex, thalamus or mesencephalon can fully disrupt sleep and wakefulness cycle, leading to insomnia and agitation during the night, and severe sleepiness during the day [8]. Insufficient sleep after stroke can be followed by chronic fatigue, cognitive and emotional dysfunction, worse neurological outcome and life quality. Therefore, there is a need of objective data about various sleep disorders arising after ischemic or haemorrhagic stroke in order to implement practical recommendations how to suspect, diagnose and treat these conditions. Our medical hypothesis is that non-breathing sleep disorders are common among patients with acute ischemic or haemorrhagic stroke. The aim of the study presented in this article was to investigate the subjective and objective sleep parameters in the patients with an acute ischemic or haemorrhagic stroke.