Q J Med 2002; 95: 741-747
© 2002 Association of Physicians
Sleep-disordered breathing following acute stroke
From the Department of Medicine, University of Newcastle upon Tyne and Department of Respiratory Medicine, Freeman Hospital, Newcastle upon Tyne, UK
Received 17 April 2002 Accepted for publication 21 July 2002.
Background: The reported prevalence of sleep apnoea following stroke varies between 44% and 72%, but its course and relations are unclear.
Aim: To determine the prevalence and course of sleep-disordered breathing in acute stroke in-patients, and its relation to age, stroke subtype, pre-stroke handicap and post-stroke outcome.
Design: Prospective uncontrolled observational study.
Methods: Paired respiratory sleep studies were performed at week 2 and week 6–9 following stroke. Pre- and post-stroke handicap (modified Rankin Score) and week 2 and week 6–9 disability (Barthel Score) and impairment (Scandinavian Neurological Stroke Score) were assessed. Pre-stroke sleepiness was determined by Epworth Score.
Results: There were 68 patients in the week 2 study, and 50 in the week 6–8 study. Mean week 2 Apnoea Hypopnoea Index (AHI) was 30; 64 patients (94%) had an AHI 
10. Mean AHI was higher in subjects with lacunar vs. cortical strokes (44 vs. 28, p<0.05), in subjects aged 65 years (32 vs. 21, p<0.05) and in those with greater pre-stroke handicap (modified Rankin Score 2 vs. <2) (41 vs. 27, p<0.05). In 50 paired studies, mean AHI fell from 31 to 24 (p<0.01) and the proportion with AHI 10 fell from 96% to 72%. Pre-stroke sleepiness was associated with post-stroke neurological impairment (r=-0.325, p<0.05) and disability (r=-0.377, p<0.05).
Discussion: Sleep-disordered breathing improves in the first 6–9 weeks following stroke, but remains highly prevalent. Worse sleep-disordered breathing was observed following lacunar stroke, and in older subjects or those with pre-stroke handicap.
Address correspondence to Professor G.J. Gibson, Department of Respiratory Medicine, Freeman Hospital, High Heaton, Newcastle upon Tyne NE7 7DN. e-mail: g.j.gibson{at}ncl.ac.uk
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