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Effect of upper airway obstruction in acute stroke on functional outcome at 6 months
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  1. P M Turkington1,
  2. V Allgar2,
  3. J Bamford3,
  4. P Wanklyn4,
  5. M W Elliott1
  1. 1Department of Respiratory Medicine, The Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, UK
  2. 2Department of Medical Statistics, The Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Leeds, UK
  3. 3Department of Neurology, The Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, UK
  4. 4Department of Elderly Medicine, The Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, UK
  1. Correspondence to:
    Dr M W Elliott
    Department of Respiratory Medicine, St James’s University Hospital, Beckett Street, Leeds LS9 7TF, UK; mark.elliottlineone.net

Abstract

Background: The aim of this study was to determine whether upper airway obstruction occurring within the first 24 hours of stroke onset has an effect on outcome following stroke at 6 months. Traditional definitions used for obstructive sleep apnoea (OSA) are arbitrary and may not apply in the acute stroke setting, so a further aim of the study was to redefine respiratory events and to assess their impact on outcome.

Methods: 120 patients with acute stroke underwent a sleep study within 24 hours of onset to determine the severity of upper airway obstruction (respiratory disturbance index, RDI-total study). Stroke severity (Scandinavian Stroke Scale, SSS) and disability (Barthel score) were also recorded. Each patient was subsequently followed up at 6 months to determine morbidity and mortality.

Results: Death was independently associated with SSS (OR (95% CI) 0.92 (0.88 to 0.95), p<0.00001) and RDI-total study (OR (95% CI) 1.07 (1.03 to 1.12), p<0.01). The Barthel index was independently predicted by SSS (p = 0.0001; r = 0.259; 95% CI 0.191 to 0.327) and minimum oxygen saturation during the night (p = 0.037; r = 0.16; 95% CI 0.006 to 0.184). The mean length of the respiratory event most significantly associated with death at 6 months was 15 seconds (sensitivity 0.625, specificity 0.525) using ROC curve analysis.

Conclusion: The severity of upper airway obstruction appears to be associated with a worse functional outcome following stroke, increasing the likelihood of death and dependency. Longer respiratory events appear to have a greater effect. These data suggest that long term outcome might be improved by reducing upper airway obstruction in acute stroke.

  • obstructive sleep apnoea
  • sleep disordered breathing
  • stroke
  • outcome
  • CPAP, continuous positive airway pressure
  • GCS, Glasgow Coma Scale
  • OSA, obstructive sleep apnoea
  • RDI, respiratory disturbance index
  • SDB, sleep disordered breathing
  • SSS, Scandinavian Stroke Scale
  • UAO, upper airway obstruction
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Footnotes

  • This project was funded by the Stroke Association.

  • Conflicts of interest: none.

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