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Sleep
Original research
Sleep-disordered breathing and ventilatory chemosensitivity in first ischaemic stroke patients: a prospective cohort study
  1. Sébastien Baillieul1,
  2. Sébastien Bailly1,
  3. Olivier Detante2,3,
  4. Sarah Alexandre1,
  5. Marie Destors1,
  6. Rita Clin1,
  7. Marjorie Dole1,
  8. Jean-Louis Pépin1,
  9. Renaud Tamisier1
  1. 1 Univ. Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, 38000 Grenoble, France
  2. 2 Stroke Unit, Neurology Department, Grenoble Alpes University Hospital, Grenoble, France
  3. 3 Grenoble Institute of Neurosciences, Inserm U1216, Université Grenoble Alpes, Grenoble, France
  1. Correspondence to Dr Sébastien Baillieul, SHU Pneumologie - Physiologie, Centre Hospitalier Universitaire Grenoble Alpes, 38043 Grenoble Cedex 9, Rhône-Alpes, France; sbaillieul{at}chu-grenoble.fr

Abstract

Rationale Sleep-disordered breathing (SDB) is highly prevalent after stroke. The clinical and ventilatory chemosensitivity characteristics of SDB, namely obstructive, central and coexisting obstructive and central sleep apnoea (coexisting sleep apnoea) following stroke are poorly described.

Objective To determine the respective clinical and ventilatory chemosensitivity characteristics of SDB at least 3 months after a first ischaemic stroke.

Methods Cross-sectional analysis of a prospective, monocentric cohort conducted in a university hospital. 380 consecutive stroke or transient ischaemic attack patients were screened between December 2016 and December 2019.

Measurements and main results Full-night polysomnography, and hypercapnic ventilatory response were performed at a median (Q1; Q3) time from stroke onset of 134.5 (97.0; 227.3) days. 185 first-time stroke patients were included in the analysis. 94 (50.8%) patients presented no or mild SDB (Apnoea-Hypopnoea Index <15 events/hour of sleep) and 91 (49.2%) moderate to severe SDB, of which 52 (57.1%) presented obstructive sleep apnoea and 39 (42.9%) coexisting or central sleep apnoea. Obstructive sleep apnoea patients significantly differed regarding their clinical presentation from patients with no or mild SDB, whereas there was no difference with coexisting and central sleep apnoea patients. The latter presented a higher frequency of cerebellar lesions along with a heightened hypercapnic ventilatory response compared with no or mild SDB patients.

Conclusion SDB in first-time stroke patients differ in their presentation by their respective clinical traits and ventilatory chemosensitivity characteristics. The heightened hypercapnic ventilatory response in coexisting and central sleep apnoea stroke patients may orientate them to specific ventilatory support.

  • sleep apnoea
  • respiratory measurement

Data availability statement

Data are available on reasonable request. Data collected for the study, including deidentified individual participant data will be made available to others following the publication of this article, for academic purposes (eg, meta-analyses) on request to the corresponding author.

https://doi.org/10.1136/thoraxjnl-2021-218003

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    Data availability statement

    Data are available on reasonable request. Data collected for the study, including deidentified individual participant data will be made available to others following the publication of this article, for academic purposes (eg, meta-analyses) on request to the corresponding author.

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    Footnotes

    • SB and SB are joint first authors.

    • J-LP and RT are joint senior authors.

    • Twitter @S_Baillieul

    • Contributors SBaillieul acts as guarantor, accepts full responsibility for the work and the conduct of the study, the analyses and interpretation, has access to the data, and controlled the decision to publish any and all data separate and apart from any sponsor. This work is based on original data that has not been previously published and is not being considered for publication in another journal. SBaillieul: Designed and conceptualised this study; major role in the acquisition of data; interpreted the data; analysed the data; drafted the manuscript for intellectual content. SBailly: designed and conceptualised this study; analysed the data; drafted the manuscript for intellectual content. OD: designed and conceptualised this study; drafted the manuscript for intellectual content. SA: acquisition of data; revised the manuscript for intellectual content. MD: acquisition of data; revised the manuscript for intellectual content. RC: acquisition of data; revised the manuscript for intellectual content. MD: major role in the acquisition of data. JLP: designed and conceptualised this study; interpreted the data; revised the manuscript for intellectual content. RT: designed and conceptualised this study; interpreted the data; revised the manuscript for intellectual content.

    • Funding JLP, RT, SBailli and SBailly are supported by the French National Research Agency in the framework of the 'Investissements d’avenir' programme (ANR-15-IDEX-02) and the 'e-health and integrated care and trajectories medicine and MIAI artificial intelligence' Chairs of excellence from the Grenoble Alpes University Foundation. This work has been partially supported by MIAI @ Grenoble Alpes, (ANR-19-P3IA-0003).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.