Chest
Volume 122, Issue 3, September 2002, Pages 852-860
Journal home page for Chest

Clinical Investigations
Sleep and Breathing
Prevalence of Sleep-Disordered Breathing and Continuous Positive Airway Pressure Compliance: Results in Chinese Patients With First-Ever Ischemic Stroke

https://doi.org/10.1378/chest.122.3.852Get rights and content

Objective

To assess the prevalence of sleep-disordered breathing (SDB), continuous positive airway pressure (CPAP) acceptance, and CPAP compliance in patients who have experienced ischemic stroke.

Design

A case-controlled study.

Setting

A university hospital.

Measurements and results

We recruited 23 women and 28 men, who were admitted to the hospital within 4 days of stroke onset, with a mean (± SD) age of 64.2 ± 13.0 years and a body mass index (BMI) of 24.3 ± 4.4 kg/m2 for this study. Twenty-seven patients (53%) and 9 patients (17.6%), respectively, reported a history of snoring and severe daytime sleepiness prior to experiencing a stroke, while the mean Epworth sleepiness scale score was 6.8 ± 3.6. Polysomnography revealed 34 patients (67%) with an apnea-hypopnea index (AHI) of ≥ 10 events per hour, 31 patients (61%) with an AHI of ≥ 15 events per hour, and 25 patients (49%) with an AHI of ≥ 20 events per hour. Significant obstructive SDB, defined as an AHI of ≥ 20/h, was more prevalent in ischemic stroke patients than in control subjects (49% vs 24%, respectively; p = 0.04) and was associated with a higher BMI (p = 0.046). Among the 34 patients with an AHI of ≥ 10/h, CPAP titration was tolerated by 16 patients, but only 4 patients who had typical sleep apnea features proceeded to home CPAP treatment with objective compliance over a period of 3 months of 2.5 ± 0.6 h per night. A subgroup of 20 patients not receiving CPAP showed partial spontaneous improvement of SDB at 1 month (baseline AHI, 32.3 ± 17.6 events per hour; AHI at 1 month, 23.0 ± 18.8 events per hour; p = 0.01) with a trend toward improvement for the obstructive but no significant change for the central events, whereas no improvement in AHI was noted for the four patients receiving CPAP.

Conclusion

There is a high prevalence of obstructive SDB in patients who have experienced acute ischemic stroke, which, in many cases, is different from classic obstructive sleep apnea syndrome, and this is reflected by the lack of significant sleepiness, poor CPAP acceptance, and partial spontaneous improvement at 1 month.

Section snippets

Materials and Methods

We screened 80 consecutive patients for inclusion in this study who had been admitted with acute stroke to the Prince of Wales Hospital, an acute-care teaching hospital, over a period of 3 months. A control group of 25 volunteers, who were matched for age and body mass index (BMI), were recruited from the same hospital.

Results

Of the 80 consecutive patients with acute stroke who we screened for this study, 16 patients (20%) were excluded because of radiographic evidence of hemorrhagic stroke. Of the remaining 64 patients, 51 patients met the inclusion criteria and consented to the study. There were 23 women and 28 men with a mean age of 64.2 ± 13.0 years, a mean BMI of 24.3 ± 4.4 kg/m2, a mean neck circumference of 38.1 ± 3.4 cm, a mean systolic BP of 168 ± 25 mm Hg, and a mean diastolic BP of 89 ± 15 mm Hg.

Discussion

This study has shown a high prevalence of significant obstructive SDB, arbitrarily defined as an AHI of ≥ 20 events per hour of sleep, among our patients following a first-ever ischemic stroke in the acute phase compared to the control group (49% vs 24%, respectively; p = 0.04). The prevalence of snoring prior to stroke was 53%, while 55% of our patients experienced hypertension. Daytime sleepiness was reported by 47% of patients and was graded as severe in 17.6%. There were fewer patients with

Acknowledgment

The authors thank Mr. W.C. Shum (Neurology RN) for collecting the stroke data and Sisters Mabel Tong, Fanny Chan, M.Y. Leung, and Ms. Erica Lee for their technical support with the sleep study and for providing CPAP education to our patients. We would also like to thank Drs. Timothy Kwok, K.H. Sze, and C.M. Lum for their input to our original research protocol, and Ms. Doris Chan and Dr. Anthony T. Chan for their statistical analysis for this project.

References (69)

  • A Fischer et al.

    Intracranial hemodynamics in sleep apnea

    Chest

    (1992)
  • T Hayakawa et al.

    Changes in cerebral oxygenation and hemodynamics during obstructive sleep apneas

    Chest

    (1996)
  • R Collins et al.

    Blood pressure, stroke and coronary heart disease: 2. Short-term reductions in blood pressure: overview of randomised drug trial in their epidemiological context

    Lancet

    (1990)
  • S MacMahon et al.

    Blood pressure, stroke, and coronary heart disease

    Lancet

    (1990)
  • H Engleman et al.

    Effect of continuous positive airway pressure treatment on daytime function in sleep apnea/hypopnea syndrome

    Lancet

    (1994)
  • C Jenkinson et al.

    Comparison of therapeutic and sub-therapeutic nasal continuous positive airway pressure for obstructive sleep apnea: a randomized prospective parallel trial

    Lancet

    (1999)
  • H Engleman et al.

    Self-reported use of CPAP and benefits of CPAP therapy

    Chest

    (1996)
  • KF Chung

    Use of the Epworth Sleepiness Scale in Chinese patients with obstructive sleep apnea and normal hospital employees

    J Psychosom Res

    (2000)
  • T Young et al.

    The occurrence of sleep-disordered breathing among middle-aged adults

    N Engl J Med

    (1993)
  • DS Hui et al.

    Prevalence of snoring and sleep-disordered breathing in a group of commercial bus drivers in Hong Kong

    Intern Med J

    (2002)
  • SG McNamara et al.

    Obstructive sleep apnea

    Thorax

    (1993)
  • E Shahar et al.

    Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study

    Am J Respir Crit Care Med

    (2001)
  • F Hu et al.

    Prospective study of snoring and risk of hypertension in women

    Am J Epidemiol

    (1999)
  • D Spriggs et al.

    Snoring increases the risk of stroke and adversely affects prognosis

    Q J Med

    (1992)
  • J Neau et al.

    Habitual snoring as a risk factor for brain infarction

    Acta Neurol Scand

    (1995)
  • M Dyken et al.

    Investigating the relationship between stroke and obstructive sleep apnea

    Stroke

    (1996)
  • D Good et al.

    Sleep disordered breathing and poor functional outcome after stroke

    Stroke

    (1996)
  • C Bassetti et al.

    Sleep apnea in acute cerebrovascular diseases: final report on 128 patients

    Sleep

    (1999)
  • T Wessendorf et al.

    Sleep-disordered breathing among patients with first-ever stroke

    J Neurol

    (2000)
  • O Parra et al.

    Time course of sleep-related breathing disorders in first-ever stroke or transient ischemic attack

    Am J Respir Crit Care Med

    (2000)
  • KS Wong et al.

    Intracranial stenosis in Chinese patients with acute stroke

    Neurology

    (1998)
  • T Brott et al.

    Measurements of acute cerebral infarction: a clinical examination scale

    Stroke

    (1989)
  • F Mahoney et al.

    Functional evaluation: the Barthel index

    Md Med J

    (1965)
  • K Kump et al.

    Assessment of the validity and utility of a sleep-symptom questionnaire

    Am J Respir Crit Care Med

    (1994)
  • Cited by (0)

    This project was funded by Chinese University of Hong Kong direct grant No. 2084008.

    View full text