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Polysomnographic indicators of mortality in stroke patients

  • Sleep Breathing Physiology and Disorders • Original Article
  • Published:
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Abstract

Purpose

The purpose of the study was to assess polysomnographic indicators of increased mortality risk in patients with stroke or a transient ischemic attack (TIA).

Methods

We performed polysomnographies in 63 acute stroke/TIA patients. Mortality data were collected from a national database after a 19–37-month follow-up period.

Results

Of the 57 stroke and 6 TIA patients, 9 stroke patients died during follow-up. All nine had moderate or severe sleep-related breathing disorders (SRBDs). Binarily divided, the group with the highest apnea hypopnea index (AHI) had an almost 10-fold higher mortality risk (hazard ratio (HR) 9.71; 95 % confidence interval (CI) 1.20–78.29; p = 0.033) compared to the patients with the lowest AHI. The patients with the longest versus shortest nocturnal wake time had a higher mortality (HR 8.78; 95 % CI 1.1–71.8; p = 0.0428). Lung disease increased mortality (HR 9.92; 95 % CI 2.00–49.23; p = 0.005), and there was a trend toward a higher mortality risk with atrial fibrillation/flutter (HR 3.63; 95 % CI 0.97–13.51; p = 0.055).

Conclusions

In stroke patients, the AHI and nocturnal wake time are indicators of increased mortality risk. SRBDs in stroke patients should receive increased attention.

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Abbreviations

AASM:

American Academy of Sleep Medicine

AHI:

Apnea hypopnea index

CSR:

Cheyne-Stokes respiration

EEG:

Electroencephalography

HSAT:

Home Sleep Apnea Testing

mBI:

Modified Barthel index

MRI:

Magnetic resonance imaging

mRS:

Modified Rankin Scale

OSA:

Obstructive sleep apnea

PSG:

Polysomnography

SSS:

Scandinavian Stroke Scale

SRBD:

Sleep-related breathing disorder

TIA:

Transient ischemic attack

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Acknowledgments

We would like to thank the patients for participating, technologist Mia Dyhr for setting up some of the PSGs, and technologist Helle Leonthin for discussing PSG scoring dilemmas. In addition, we thank Sune Birch, M.Sc., for performing the statistical analyses and Margit Graves Ponsaing, M.A., for proofreading the manuscript.

Author information

Authors and Affiliations

  1. Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet - Glostrup, Copenhagen University Hospital, Nordre Ringvej 57, DK-2600, Glostrup, Denmark

    Laura B. Ponsaing & Poul Jennum

  2. Center for Healthy Aging, Copenhagen University, Blegdamsvej 3b, DK-2200, Copenhagen N, Denmark

    Laura B. Ponsaing & Poul Jennum

  3. The Stroke Unit, Department of Neurology, Rigshospitalet - Glostrup, Copenhagen University Hospital, Nordre Ringvej 57, DK-2600, Glostrup, Denmark

    Helle K. Iversen

Authors
  1. Laura B. Ponsaing
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  2. Helle K. Iversen
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  3. Poul Jennum
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Corresponding author

Correspondence to Laura B. Ponsaing.

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Funding

We thank the Center for Healthy Aging, Copenhagen University, along with the Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, and the Stroke Unit, Department of Neurology, Rigshospitalet - Glostrup, for the financial support of the study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Comments

The study further substantiates that sleep disordered breathing frequently occurs following an acute stroke. More notably though is the finding that an elevated AHI is associated with an increased risk of short-term mortality. However, their results are provocative as it is unknown if positive airway pressure (PAP) therapy can improve outcomes. Adherence to PAP was low and in many cases this treatment was not accepted. In these highly prevalent disorders, further study is warranted to determine should aggressive treatment algorithms for OSA, to include non-PAP therapies, become part of the treatment plan. Conversely, is there a degree of stroke severity whereby treatment of OSA does not improve morbidity or mortality and treatment of OSA is not indicated.

Vincent Mysliwiec

WA, USA

The work was performed at The Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet - Glostrup, Copenhagen University Hospital and The Stroke Unit, Department of Neurology, Rigshospitalet - Glostrup, Copenhagen University Hospital.

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Ponsaing, L.B., Iversen, H.K. & Jennum, P. Polysomnographic indicators of mortality in stroke patients. Sleep Breath 21, 235–242 (2017). https://doi.org/10.1007/s11325-016-1387-z

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  • DOI: https://doi.org/10.1007/s11325-016-1387-z

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