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Prospective study of sleep-disordered breathing in 28 patients with acute unilateral lateral medullary infarction

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Objective

Acute unilateral lateral medullary infarction (ULMI) is complicated by respiratory failure in 2–6% of patients. However, studies investigating milder respiratory disorders not leading to overt respiratory failure, i.e., sleep-disordered breathing (SDB) and its outcome, are lacking. The aim of our study was to identify and prospectively follow SDB in acute ULMI.

Methods

We prospectively followed 28 patients with MRI-confirmed acute ULMI. Polysomnography (PSG) was performed 1–3 times in the acute phase (at 1–4, 5–10, and 14–21 days after onset of symptoms) and after 3–6 months. PSG recordings in the acute phase were analyzed and compared to the follow-up.

Results

Apnea-hypopnea index (AHI) ≥ 5/h, AHI ≥ 15/h, and AHI ≥ 30/h in the acute phase were observed in 22 (79%), 19 (68%), and 10 (36%) patients, respectively. CSA, OSA, mixed CSA/OSA, or multiple interchanging SDB types were observed in the acute phase in 12 (43%), 2 (7%), 2 (7%), and 6 (21%) patients, respectively. Peak AHI varied in individual patients (median at 7 (3–14) days after onset). At follow-up, AHI and central AHI tended to decrease (p = 0.007, p = 0.003, respectively), obstructive AHI did not change (p = 0.396). Sleep architecture partially improved with significantly higher percentage of N2 and lower percentage of wakefulness after sleep onset (p = 0.007, p = 0.012, respectively).

Conclusions

Our data show that SDB, particularly CSA, is common in the acute phase of ULMI and that the frequency of central events decreases in the subacute phase. Further studies are needed to clarify the clinical significance and possible treatment options of SDB in these patients.

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Funding

This study was funded by the Slovenian Research Agency (Grant No. P3–0338 and No P3–0171).

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Authors and Affiliations

  1. Department of Vascular Neurology and Intensive Therapy, University Medical Center Ljubljana, Zaloška 2, 1000, Ljubljana, Slovenia

    Katja Pavšič, Janja Pretnar-Oblak & Fajko F. Bajrović

  2. Department of Neurology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia

    Katja Pavšič, Janja Pretnar-Oblak, Fajko F. Bajrović & Leja Dolenc-Grošelj

  3. Faculty of Medicine, Institute of Pathophysiology, University of Ljubljana, Ljubljana, Slovenia

    Fajko F. Bajrović

  4. Institute of Clinical Neurophysiology, University Medical Center Ljubljana, Ljubljana, Slovenia

    Leja Dolenc-Grošelj

Authors
  1. Katja Pavšič
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  2. Janja Pretnar-Oblak
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  3. Fajko F. Bajrović
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Correspondence to Katja Pavšič.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the 1964 Helsinki declaration and its later amendments, and the study was approved by the Slovenian Medical Ethics Committee (number KME 69/03/17).

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All patients enrolled in this study signed an informed consent.

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Pavšič, K., Pretnar-Oblak, J., Bajrović, F.F. et al. Prospective study of sleep-disordered breathing in 28 patients with acute unilateral lateral medullary infarction. Sleep Breath 24, 1557–1563 (2020). https://doi.org/10.1007/s11325-020-02031-2

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  • DOI: https://doi.org/10.1007/s11325-020-02031-2

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