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Sleep and Breathing

, Volume 16, Issue 3, pp 759–764 | Cite as

Effect of transnasal insufflation on sleep disordered breathing in acute stroke: a preliminary study

  • José Haba-Rubio
  • Daniela Andries
  • Vincianne Rey
  • Patrik Michel
  • Mehdi Tafti
  • Raphael HeinzerEmail author
Original Article

Abstract

Background and Purpose

Sleep disordered breathing (SDB) is frequent in acute stroke patients and is associated with early neurologic worsening and poor outcome. Although continuous positive airway pressure (CPAP) effectively treats SDB, compliance is low. The objective of the present study was to assess the tolerance and the efficacy of a continuous high-flow-rate air administered through an open nasal cannula (transnasal insufflation, TNI), a less-intrusive method, to treat SDB in acute stroke patients.

Methods

Ten patients (age, 56.8 ± 10.7 years), with SDB ranging from moderate to severe (apnea–hypopnea index, AHI, >15/h of sleep) and on a standard sleep study at a mean of 4.8 ± 3.7 days after ischemic stroke (range, 1–15 days), were selected. The night after, they underwent a second sleep study while receiving TNI (18 L/min).

Results

TNI was well tolerated by all patients. For the entire group, TNI decreased the AHI from 40.4 ± 25.7 to 30.8 ± 25.7/h (p = 0.001) and the oxygen desaturation index >3% from 40.7 ± 28.4 to 31 ± 22.5/h (p = 0.02). All participants except one showed a decrease in AHI. The percentage of slow-wave sleep significantly increased with TNI from 16.7 ± 8.2% to 22.3 ± 7.4% (p = 0.01). There was also a trend toward a reduction in markers of sleep disruption (number of awakenings, arousal index).

Conclusions

TNI improves SDB indices, and possibly sleep parameters, in stroke patients. Although these changes are modest, our findings suggest that TNI is a viable treatment alternative to CPAP in patients with SDB in the acute phase of ischemic stroke.

Keywords

Transnasal insufflation Stroke Sleep disordered breathing 

Abbreviations

SDB

Sleep disordered breathing

CPAP

Continuous positive airway pressure

TNI

Transnasal insufflation

AHI

Apnea–hypopnea index

CBFV

Cerebral blood flow velocity

PSG

Polysomnography

BL

Baseline diagnostic night

RERAs

Respiratory effort-related arousals

RDI

Respiratory disturbance index

ODI

Oxygen desaturation indexes

NIHSS

National Institutes of Health Stroke Scale

OAI

Obstructive Apnea Index

CAI

Central Apnea Index

MAI

Mixed Apnea Index

HI

Hypopnea Index

Notes

Acknowledgments

The authors thank Pr Hartmut Schneider for his helpful comments.

Disclosure statement

This is not an industry-supported study. The authors have no financial conflicts of interest.

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • José Haba-Rubio
    • 1
  • Daniela Andries
    • 1
  • Vincianne Rey
    • 1
    • 2
  • Patrik Michel
    • 2
  • Mehdi Tafti
    • 1
    • 3
  • Raphael Heinzer
    • 1
    Email author
  1. 1.Center for Investigation and Research in SleepCentre Hospitalier Universitaire Vaudois and Université de LausanneLausanneSwitzerland
  2. 2.Neurology ServiceCentre Hospitalier Universitaire Vaudois and Université de LausanneLausanneSwitzerland
  3. 3.Center for Integrative GenomicsCentre Hospitalier Universitaire Vaudois and Université de LausanneLausanneSwitzerland

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