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Sleep-disordered breathing and cerebral small vessel disease—acute and 6 months after ischemic stroke

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Sleep-disordered breathing (SDB) occurs frequently after stroke and is associated with poor functional outcome and increased mortality. The purpose of this study was to detect changes in SDB over time after acute ischemic stroke and investigate relationships between SDB and stroke etiologies with focus on cerebral small vessel disease.

Methods

From May 2015 to August 2016, we conducted an observational study of 99 patients with mild to moderate stroke (median age: 68 years, range 36–88; 56% men). Polysomnography was performed within 7 days of stroke onset (n = 91) and after 6 months (n = 52). The strokes were classified using the etiological TOAST classification. Total small vessel disease (SVD) scores were calculated based on MRIs.

Results

SDB, defined as an apnea–hypopnea index (AHI) ≥ 15, was found in 56% of patients in the acute state and in 44% at follow-up. AHI decreased over time (median change 4.7, 95% confidence interval [95% CI] 0.5–8.9; p = 0.03). Patients with AHI ≥ 15 in both the acute state and at follow-up had higher SVD score at follow-up (p = 0.003). AHI was not associated with ischemic stroke subgroups according to the TOAST classification.

Discussion

In conclusion, 6 months after stroke, AHI decreased, but 44% still had AHI ≥ 15. Persistent SDB in both the acute state and at follow-up was associated with a higher SVD score, but not to the TOAST subgroups. SDB evaluation should be offered to stroke patients, and the effect of SDB on cerebral small vessel disease needs to be further investigated using the well-defined SVD score.

Trial registration

clinicaltrials.gov NCT02111408, April 11, 2014

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Funding

This study was funded by the Clinical Stroke Research Unit, Department of Neurology, Rigshospitalet, Glostrup; the Grosser L. F. Foghts Foundation; and the Hoerslev Foundation.

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Authors and Affiliations

  1. Clinical Stroke Research Unit, Department of Neurology, Rigshospitalet, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark

    Sofie Amalie Simonsen, Adam Vittrup Andersen, Anders Sode West & Helle K. Iversen

  2. Department of Radiology, Rigshospitalet, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark

    Frauke Wolfram

  3. Danish Center for Sleep Medicine, Department of Neurophysiology, Rigshospitalet, Valdemar Hansens Vej 1-23, 2600, Glostrup, Denmark

    Poul Jennum

Authors
  1. Sofie Amalie Simonsen
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  2. Adam Vittrup Andersen
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  3. Anders Sode West
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  4. Frauke Wolfram
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  5. Poul Jennum
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  6. Helle K. Iversen
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Contributions

SS and HI researched the literature and conceived the study. SS, AW, PJ, and HI were involved in protocol development, data analysis, and data interpretation. AA and FW were involved in patient recruitment and data acquisition. SS wrote the first draft of the manuscript. All the authors reviewed and edited the manuscript and approved the final version of the manuscript.

Corresponding author

Correspondence to Sofie Amalie Simonsen.

Ethics declarations

Ethics approval

The study has been approved by the appropriate ethic committee (H-2–2013-091) and the data-protecting agency (GLO-2013–18; IT suite nr. 02385) and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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All persons gave their written informed consent prior to their inclusion in the study.

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Not applicable.

Conflict of interest

The authors declare no competing interests.

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Simonsen, S.A., Andersen, A.V., West, A.S. et al. Sleep-disordered breathing and cerebral small vessel disease—acute and 6 months after ischemic stroke. Sleep Breath 26, 1107–1113 (2022). https://doi.org/10.1007/s11325-021-02482-1

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  • DOI: https://doi.org/10.1007/s11325-021-02482-1

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