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Influence of Drugs on Sleep Apnoea in Stroke Patients

  • Clinical Pharmacovigilance
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Abstract

Objective: It is known that a number of different drugs influence respiration. We hypothesised that certain drugs affect central or obstructive sleep apnoea in patients who have experienced a stroke. The aim of this study was to analyse the possible influence of drugs in this group of patients.

Design and Setting: Cross-sectional study in a stroke rehabilitation unit.

Study Participants: 132 patients (78 women and 54 men) consecutively admitted to a stroke rehabilitation unit, with a mean age of 77 ± 8 years.

Main Outcome Measures: All patients underwent a brain computer tomography scan in the acute phase after the stroke. Overnight respiratory sleep recordings were performed on all patients 23 ± 7 days after experiencing a stroke. Medications were analysed at the time of the overnight respiratory sleep recordings. The number of central and obstructive apnoea-hypopnoea indices per hour of sleep was measured.

Results: Both short- and long-acting calcium antagonists demonstrated a strong association with central apnoeas [short-acting B-value = 15.21, 95% confidence interval (CI) 5.6 to 24.8, p < 0.002; long-acting B-value = 10.05, 95% CI 3.7 to 16.4, p < 0.002]. This association was independent of hypertension, angina pectoris and cardiac arrhythmias. Oral estriol (estrogen) was negatively associated with central sleep apnoeas (B-value = −9.19, 95 % CI −15.4 to −3.0, p < 0.004). Antiepileptic drugs had the strongest association with obstructive apnoeas (B-value = 10.37, 95% CI 2.0 to 18.7, p < 0.016).

Conclusions: Both short- and long-acting calcium antagonists were associated with central apnoeas-hypopnoeas, and antiepileptic drugs with obstructive apnoeas-hypopnoeas in stroke patients. However, the clinical significance of these findings is unclear and future studies are needed to elucidate a possible cause and effect.

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Acknowledgements

The study was supported by grants from the Gun and Bertil Stohnes Foundation, the Borgerskapets in Umeå Foundation, 1987 year’s Foundation for Stroke Research, the Fund for Medical Research at Umeå University Hospital, the Foundation for ‘Gamla Tjänarinnor’, the Thureús Fund and the Fund of Loo and Hans Osterman. The authors’ thank Ulla Britt Johansson RN and Ann-Christine Löfgren RN for data collection, Carin Sahlin-Ingridsson RTA for scoring the sleep apnoea recordings and Associate Professor Dr Sture Eriksson for statistical advice.

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Authors and Affiliations

  1. Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, SE-901 87, Umeå, Sweden

    Olov Sandberg, Gösta Bucht & Yngve Gustafson

  2. Department of Public Health and Clinical Medicine, Respiratory Medicine, Umeå University, Umeå, Sweden

    Karl A. Franklin

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  1. Olov Sandberg
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Correspondence to Olov Sandberg.

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Sandberg, O., Franklin, K.A., Bucht, G. et al. Influence of Drugs on Sleep Apnoea in Stroke Patients. Clin. Drug Investig. 19, 447–455 (2000). https://doi.org/10.2165/00044011-200019060-00007

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