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

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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.

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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

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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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Authors and Affiliations

  1. Center for Investigation and Research in Sleep, Centre Hospitalier Universitaire Vaudois and Université de Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland

    José Haba-Rubio, Daniela Andries, Vincianne Rey, Mehdi Tafti & Raphael Heinzer

  2. Neurology Service, Centre Hospitalier Universitaire Vaudois and Université de Lausanne, Lausanne, Switzerland

    Vincianne Rey & Patrik Michel

  3. Center for Integrative Genomics, Centre Hospitalier Universitaire Vaudois and Université de Lausanne, Lausanne, Switzerland

    Mehdi Tafti

Authors
  1. José Haba-Rubio
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  2. Daniela Andries
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  3. Vincianne Rey
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  4. Patrik Michel
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  5. Mehdi Tafti
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  6. Raphael Heinzer
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Corresponding author

Correspondence to Raphael Heinzer.

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Trial registration number

ACTRN12611000150943

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Haba-Rubio, J., Andries, D., Rey, V. et al. Effect of transnasal insufflation on sleep disordered breathing in acute stroke: a preliminary study. Sleep Breath 16, 759–764 (2012). https://doi.org/10.1007/s11325-011-0572-3

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  • DOI: https://doi.org/10.1007/s11325-011-0572-3

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