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SLEEP DISORDERED BREATHING |
1 Department of Respiratory Medicine, The Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, UK
2 Department of Medical Statistics, The Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Leeds, UK
3 Department of Neurology, The Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, UK
4 Department of Elderly Medicine, The Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, UK
Correspondence to:
Correspondence to:
Dr M W Elliott
Department of Respiratory Medicine, St James’s University Hospital, Beckett Street, Leeds LS9 7TF, UK; mark.elliott{at}lineone.net
Background: The aim of this study was to determine whether upper airway obstruction occurring within the first 24 hours of stroke onset has an effect on outcome following stroke at 6 months. Traditional definitions used for obstructive sleep apnoea (OSA) are arbitrary and may not apply in the acute stroke setting, so a further aim of the study was to redefine respiratory events and to assess their impact on outcome.
Methods: 120 patients with acute stroke underwent a sleep study within 24 hours of onset to determine the severity of upper airway obstruction (respiratory disturbance index, RDI-total study). Stroke severity (Scandinavian Stroke Scale, SSS) and disability (Barthel score) were also recorded. Each patient was subsequently followed up at 6 months to determine morbidity and mortality.
Results: Death was independently associated with SSS (OR (95% CI) 0.92 (0.88 to 0.95), p<0.00001) and RDI-total study (OR (95% CI) 1.07 (1.03 to 1.12), p<0.01). The Barthel index was independently predicted by SSS (p = 0.0001; r = 0.259; 95% CI 0.191 to 0.327) and minimum oxygen saturation during the night (p = 0.037; r = 0.16; 95% CI 0.006 to 0.184). The mean length of the respiratory event most significantly associated with death at 6 months was 15 seconds (sensitivity 0.625, specificity 0.525) using ROC curve analysis.
Conclusion: The severity of upper airway obstruction appears to be associated with a worse functional outcome following stroke, increasing the likelihood of death and dependency. Longer respiratory events appear to have a greater effect. These data suggest that long term outcome might be improved by reducing upper airway obstruction in acute stroke.
Keywords: obstructive sleep apnoea; sleep disordered breathing; stroke; outcome
Abbreviations: CPAP, continuous positive airway pressure; GCS, Glasgow Coma Scale; OSA, obstructive sleep apnoea; RDI, respiratory disturbance index; SDB, sleep disordered breathing; SSS, Scandinavian Stroke Scale; UAO, upper airway obstruction
Relevant Article
Thorax 2004 59: 361.
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