title: Early sleep apnea screening on a stroke unit is feasible in patients with acute cerebral ischemia.
abstract: Early screening for sleep apnea (SA) is rarely considered in patients with acute cerebral ischemia. We aimed to evaluate the feasibility of early SA screening on a stroke unit, its impact on post-discharge SA care and the relation of SA to clinical features. Patients with acute ischemic stroke (AIS) and transient ischemic attack (TIA) prospectively underwent overnight cardiorespiratory polygraphy within 3 ± 2 days of symptom-onset. Feasibility was defined as analyzable polygraphy in 90 % of studied patients. We enrolled 61 patients (84 % AIS, 16 % TIA): mean age 66 ± 8 years, 44 % men, median NIHSS 1 (0-15), median ESS 5 (0-13). Analyzability was given in 56/61 (91.8 %; one-sided 95 % CI, lower-bound 86.0 %) patients indicating excellent feasibility of early SA screening with no significant differences in stroke severity (100 % in TIA, 91 % minor stroke, 83 % major stroke, p = 0.474). Ninety-one percent (51/56) had an apnea-hypopnea index ≥ 5/h (median: 20/h [0-79]); 32 % (18/56) mild, 30 % (17/56) moderate, and 29 % (16/56) severe SA. When comparing sleep-related ischemic stroke (SIS) and non-SIS patients, no differences were found regarding the presence (95 vs. 89 %, p = 0.49) or severity (e.g., severe SA: 32 vs. 27 %, p = 0.69) of SA. After 12 months, 27/38 (71 %) patients given specific recommendations completed in-laboratory sleep work-up and 7/27 (25 %) were prescribed for non-invasive ventilatory correction. In conclusion, early SA screening is feasible in patients with acute cerebral ischemia and may have a positive impact on post-discharge SA care. Given the high frequency and atypical presentation of SA, early screening for SA should be considered in all acute cerebral ischemia patients.
authors.affiliation: Department of Neurology, Dresden University Stroke Center, University of Technology Dresden, Fetscherstrasse 74, 01307 Dresden, Germany. Jessica.Kepplinger@uniklinikum-dresden.de
authors.forename: Jessica
authors.initials: J
authors.lastname: Kepplinger
authors.forename: Kristian
authors.initials: K
authors.lastname: Barlinn
authors.forename: Karen C
authors.initials: KC
authors.lastname: Albright
authors.forename: Wiebke
authors.initials: W
authors.lastname: Schrempf
authors.forename: Amelia K
authors.initials: AK
authors.lastname: Boehme
authors.forename: Lars-Peder
authors.initials: LP
authors.lastname: Pallesen
authors.forename: Uta
authors.initials: U
authors.lastname: Schwanebeck
authors.forename: Xina
authors.initials: X
authors.lastname: Graehlert
authors.forename: Alexander
authors.initials: A
authors.lastname: Storch
authors.forename: Heinz
authors.initials: H
authors.lastname: Reichmann
authors.forename: Andrei V
authors.initials: AV
authors.lastname: Alexandrov
authors.forename: Ulf
authors.initials: U
authors.lastname: Bodechtel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002544:Cerebral Infarction / Q000209:etiology; D002940:Circadian Rhythm; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications*; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011446:Prospective Studies; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000175:diagnosis* / Q000209:etiology*; D020521:Stroke / Q000150:complications* / Q000209:etiology; D055815:Young Adult