title: Supine sleep and positional sleep apnea after acute ischemic stroke and intracerebral hemorrhage.
abstract: OBJECTIVE
  Obstructive sleep apnea is frequent during the acute phase of stroke, and it is associated with poorer outcomes. A well-established relationship between supine sleep and obstructive sleep apnea severity exists in non-stroke patients. This study investigated the frequency of supine sleep and positional obstructive sleep apnea in patients with ischemic or hemorrhagic stroke.
  
  
  METHODS
  Patients who suffered their first acute stroke, either ischemic or hemorrhagic, were subjected to a full polysomnography, including the continuous monitoring of sleep positions, during the first night after symptom onset. Obstructive sleep apnea severity was measured using the apnea-hypopnea index, and the NIHSS measured stroke severity.
  
  
  RESULTS
  We prospectively studied 66 stroke patients. The mean age was 57.6 ± 11.5 years, and the mean body mass index was 26.5 ± 4.9. Obstructive sleep apnea (apnea-hypopnea index ≥5) was present in 78.8% of patients, and the mean apnea-hypopnea index was 29.7 ± 26.6. The majority of subjects (66.7%) spent the entire sleep time in a supine position, and positional obstructive sleep apnea was clearly present in the other 23.1% of cases. A positive correlation was observed between the NIHSS and sleep time in the supine position (r(s) = 0.5; p<0.001).
  
  
  CONCLUSIONS
  Prolonged supine positioning during sleep was highly frequent after stroke, and it was related to stroke severity. Positional sleep apnea was observed in one quarter of stroke patients, which was likely underestimated during the acute phase of stroke. The adequate positioning of patients during sleep during the acute phase of stroke may decrease obstructive respiratory events, regardless of the stroke subtype.
authors.affiliation: University of São Paulo, Ribeirão Preto School of Medicine, Neurology Division, Department of Neuroscience and Behavioral Sciences, Ribeirão Preto/SP, Brazil.
authors.forename: Millene R
authors.initials: MR
authors.lastname: Camilo
authors.forename: Regina M F
authors.initials: RM
authors.lastname: Fernandes
authors.forename: Heidi H
authors.initials: HH
authors.lastname: Sander
authors.forename: Fernando
authors.initials: F
authors.lastname: Nobre
authors.forename: Taiza
authors.initials: T
authors.lastname: Santos-Pontelli
authors.forename: Antonio C dos
authors.initials: AC
authors.lastname: Santos
authors.forename: Draulio B de
authors.initials: DB
authors.lastname: Araujo
authors.forename: João P
authors.initials: JP
authors.lastname: Leite
authors.forename: Octavio M
authors.initials: OM
authors.lastname: Pontes-Neto
mesh_terms: D015992:Body Mass Index; D002543:Cerebral Hemorrhage / Q000150:complications / Q000503:physiopathology*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012890:Sleep / Q000502:physiology*; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000209:etiology; D020521:Stroke / Q000150:complications / Q000503:physiopathology*; D016683:Supine Position / Q000502:physiology*; D013997:Time Factors