title: Longitudinal polysomnographic assessment from acute to subacute phase in infratentorial versus supratentorial stroke.
abstract: BACKGROUND
  Regulation of sleep and sleep-related breathing resides in different brain structures. Vascular lesions can be expected to differ in their consequences on sleep depending on stroke topography. However, studies addressing the differences in sleep and sleep-related breathing depending on stroke topography are scarce. The aim of the present investigation was to compare the sleep and sleep-related breathing of patients with supratentorial versus infratentorial stroke.
  
  
  METHODS
  This study was part of the prospective multicenter study SAS-CARE-1 (Sleep-Disordered Breathing in Transient Ischemic Attack (TIA)/Ischemic Stroke and Continuous Positive Airway Pressure (CPAP) Treatment Efficacy (SAS-CARE); NCT01097967). We prospectively included 14 patients (13 male, age 66 ± 6 years) with infratentorial lesions and 14 patients (14 male, age 64 ± 7 years) with supratentorial lesions, matched for age and stroke severity. Polysomnography was recorded in all during the acute phase within 9 days after stroke onset and 3 months later.
  
  
  RESULTS
  During the acute phase after stroke, patients with infratentorial lesions had significantly more sleep-related breathing disorders than patients with supratentorial lesions with an apnea-hypopnea index >20 observed in 8 (57%) patients with infratentorial stroke and in only 2 (14%) patients with supratentorial stroke. Sleep-related breathing improved from the acute to the subacute phase (3 months), albeit remaining elevated in a significant proportion of subjects. Sleep parameters did not differ between the two patient groups but there was a general improvement of sleep from the acute to the subacute phase which was comparable for both patient groups. Although stroke severity was mild, recovery after 3 months was worse in patients with infratentorial stroke with 12 of 14 patients with supratentorial stroke being symptom free (NIHSS = 0), while this was the case for only 6 of 14 patients with infratentorial stroke.
  
  
  CONCLUSIONS
  Patients with infratentorial lesions are at an increased risk for sleep-related breathing disorders, which are frequent in this group. Monitoring of sleep-related breathing is therefore especially recommended in patients with infratentorial stroke. Because of the absence of reliable differences in sleep parameters between the two patient groups, polygraphy, with reduced diagnostic costs, rather than polysomnography could be considered. The higher prevalence of sleep-related breathing disorders and the poorer recovery of patients with infratentorial lesions suggest that early treatment interventions should be considered.
authors.affiliation: Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland.
authors.forename: Mauro
authors.initials: M
authors.lastname: Manconi
authors.forename: Irina
authors.initials: I
authors.lastname: Zavalko
authors.forename: Carlo
authors.initials: C
authors.lastname: Cereda
authors.forename: Iraida
authors.initials: I
authors.lastname: Pisarenco
authors.forename: Sebastian
authors.initials: S
authors.lastname: Ott
authors.forename: Stephany
authors.initials: S
authors.lastname: Fulda
authors.forename: Claudio L
authors.initials: CL
authors.lastname: Bassetti
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001921:Brain / Q000098:blood supply* / Q000473:pathology; D045422:Continuous Positive Airway Pressure / Q000379:methods; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000379:methods; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D020521:Stroke / Q000150:complications* / Q000175:diagnosis / Q000628:therapy