Are stroke cases affected by sleep disordered breathings all the same?

Abstract Sleep disordered breathings (SDB) worsens the clinical prognosis of stroke patients. Continuous positive airway pressure (CPAP) is a promising effective treatment. Unfortunately, not all patients are compliant with CPAP, suggesting that it is not appropriate for all patients with obstructiv...

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Bibliographic Details
Published in:Medical hypotheses 2014-08, Vol.83 (2), p.217-223
Main Authors: Sacchetti, M.L, Della Marca, G
Format: Article
Language:English
Subjects:
Continuous Positive Airway Pressure - methods
Humans
Internal Medicine
Models, Biological
Patient Outcome Assessment
Sleep - physiology
Sleep Apnea Syndromes - classification
Sleep Apnea Syndromes - etiology
Sleep Apnea Syndromes - therapy
Stroke - classification
Stroke - complications
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Summary:Abstract Sleep disordered breathings (SDB) worsens the clinical prognosis of stroke patients. Continuous positive airway pressure (CPAP) is a promising effective treatment. Unfortunately, not all patients are compliant with CPAP, suggesting that it is not appropriate for all patients with obstructive sleep apnoea (OSA) after stroke. People with the highest likelihood of benefiting have to be identified. We present a classification of cases with stroke and SDB to be adopted in order to identify the best responders to CPAP treatment. We propose to classify patients in four subgroups: (1) patients who terminate the apnoea by arousing from sleep; these cases are those affected either by an anatomical or a functional obstruction of upper airways that may precede or are the consequence of stroke; (2) cases that alternate OSA to central sleep apnoea (CSA) cause of an altered loop gain; (3) cases in whom ischemic damages have altered the sleep microstructure (CAP); (4) cases that manifest a CSA as the direct consequence of stroke on the central neuronal drive to breath. So far, no study has investigated the consequences of stroke on sleep microstructure. In order to better elucidate these relationships, when reviewing the PSG tracings of stroke patients, the microstructure of sleep should be systematically analysed.
ISSN:0306-9877
1532-2777
DOI:10.1016/j.mehy.2014.04.026