Central periodic breathing during sleep in 74 patients with acute ischemic stroke – Neurogenic and cardiogenic factors

• Published in: Journal of neurology 2008-11, Vol.255 (11), p.1687-1692
• Main Authors: Siccoli, M. M., Valko, P. O., Hermann, D. M., Bassetti, C. L.
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Age Factors; Aged; Aged, 80 and over; Biological and medical sciences; Brain - blood supply; Brain - pathology; Brain Ischemia - complications; Brain Ischemia - physiopathology; Cheyne-Stokes Respiration - complications; Cheyne-Stokes Respiration - physiopathology; Electrocardiography; Female; Humans; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Neurology; Neuroradiology; Neurosciences; Original Communication; Risk Factors; Sleep Disorders, Intrinsic - complications; Sleep Disorders, Intrinsic - physiopathology; Stroke - complications; Stroke - physiopathology; Vascular diseases and vascular malformations of the nervous system; Ventricular Function, Left
• ISSN: 0340-5354; 1432-1459
• DOI: 10.1007/s00415-008-0981-9

Objectives The aims of our study were 1) to better characterize central periodic breathing during sleep (CPBS) and its clinical relevance in acute stroke, 2) to better define the role of brain damage in its pathogenesis. Methods We included 74 consecutive patients admitted within 96 hours after stroke onset. Stroke severity at admission, stroke outcome at discharge and stroke topography were assessed. ECG and transesophageal echocardiography were performed. Nocturnal breathing was assessed with an ambulatory device the first night after admission. CPBS severity was represented as absolute time and percentage of recording time. Results Age was 63 ± 13 (25–82), 49 (66 %) were male. Thirty (41 %) patients showed CPBS during ≥ 10 % and 7 (9 %) during ≥ 50 % of recording time. CPBS severity was associated with age (p = 0.017), stroke severity (p = 0.008), ECG abnormalities (p = 0.005) and lower left ventricular ejection fraction (p < 0.0001). CPBS severity was higher in patients with extensive hemispheric strokes (n = 6, p < 0.0001), and lower in patients with partial strokes involving the left insula (n = 5, p < 0.0001) and the mesencephalon (n = 5, p = 0.002). Conclusions CPBS is frequent in acute ischemic stroke and is associated with older age, stroke severity/extension, and lower left ventricular function. The lower occurrence of CPBS in left insular and mesencephalic stroke suggests a major role of distinct brain areas in the modulation of respiratory phenomena accompanying acute stroke.