Sleep-disordered breathing and poor functional outcome after stroke

David Good, Joseph Q. Henkle, David Gelber, Jennifer Welsh, Steve Verhulst

Research output: Contribution to journalArticle

333 Citations (Scopus)

Abstract

Background and Purpose: We objectively evaluated patients with recent stroke to determine the prevalence of sleep-disordered breathing (SDB) and whether SDB was associated with unfavorable clinical outcomes. Methods: Forty-seven patients with recent ischemic stroke (median, 13 days) were studied with computerized overnight oximetry for evidence of arterial oxyhemoglobin desaturation (SaO2). Polysomnography was also performed on 19 patients. Medical history, sleep history, location of stroke, and severity of neurological deficit were recorded, and patients were observed by staff for evidence of snoring and excessive daytime sleepiness. Functional abilities were measured with the use of the Barthel Index (BI). Outcome variables included ability to return home at discharge, continued residence at home at 3 and 12 months. BI at discharge, BI at 3 and 12 months, and death from any cause at 12 months. Results: Mean SaO2 during oximetry was 94.0 ± 1.7%, and percentage of recording time spent at <90% SaO2 was 4.3±5.7%. The number of desaturation events per hour of recording time (desaturation index [DI]) was 9.5±9.67, with 15 of 47 (32%) having DI > 10 and 6 of 47 (13%) having DI > 20. Oximetry measures of SDB correlated with lower BI scores at discharge and lower BI at 3- and 12-month follow-ups (P<.05, Pearson coefficients). Oximetry measures correlated with return home after discharge, but the association between oximetry measures and living at home was lost at 12 months. Two oximetry variables correlated with death at 1 year. Brain stem location correlated with higher DI and time at <90% SaO2, but patients with hemispheric stroke and oximetry abnormalities also had worse functional outcome. No correlation was found between oximetry values and sex, age, preexisting medical conditions (except previous stroke), or severity of neurological deficit. Oximetry abnormalities were associated with a history of snoring. Polysmonography on 19 patients confirmed oximetry evidence of severe SDB. Eighteen of 19 patients (95%) had an apnea-hypopnea index (AHI) of >10 events per hour of recording, 13 of 19 (68%) had an AHI > 20, and 10 of 19 (53%) had an AHI > 30. Desaturation events were largely due to obstructive apneas. Conclusions: SDB accompanied by arterial oxyhemoglobin desaturation is common in patients undergoing rehabilitation after stroke and is associated with higher mortality at 1 year and lower BI scores at discharge and at 3 and 12 months after stroke. SDB may be an independent predictor of worse functional outcome. Obstructive sleep apnea appeared to be the most common form of SDB, and the frequent history of snoring suggests that SDB preceded the stroke in most patients.

Original languageEnglish (US)
Pages (from-to)252-259
Number of pages8
JournalStroke
Volume27
Issue number2
DOIs
StatePublished - Jan 1 1996

Fingerprint

Sleep Apnea Syndromes
Stroke
Oximetry
Snoring
Oxyhemoglobins
Aptitude
Polysomnography
Obstructive Sleep Apnea
Apnea
Cause of Death
Sleep
History
Mortality

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Good, D., Henkle, J. Q., Gelber, D., Welsh, J., & Verhulst, S. (1996). Sleep-disordered breathing and poor functional outcome after stroke. Stroke, 27(2), 252-259. https://doi.org/10.1161/01.STR.27.2.252
Good, David ; Henkle, Joseph Q. ; Gelber, David ; Welsh, Jennifer ; Verhulst, Steve. / Sleep-disordered breathing and poor functional outcome after stroke. In: Stroke. 1996 ; Vol. 27, No. 2. pp. 252-259.
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abstract = "Background and Purpose: We objectively evaluated patients with recent stroke to determine the prevalence of sleep-disordered breathing (SDB) and whether SDB was associated with unfavorable clinical outcomes. Methods: Forty-seven patients with recent ischemic stroke (median, 13 days) were studied with computerized overnight oximetry for evidence of arterial oxyhemoglobin desaturation (SaO2). Polysomnography was also performed on 19 patients. Medical history, sleep history, location of stroke, and severity of neurological deficit were recorded, and patients were observed by staff for evidence of snoring and excessive daytime sleepiness. Functional abilities were measured with the use of the Barthel Index (BI). Outcome variables included ability to return home at discharge, continued residence at home at 3 and 12 months. BI at discharge, BI at 3 and 12 months, and death from any cause at 12 months. Results: Mean SaO2 during oximetry was 94.0 ± 1.7{\%}, and percentage of recording time spent at <90{\%} SaO2 was 4.3±5.7{\%}. The number of desaturation events per hour of recording time (desaturation index [DI]) was 9.5±9.67, with 15 of 47 (32{\%}) having DI > 10 and 6 of 47 (13{\%}) having DI > 20. Oximetry measures of SDB correlated with lower BI scores at discharge and lower BI at 3- and 12-month follow-ups (P<.05, Pearson coefficients). Oximetry measures correlated with return home after discharge, but the association between oximetry measures and living at home was lost at 12 months. Two oximetry variables correlated with death at 1 year. Brain stem location correlated with higher DI and time at <90{\%} SaO2, but patients with hemispheric stroke and oximetry abnormalities also had worse functional outcome. No correlation was found between oximetry values and sex, age, preexisting medical conditions (except previous stroke), or severity of neurological deficit. Oximetry abnormalities were associated with a history of snoring. Polysmonography on 19 patients confirmed oximetry evidence of severe SDB. Eighteen of 19 patients (95{\%}) had an apnea-hypopnea index (AHI) of >10 events per hour of recording, 13 of 19 (68{\%}) had an AHI > 20, and 10 of 19 (53{\%}) had an AHI > 30. Desaturation events were largely due to obstructive apneas. Conclusions: SDB accompanied by arterial oxyhemoglobin desaturation is common in patients undergoing rehabilitation after stroke and is associated with higher mortality at 1 year and lower BI scores at discharge and at 3 and 12 months after stroke. SDB may be an independent predictor of worse functional outcome. Obstructive sleep apnea appeared to be the most common form of SDB, and the frequent history of snoring suggests that SDB preceded the stroke in most patients.",
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Good, D, Henkle, JQ, Gelber, D, Welsh, J & Verhulst, S 1996, 'Sleep-disordered breathing and poor functional outcome after stroke', Stroke, vol. 27, no. 2, pp. 252-259. https://doi.org/10.1161/01.STR.27.2.252

Sleep-disordered breathing and poor functional outcome after stroke. / Good, David; Henkle, Joseph Q.; Gelber, David; Welsh, Jennifer; Verhulst, Steve.

In: Stroke, Vol. 27, No. 2, 01.01.1996, p. 252-259.

Research output: Contribution to journalArticle

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T1 - Sleep-disordered breathing and poor functional outcome after stroke

AU - Good, David

AU - Henkle, Joseph Q.

AU - Gelber, David

AU - Welsh, Jennifer

AU - Verhulst, Steve

PY - 1996/1/1

Y1 - 1996/1/1

N2 - Background and Purpose: We objectively evaluated patients with recent stroke to determine the prevalence of sleep-disordered breathing (SDB) and whether SDB was associated with unfavorable clinical outcomes. Methods: Forty-seven patients with recent ischemic stroke (median, 13 days) were studied with computerized overnight oximetry for evidence of arterial oxyhemoglobin desaturation (SaO2). Polysomnography was also performed on 19 patients. Medical history, sleep history, location of stroke, and severity of neurological deficit were recorded, and patients were observed by staff for evidence of snoring and excessive daytime sleepiness. Functional abilities were measured with the use of the Barthel Index (BI). Outcome variables included ability to return home at discharge, continued residence at home at 3 and 12 months. BI at discharge, BI at 3 and 12 months, and death from any cause at 12 months. Results: Mean SaO2 during oximetry was 94.0 ± 1.7%, and percentage of recording time spent at <90% SaO2 was 4.3±5.7%. The number of desaturation events per hour of recording time (desaturation index [DI]) was 9.5±9.67, with 15 of 47 (32%) having DI > 10 and 6 of 47 (13%) having DI > 20. Oximetry measures of SDB correlated with lower BI scores at discharge and lower BI at 3- and 12-month follow-ups (P<.05, Pearson coefficients). Oximetry measures correlated with return home after discharge, but the association between oximetry measures and living at home was lost at 12 months. Two oximetry variables correlated with death at 1 year. Brain stem location correlated with higher DI and time at <90% SaO2, but patients with hemispheric stroke and oximetry abnormalities also had worse functional outcome. No correlation was found between oximetry values and sex, age, preexisting medical conditions (except previous stroke), or severity of neurological deficit. Oximetry abnormalities were associated with a history of snoring. Polysmonography on 19 patients confirmed oximetry evidence of severe SDB. Eighteen of 19 patients (95%) had an apnea-hypopnea index (AHI) of >10 events per hour of recording, 13 of 19 (68%) had an AHI > 20, and 10 of 19 (53%) had an AHI > 30. Desaturation events were largely due to obstructive apneas. Conclusions: SDB accompanied by arterial oxyhemoglobin desaturation is common in patients undergoing rehabilitation after stroke and is associated with higher mortality at 1 year and lower BI scores at discharge and at 3 and 12 months after stroke. SDB may be an independent predictor of worse functional outcome. Obstructive sleep apnea appeared to be the most common form of SDB, and the frequent history of snoring suggests that SDB preceded the stroke in most patients.

AB - Background and Purpose: We objectively evaluated patients with recent stroke to determine the prevalence of sleep-disordered breathing (SDB) and whether SDB was associated with unfavorable clinical outcomes. Methods: Forty-seven patients with recent ischemic stroke (median, 13 days) were studied with computerized overnight oximetry for evidence of arterial oxyhemoglobin desaturation (SaO2). Polysomnography was also performed on 19 patients. Medical history, sleep history, location of stroke, and severity of neurological deficit were recorded, and patients were observed by staff for evidence of snoring and excessive daytime sleepiness. Functional abilities were measured with the use of the Barthel Index (BI). Outcome variables included ability to return home at discharge, continued residence at home at 3 and 12 months. BI at discharge, BI at 3 and 12 months, and death from any cause at 12 months. Results: Mean SaO2 during oximetry was 94.0 ± 1.7%, and percentage of recording time spent at <90% SaO2 was 4.3±5.7%. The number of desaturation events per hour of recording time (desaturation index [DI]) was 9.5±9.67, with 15 of 47 (32%) having DI > 10 and 6 of 47 (13%) having DI > 20. Oximetry measures of SDB correlated with lower BI scores at discharge and lower BI at 3- and 12-month follow-ups (P<.05, Pearson coefficients). Oximetry measures correlated with return home after discharge, but the association between oximetry measures and living at home was lost at 12 months. Two oximetry variables correlated with death at 1 year. Brain stem location correlated with higher DI and time at <90% SaO2, but patients with hemispheric stroke and oximetry abnormalities also had worse functional outcome. No correlation was found between oximetry values and sex, age, preexisting medical conditions (except previous stroke), or severity of neurological deficit. Oximetry abnormalities were associated with a history of snoring. Polysmonography on 19 patients confirmed oximetry evidence of severe SDB. Eighteen of 19 patients (95%) had an apnea-hypopnea index (AHI) of >10 events per hour of recording, 13 of 19 (68%) had an AHI > 20, and 10 of 19 (53%) had an AHI > 30. Desaturation events were largely due to obstructive apneas. Conclusions: SDB accompanied by arterial oxyhemoglobin desaturation is common in patients undergoing rehabilitation after stroke and is associated with higher mortality at 1 year and lower BI scores at discharge and at 3 and 12 months after stroke. SDB may be an independent predictor of worse functional outcome. Obstructive sleep apnea appeared to be the most common form of SDB, and the frequent history of snoring suggests that SDB preceded the stroke in most patients.

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