ABSTRACT
Obstructive sleep apnoea (OSA) is a risk factor for stroke, but little is known about the effect of OSA and continuous positive airway pressure (CPAP) on the incidence of long-term, nonfatal cardiovascular events (CVE) in stroke patients. A prospective observational study was made in 223 patients consecutively admitted for stroke. A sleep study was performed on 166 of them. 31 had an apnoea/hypopnoea index (AHI) <10 events · h(-1); 39 had an AHI between 10 and 19 events · h(-1) and 96 had an AHI ≥ 20 events · h(-1). CPAP treatment was offered when AHI was ≥ 20 events · h(-1). Patients were followed up for 7 yrs and incident CVE data were recorded. The mean ± SD age of the subjects was 73.3 ± 11 yrs; mean AHI was 26 ± 16.7 events · h(-1). Patients with moderate-to-severe OSA who could not tolerate CPAP (AHI ≥ 20 events · h(-1); n = 68) showed an increased adjusted incidence of nonfatal CVE, especially new ischaemic strokes (hazard ratio 2.87, 95% CI 1.11-7.71; p = 0.03), compared with patients with moderate-to-severe OSA who tolerated CPAP (n = 28), patients with mild disease (AHI 10-19 events · h(-1); n = 36) and patients without OSA (AHI <10 events · h(-1); n = 31). Our results suggest that the presence of moderate-to-severe OSA is associated with an increased long-term incidence of nonfatal CVE in stroke patients and that CPAP reduces the excess of incidence seen in these patients.
Subject(s)
Brain Ischemia/epidemiology , Continuous Positive Airway Pressure/statistics & numerical data , Sleep Apnea, Obstructive/epidemiology , Sleep Apnea, Obstructive/therapy , Stroke/epidemiology , Adult , Aged , Aged, 80 and over , Disease-Free Survival , Female , Follow-Up Studies , Humans , Incidence , Kaplan-Meier Estimate , Male , Middle Aged , Proportional Hazards Models , Prospective Studies , Risk Factors , Secondary PreventionABSTRACT
La presión positiva continua en la vía aérea (CPAP) es un tratamiento efectivo para la mayoría de pacientes con síndrome de apneas-hipopneas durante el sueño (SAHS), mejorando la somnolencia, función cognitiva y el estado de ánimo. Sin embargo, un porcentaje de pacientes siguen quejándose de somnolencia tras la CPAP. En estos casos es recomendable rehacer la historia clínica, confirmar el diagnóstico de SAHS, comprobar el grado de cumplimiento del tratamiento, y descartar trastornos de sueño asociados como una pobre higiene de sueño, depresión, narcolepsia o hipersomnia idiopática. Si es necesario debe repetirse el estudio polisomnográfico (PSG) seguido de un test de latencias múltiples de sueño (MSLT) o incluso un PSG completo con titulación de CPAP. Estudios experimentales en animales parecen sugerir que la hipoxia intermitente crónica producida por las apneas podría deteriorar las estructuras cerebrales que regulan la alerta. Si esta alteración estuviera presente en humanos podría ser otra causa de somnolencia residual tras CPAP. Se ha comprobado que el modafinil reduce la somnolencia subjetiva tras CPAP en los pacientes con SAHS (AU)
Nasal continuous positive airway pressure (CPAP) is an effective treatment for most patients with sleep apnea/hypopnea syndrome (SAHS), improving sleepiness, cognitive function and mood. A number of patients, however, complain about persistent sleepiness after CPAP. In these cases another clinical history should be carried out to confirm the diagnosis of OSAS, to check CPAP compliance and to exclude associated conditions such as poor sleep hygiene, depression, narcolepsy or idiopathic hypersomnia. If necessary, a full polysomnography (PSG) followed by a multiple sleep latency test (MSLT) or even a full PSG with CPAP titration should be performed. Experimental data in animals suggest that long-term intermittent hypoxia related to the apneic events could deteriorate the brain structures that regulate alertness. This impairment, if present in humans, could be another reason for residual sleepiness after CPAP. Modafinil has been shown to reduce subjective sleepiness after CPAP in OSAS patients (AU)
