Semin Neurol 2006; 26(1): 117-122
DOI: 10.1055/s-2006-933315
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Sleep Disorders and Stroke

Devin L. Brown1
  • 1Assistant Professor, Stroke Program, University of Michigan, Ann Arbor, Michigan
Further Information

Publication History

Publication Date:
15 February 2006 (online)

ABSTRACT

Obstructive sleep apnea (OSA) is a very common condition in patients with stroke and is found in over half of stroke patients. There is a complex relationship between OSA and stroke, attributable to shared risk factors. There are numerous mechanisms by which OSA may contribute to increased stroke risk, including promotion of atherosclerosis, hypercoagulability, and adverse effects on cerebral hemodynamics. Obstructive sleep apnea is also a risk factor for hypertension, and likely for atrial fibrillation and diabetes, conditions that in turn are risk factors for stroke. OSA is also associated with poor outcomes following stroke. Further epidemiological studies are needed to assess the relationship between OSA and stroke better. Clinical trials using continuous positive airway pressure as a treatment for OSA in stroke patients are needed to determine whether treatment of this condition alters outcome following stroke.

REFERENCES

  • 1 Dyken M, Somers V, Yamada T, Ren Z, Zimmerman M B. Investigating the relationship between stroke and obstructive sleep apnea.  Stroke. 1996;  27 401-407
  • 2 Iranzo A, Santamaria J, Berenguer J. Prevalence and clinical importance of sleep apnea in the first night after cerebral infarction.  Neurology. 2002;  58 911-916
  • 3 Turkington P, Bamford J, Wanklyn P, Elliott M. Prevalence and predictors of upper airway obstruction in the first 24 hours after acute stroke.  Stroke. 2002;  33 2037-2042
  • 4 Shahar E, Whitney C W, Redline S et al.. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study.  Am J Respir Crit Care Med. 2001;  163 19-25
  • 5 Chin K, Nakamura T, Kouichi S et al.. Effects of nasal continuous positive airway pressure on soluble cell adhesion molecules in patients with obstructive sleep apnea syndrome.  Am J Med. 2000;  109 562-567
  • 6 Bokinsky G, Miller M, Ault K, Husband P, Mitchell J. Spontaneous platelet activation and aggregation during obstructive sleep apnea and its response to therapy with nasal continuous positive airway pressure: a preliminary investigation.  Chest. 1995;  108 625-630
  • 7 Good D, Henkle J, Gelber D, Welsh J, Verhulst S. Sleep-disordered breathing and poor functional outcome after stroke.  Stroke. 1996;  27 252-259
  • 8 American Academy of Sleep Medicine Task Force . Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research.  Sleep. 1999;  22 667-689
  • 9 Young T, Peppard P, Palta M et al.. Population-based study of sleep-disordered breathing as a risk factor for hypertension.  Arch Intern Med. 1997;  157 1746-1752
  • 10 Pepperell J, Ramdassingh-Dow S, Crosthwaite N et al.. Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomized parallel trial.  Lancet. 2002;  359 204-210
  • 11 Kanagala R, Murali N S, Friedman P A et al.. Obstructive sleep apnea and the recurrence of atrial fibrillation.  Circulation. 2003;  107 2589-2594
  • 12 Javaheri S, Parker T J, Liming J D et al.. Sleep apnea in 81 ambulatory male patients with stable heart failure: types and their prevalences, consequences, and presentations.  Circulation. 1998;  97 2154-2159
  • 13 Elmasry A, Lindberg E, Berne C et al.. Sleep-disordered breathing and glucose metabolism in hypertensive men: a population-based study.  J Intern Med. 2001;  249 153-161
  • 14 Vgontzas A N, Papanicolaou D A, Bixler E O et al.. Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance, and hypercytokinemia.  J Clin Endocrinol Metab. 2000;  85 1151-1158
  • 15 Thomas C E. Patent foramen ovale and stroke risk: incidental finding or causal culprit?.  Semin Neurol. 2005;  25 371-375
  • 16 Homma S, Sacco R L, Di Tullio M R, Sciacca R R, Mohr J P. for the PFO in Cryptogenic Stroke Study (PICSS) Investigators . Effect of medical treatment in stroke patients with patent foramen ovale: patent foramen ovale in cryptogenic stroke study.  Circulation. 2002;  105 2625-2631
  • 17 Beelke M, Angeli S, Del Sette M et al.. Obstructive sleep apnea can be provocative for right-to-left shunting through a patent foramen ovale.  Sleep. 2002;  25 856-862
  • 18 Schulz R, Mahmoudi S, Hattar K et al.. Enhanced release of superoxide from polymorphonuclear neutrophils in obstructive sleep apnea: impact of continuous positive airway pressure therapy.  Am J Respir Crit Care Med. 2000;  162 566-570
  • 19 Hui D S, Ko F W, Fok J P et al.. The effects of nasal continuous positive airway pressure on platelet activation in obstructive sleep apnea syndrome.  Chest. 2004;  125 1768-1775
  • 20 Wessendorf T E, Thilmann A F, Wang Y M, Schreiber A, Konietzko N, Teschler H. Fibrinogen levels and obstructive sleep apnea in ischemic stroke.  Am J Respir Crit Care Med. 2000;  162 2039-2042
  • 21 Winnicki M, Shamsuzzaman A, Lanfranchi P et al.. Erythropoietin and obstructive sleep apnea.  Am J Hypertens. 2004;  17 783-786
  • 22 Somers V, Dyken M, Clary M, Abboud F M. Sympathetic neural mechanisms in obstructive sleep apnea.  J Clin Invest. 1995;  96 1897-1904
  • 23 Balfors E M, Franklin K A. Impairment of cerebral perfusion during obstructive sleep apneas.  Am J Respir Crit Care Med. 1994;  150 1587-1591
  • 24 Netzer N, Werner P, Jochums I, Lehmann M, Strohl K. Blood flow of the middle cerebral artery with sleep-disordered breathing: correlation with obstructive hypopneas.  Stroke. 1998;  29 87-93
  • 25 Ross R. Atherosclerosis: an inflammatory disease.  N Engl J Med. 1999;  340 115-126
  • 26 Yokoe T, Minoguchi K, Matsuo H et al.. Elevated levels of C-reactive protein and interleukin-6 in patients with obstructive sleep apnea syndrome are decreased by nasal continuous positive airway pressure.  Circulation. 2003;  107 1129-1134
  • 27 Dyugovskaya L, Lavie P, Lavie L. Increased adhesion molecules expression and production of reactive oxygen species in leukocytes of sleep apnea patients.  Am J Respir Crit Care Med. 2002;  165 934-939
  • 28 Barcelo A, Miralles C, Barbe F, Vila M, Pons S, Agusti A G. Abnormal lipid peroxidation in patients with sleep apnoea.  Eur Respir J. 2000;  16 644-647
  • 29 Ip M S, Lam B, Chan L Y et al.. Circulating nitric oxide is suppressed in obstructive sleep apnea and is reversed by nasal continuous positive airway pressure.  Am J Respir Crit Care Med. 2000;  162 2166-2171
  • 30 Parra O, Abroix A, Bechich S et al.. Time course of sleep-related breathing disorders in first-ever stroke or transient ischemic attack.  Am J Respir Crit Care Med. 2000;  161 375-380
  • 31 Bassetti C, Aldrich M, Quint D. Sleep-disordered breathing in patients with acute supra- and infratentorial strokes: a prospective study of 39 patients.  Stroke. 1997;  28 1765-1772
  • 32 Bassetti C, Aldrich M S. Night time versus daytime transient ischaemic attack and ischaemic stroke: a prospective study of 110 patients.  J Neurol Neurosurg Psychiatry. 1999;  67 463-467
  • 33 Bassetti C, Aldrich M. Sleep apnea in acute cerebrovascular diseases: final report on 128 patients.  Sleep. 1999;  22 217-223
  • 34 Bassetti C, Aldrich M, Chervin R, Quint D. Sleep apnea in patients with transient ischemic attack and stroke: a prospective study of 59 patients.  Neurology. 1996;  47 1167-1173
  • 35 Hui D, Choy D, Wong L et al.. Prevalence of sleep-disordered breathing and continuous positive airway pressure compliance: results in Chinese patients with first-ever ischemic stroke.  Chest. 2002;  122 852-860
  • 36 Kaneko Y, Hajek V, Zivanovic V, Raboud J, Bradley T. Relationship of sleep apnea to functional capacity and length of hospitalization following stroke.  Sleep. 2003;  26 293-297
  • 37 Cherkassky T, Oksenberg A, Froom P, Ring H. Sleep-related breathing disorders and rehabilitation outcome of stroke patients: a prospective study.  Am J Phys Med Rehabil. 2003;  82 452-455
  • 38 Turkington P M, Allgar V, Bamford J, Wanklyn P, Elliott M W. Effect of upper airway obstruction in acute stroke on functional outcome at 6 months.  Thorax. 2004;  59 367-371
  • 39 Wei L, Erinjeri J, Rovainen C, Woolsey T. Collateral growth and angiogenesis around cortical stroke.  Stroke. 2001;  32 2179-2184
  • 40 Aoyagi A, Saito H, Abe K, Nishiyama N. Early impairment and late recovery of synaptic transmission in the rat dentate gyrus following transient forebrain ischemia in vivo.  Brain Res. 1998;  799 130-137
  • 41 Frost S, Barbay S, Friel K, Plautz E, Nudo R. Reorganization of remote cortical regions after ischemic brain injury: a potential substrate for stroke recovery.  J Neurophysiol. 2003;  89 3205-3214
  • 42 Stroemer R, Kent T A, Hulsebosch C E. Neocortical neural sprouting, synaptogenesis, and behavioral recovery after neocortical infarction in rats.  Stroke. 1995;  26 2135-2144
  • 43 Dereski M, Chopp M, Knight R, Rodolosi L, Garcia J. The heterogeneous temporal evolution of focal ischemic neuronal damage in the rat.  Acta Neuropathol (Berl). 1993;  85 327-333
  • 44 Baird A, Benfield A, Schlaug G et al.. Enlargement of human cerebral ischemic lesion volumes measured by diffusion-weighted magnetic resonance imaging.  Ann Neurol. 1997;  41 581-589
  • 45 Chopp M, Li Y, Jiang N, Zhang R, Prostak J. Antibodies against adhesion molecules reduce apoptosis after transient middle cerebral artery occlusion in rat brain.  J Cereb Blood Flow Metab. 1996;  16 578-584
  • 46 Sandberg O, Franklin K, Bucht G, Eriksson S, Gustafson Y. Nasal continuous positive airway pressure in stroke patients with sleep apnoea: a randomized treatment study.  Eur Respir J. 2001;  18 630-634
  • 47 Wessendorf T E, Wang Y M, Thilmann A F, Sorgenfrei U, Konietzko N, Teschler H. Treatment of obstructive sleep apnoea with nasal continuous positive airway pressure in stroke.  Eur Respir J. 2001;  18 623-629
  • 48 Disler P, Hansford A, Skelton J et al.. Diagnosis and treatment of obstructive sleep apnea in a stroke rehabilitation unit: a feasibility study.  Am J Phys Med Rehabil. 2002;  81 622-625

Devin L BrownM.D. 

Assistant Professor, Stroke Program, University of Michigan, TC 1920/0316, 1500 East Medical Center Drive, Ann Arbor, MI 48109

    >