Stroke and
Sleep Apnea
Many people who survive a stroke are
found to have sleep apnea, an interruption in breathing during
sleep. Many investigations have revealed that the coexistence of
stroke and sleep apnea is quite high, somewhere between 30 and 90 %
of stroke survivors. Some of these stroke survivors had sleep apnea
before the stroke. Others developed it after the stroke.
The commonest type of sleep apnea in
this population is the obstructive type, whereby breathing is cut
off because of a block in the swallowing part of the throat. The
tongue, uvula, and soft palate tissues may come together and limit
the flow of air periodically during the night. This phenomenon does
not have to include snoring but usually it will.
One of the possible reasons for a person
with a stroke to worsen after the initial event is poor breathing at
night which lowers the oxygen to the brain during recovery and may
also have deleterious blood pressure effects. This is an important
reason for recognizing if there is sleep apnea and beginning
treatment during the stroke rehabilitation, if this is possible.
Furthermore, it is now known that the more times the oxygen level
drops below the safe zone during the early recovery following
stroke, the more dependent in care is the stroke survivor after
rehabilitation.
Clearly, it is important for a person
recovering from stroke to have an evaluation regarding breathing
adequacy. Screening for blood oxygen levels during the night can
determine if a more thorough overnight formal sleep study is called
for. If a formal study identifies obstructive sleep apnea, treatment
can be immediately implemented.
References:
Turkington PM & Elliott MW. Sleep
disordered breathing following
Slp Diag & Ther 2006; 1(2):
52-5.
Good D et al. Sleep disordered breathing
and poor functional outcome after
stroke. Stroke 1996;
27:252-9
Turkington PM et al. Effect of upper
airway obstruction in acute stroke on
Functional outcome at 6 months. Thorax,
2004; 59:367-71.
Kenko Y et al. Relationship of sleep
apnea to functional capacity and
length of hospitalization
following stroke.
Harbison J et al. Sleep-disordered
breathing following stroke. QJM 2002;
95:741-7.
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