Sleep apnea, including obstructive, central or mixed apnea, was present in 50%-70% of stroke patients

Should all stroke patients be evaluated for sleep apnea? The answer is yes according to a new study that showed that sleep apnea was present in 50-70% of stroke patients. Unfortunately when patients are diagnosed with sleep apnea they are usually placed on CPAP machines that are very effective but have historically have not been used by most patients. The authors stated "SDB, presenting with obstructive, central, or mixed apneas, is present in 50%-70% of stroke patients. We recommend screening for SDB in all stroke patients by respirography. Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive SDB, which reverses the vascular risk of the patients." The medical term for patients following medical advice is compliance. CPAP has very poor compliance, a recent study showed 60% of patients are non-compliant with CPAP. That means 60% do not use this life saving technology. Dental Sleep Medicine offers and alternative to CPAP. Oral appliances are preferred by most patients offered a choice of CPAP or Appliances and compliance is much higher than CPAP approaching 90-95%.

It is obvious that the authors of this article are not aware of the fact that the majority of patients are CPAP intolerant.

The NHLBI considers sleep apnea to be a TMJ disorder "CARDIOVASCULAR AND SLEEP-RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS " (http://www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf) and considers treatment essential.

Early diagnosis of sleep apnea may prevent a large number of strokes according to scientists. Heart Attacks and Stokes are two of the top three causes of death (cancer is third) and sleep apnea is highly associated with both conditions.

Neurology. 2009 Oct 20;73(16):1313-22.
Sleep-related breathing and sleep-wake disturbances in ischemic stroke.
Hermann DM, Bassetti CL.

Department of Neurology, University Hospital Essen, Essen, Germany. dirk.hermann@uk-essen.de
BACKGROUND: Sleep-related breathing disturbances (SDB) and sleep-wake disturbances (SWD) are often neglected in stroke patients. Recent studies suggest that they are frequent and have an impact on stroke outcome. METHODS: We review current knowledge about frequency, clinical presentation, and consequences of poststroke SDB and SWD, and discuss treatment options. RESULTS: SDB, presenting with obstructive, central, or mixed apneas, is present in 50%-70% of stroke patients. We recommend screening for SDB in all stroke patients by respirography. Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive SDB, which reverses the vascular risk of the patients. In the absence of controlled trials, CPAP treatment should be reserved for patients with severe obstructive SDB, daytime symptoms (e.g., sleepiness), or high cardiovascular risk profile. Oxygen and adaptive servoventilation may be used for central SDB. SWD including insomnia, disturbances of wakefulness (hypersomnia, excessive daytime sleepiness, fatigue), sleep-related movement disorders (restless legs syndrome, periodic limb movements during sleep), and parasomnias (REM sleep behavior disorder) are found in 10%-50% of patients. SWD are associated with cognitive disturbances and may compromise neurologic recovery. Hypnotics and sedative antidepressants may aggravate SDB and neurologic recovery and should be used with caution. For disturbances of wakefulness, dopaminergic drugs, modafinil, or activating antidepressants may be considered. Poststroke sleep-related movement disorders can be treated with dopaminergic drugs; REM sleep behavior disorder with clonazepam. CONCLUSIONS: Sleep-related breathing disturbances and sleep-wake disturbances are frequent conditions that affect stroke outcome. In view of existing treatment options, these conditions deserve the neurologist's awareness.

PMID: 19841384 [PubMed - indexed for MEDLINE]

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