Volume 2 • Issue 2 • 1000113 J Sleep Disorders Ther ISSN: 2167-0277 JSDT, an open access journal Open Access Research Article Sleep Disorders & Therapy Sacchetti et al., J Sleep Disorders Ther 2013, 2:2 http://dx.doi.org/10.4172/2167-0277.1000113 Sleep Disordered Breathing after Stroke: Clinical Profile of Patients with Obstructive- as Opposed to Central-Sleep Apnea Maria Luisa Sacchetti 1 *, Maria Teresa Di Mascio 1 , Giacomo Della Marca 2 , Antonio Minni 3 , Silvia Ottaviani 1 , Danilo Toni 1 and Marco Fiorelli 1 1 Department of Neurology and Psychiatry, Sapienza University, Rome, Italy 2 Sleep Unit, Institute of Neurology, Catholic University, A. Gemelli, Rome, Italy 3 Department of Sensory Organs, Sapienza University of Rome, Rome, Italy *Corresponding author: Maria Luisa Sacchetti, Department of Neurology and Psychiatry, Sapienza University, Rome, Italy, Tel: +39 06 4453610; E-mail: marialuisa.sacchetti@uniroma1.it Received April 01, 2013; Accepted April 20, 2013; Published April 25, 2013 Citation: Sacchetti ML, Di Mascio MT, Marca GD, Minni A, Ottaviani S, et al. (2013) Sleep Disordered Breathing after Stroke: Clinical Proile of Patients with Obstructive- as Opposed to Central-Sleep Apnea. J Sleep Disorders Ther 2: 113. doi:10.4172/2167-0277.1000113 Copyright: © 2013 Sacchetti ML, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Aim: In order to deine the clinical and instrumental proile of patients with Obstructive Sleep Apnea/Hypopnea (OSAH) and to compare them with that of cases with Central Sleep Apnea/Hypopnea (CSAH), a series of stable strokes were studied. Methods: Thirty four patients were submitted to both clinical and polisomnographyc study (PSG) after 4 months of stroke. A Sleep Disordered Breathing (SDB) was diagnosed in all cases with an AHI>5. Patients were classiied as affected by predominantly OSAH (pOSAH), predominantly CSAH (pCSAH), or normal patients. Comparisons were made among the groups and correlation analyses were done in each group. Signiicance was set at p<0.005. Results: Thirty-four ischemic strokes were enrolled (55% embolic, 6% large artery, 32% lacunar, 9% with undetermined cause). The 76% of them had a SDB ( pOSAH=61%; pCSAH=39%). Nearly the 47% of cases had an obstruction of the upper airways alone or combined with an increase in pharyngeal tissue. No signiicant differences were found between pOSAH and pCSAH. In pOSAH cases, 8 cases (50%) had an obstruction of the upper airways; in 4 of them it was combined with an increase in pharyngeal tissue; the time interval from stroke to PSG (Δ t), was inversely related to both TST (p 0.017) and TSP (p 0.039); the NIH-SS at entry was directly related to the number of arousals /h of sleep (p 0.044); the more severe AHI the higher is ODI (p 0.000). In the pCSAH group, 4 cases (40%) had an obstruction of the upper airways combined with an increase in pharyngeal tissue; two of these 4 cases had also a BMI>30. In CSAH, Δt was inversely related to SE Index (p 0.021), and directly related to both the number of arrhythmias/h sleep (p 0.016) and ODI (p 0.033). No correlations were found between the number of arrhythmias/h sleep and causes of stroke both in pOSAH and in pCSAH groups. Conclusions: Our data suggest a direct effect of stroke on the peripheral breathing system with subsequent alteration of loop gain and CSAH phenotype, at least in a subgroup of cases. To conirm this hypothesis multicenter clinical sleep studied are needed. Keywords: Sleep apnea; Stroke; Loop gain; Cycling alternating patterns Introduction Prevalence of Sleep-Disordered Breathing (SDB) in patients with irst-ever stroke or TIA is higher than in normal populations [1]. he disturb more frequently recognized in these cases is a ‘mixed’ rather than purely obstructive or central disorder [1,2]. In some cases, what starts as clearly obstructive disease, evolves into predominantly central by the end of the recording [3,4]. his phenomenon has been reported to frequently occur in patients afected by Congestive Heart Failure (CHF) [4,5]; more oten it is precipitated by the Continuous Positive Airway Pressure (CPAP) treatment of an obstructive sleep apnea/ hypopnea (OSAH) [6-8]. Characteristics of SDB in patients with stable stroke have not been studied jet. In order to deine the clinical and instrumental proile of patients afected by OSAH and to compare them with the proile of cases afected by a Central Sleep Apnea/Hypopnea (CSAH), we report here data on a series of 34 cases with stable stroke, studied at Sapienza, University of Rome. Methods Patients A consecutive series of patients with acute stroke, admitted to the Stroke Unit of Policlinico Umberto I University Hospital, were screened. Ater the exclusion of patients who did not consent to enter the study, elected cases were submitted to both clinical and instrumental diagnostic tests at 4 months of stroke onset. Stroke risk proile was assessed, and then classiied, according to the Italian SPREAD guidelines [9]. Participants were visited irstly at stroke onset and at discharge from the Stroke Unit, and then on the day of the polisomnographic Study (PSG). he severity of neurological deicit was assessed by means of NIH-SS [10,11]. Causes of stroke were classiied as to TOAST criteria [12]. Daytime sleepiness was estimated with the Epworth Sleepiness Scale questionnaire (ESS) [13]. he presences of symptoms other than daytime sleepiness have also been investigated, and classiied so as: choking, gasping, fragmented sleep, unrefreshing sleeps, reported daytime sleepiness, inattention, accordingly with guidelines [13,14]. In order to identify conditions predisposing to OSAHS, an otorhinolaryngology’s (ORL) evaluation was performed.