Early sleep apnea screening on a stroke unit is feasible in patients with acute cerebral ischemia

Jessica Kepplinger, Kristian Barlinn, Karen C. Albright, Wiebke Schrempf, Amelia K. Boehme, Lars Peder Pallesen, Uta Schwanebeck, Xina Graehlert, Alexander Storch, Heinz Reichmann, Andrei Alexandrov, Ulf Bodechtel

Research output: Contribution to journalArticle

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Abstract

Early screening for sleep apnea (SA) is rarely considered in patients with acute cerebral ischemia. We aimed to evaluate the feasibility of early SA screening on a stroke unit, its impact on post-discharge SA care and the relation of SA to clinical features. Patients with acute ischemic stroke (AIS) and transient ischemic attack (TIA) prospectively underwent overnight cardiorespiratory polygraphy within 3 ± 2 days of symptom-onset. Feasibility was defined as analyzable polygraphy in 90 % of studied patients. We enrolled 61 patients (84 % AIS, 16 % TIA): mean age 66 ± 8 years, 44 % men, median NIHSS 1 (0-15), median ESS 5 (0-13). Analyzability was given in 56/61 (91.8 %; one-sided 95 % CI, lower-bound 86.0 %) patients indicating excellent feasibility of early SA screening with no significant differences in stroke severity (100 % in TIA, 91 % minor stroke, 83 % major stroke, p = 0.474). Ninety-one percent (51/56) had an apnea- hypopnea index C5/h (median: 20/h [0-79]); 32 % (18/ 56) mild, 30 % (17/56) moderate, and 29 % (16/56) severe SA. When comparing sleep-related ischemic stroke (SIS) and non-SIS patients, no differences were found regarding the presence (95 vs. 89 %, p = 0.49) or severity (e.g., severe SA: 32 vs. 27 %, p = 0.69) of SA. After 12 months, 27/38 (71 %) patients given specific recommendations completed in-laboratory sleep work-up and 7/27 (25 %) were prescribed for non-invasive ventilatory correction. In conclusion, early SA screening is feasible in patients with acute cerebral ischemia and may have a positive impact on post-discharge SA care. Given the high frequency and atypical presentation of SA, early screening for SA should be considered in all acute cerebral ischemia patients.

Original languageEnglish (US)
Pages (from-to)1343-1350
Number of pages8
JournalJournal of Neurology
Volume260
Issue number5
DOIs
StatePublished - May 1 2013

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Sleep Apnea Syndromes
Brain Ischemia
Stroke
Transient Ischemic Attack
Sleep
Apnea

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

Cite this

Kepplinger, J., Barlinn, K., Albright, K. C., Schrempf, W., Boehme, A. K., Pallesen, L. P., ... Bodechtel, U. (2013). Early sleep apnea screening on a stroke unit is feasible in patients with acute cerebral ischemia. Journal of Neurology, 260(5), 1343-1350. https://doi.org/10.1007/s00415-012-6803-0

Early sleep apnea screening on a stroke unit is feasible in patients with acute cerebral ischemia. / Kepplinger, Jessica; Barlinn, Kristian; Albright, Karen C.; Schrempf, Wiebke; Boehme, Amelia K.; Pallesen, Lars Peder; Schwanebeck, Uta; Graehlert, Xina; Storch, Alexander; Reichmann, Heinz; Alexandrov, Andrei; Bodechtel, Ulf.

In: Journal of Neurology, Vol. 260, No. 5, 01.05.2013, p. 1343-1350.

Research output: Contribution to journalArticle

Kepplinger, J, Barlinn, K, Albright, KC, Schrempf, W, Boehme, AK, Pallesen, LP, Schwanebeck, U, Graehlert, X, Storch, A, Reichmann, H, Alexandrov, A & Bodechtel, U 2013, 'Early sleep apnea screening on a stroke unit is feasible in patients with acute cerebral ischemia', Journal of Neurology, vol. 260, no. 5, pp. 1343-1350. https://doi.org/10.1007/s00415-012-6803-0
Kepplinger J, Barlinn K, Albright KC, Schrempf W, Boehme AK, Pallesen LP et al. Early sleep apnea screening on a stroke unit is feasible in patients with acute cerebral ischemia. Journal of Neurology. 2013 May 1;260(5):1343-1350. https://doi.org/10.1007/s00415-012-6803-0
Kepplinger, Jessica ; Barlinn, Kristian ; Albright, Karen C. ; Schrempf, Wiebke ; Boehme, Amelia K. ; Pallesen, Lars Peder ; Schwanebeck, Uta ; Graehlert, Xina ; Storch, Alexander ; Reichmann, Heinz ; Alexandrov, Andrei ; Bodechtel, Ulf. / Early sleep apnea screening on a stroke unit is feasible in patients with acute cerebral ischemia. In: Journal of Neurology. 2013 ; Vol. 260, No. 5. pp. 1343-1350.
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abstract = "Early screening for sleep apnea (SA) is rarely considered in patients with acute cerebral ischemia. We aimed to evaluate the feasibility of early SA screening on a stroke unit, its impact on post-discharge SA care and the relation of SA to clinical features. Patients with acute ischemic stroke (AIS) and transient ischemic attack (TIA) prospectively underwent overnight cardiorespiratory polygraphy within 3 ± 2 days of symptom-onset. Feasibility was defined as analyzable polygraphy in 90 {\%} of studied patients. We enrolled 61 patients (84 {\%} AIS, 16 {\%} TIA): mean age 66 ± 8 years, 44 {\%} men, median NIHSS 1 (0-15), median ESS 5 (0-13). Analyzability was given in 56/61 (91.8 {\%}; one-sided 95 {\%} CI, lower-bound 86.0 {\%}) patients indicating excellent feasibility of early SA screening with no significant differences in stroke severity (100 {\%} in TIA, 91 {\%} minor stroke, 83 {\%} major stroke, p = 0.474). Ninety-one percent (51/56) had an apnea- hypopnea index C5/h (median: 20/h [0-79]); 32 {\%} (18/ 56) mild, 30 {\%} (17/56) moderate, and 29 {\%} (16/56) severe SA. When comparing sleep-related ischemic stroke (SIS) and non-SIS patients, no differences were found regarding the presence (95 vs. 89 {\%}, p = 0.49) or severity (e.g., severe SA: 32 vs. 27 {\%}, p = 0.69) of SA. After 12 months, 27/38 (71 {\%}) patients given specific recommendations completed in-laboratory sleep work-up and 7/27 (25 {\%}) were prescribed for non-invasive ventilatory correction. In conclusion, early SA screening is feasible in patients with acute cerebral ischemia and may have a positive impact on post-discharge SA care. Given the high frequency and atypical presentation of SA, early screening for SA should be considered in all acute cerebral ischemia patients.",
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