Clinical characteristics associated with moderate and severe sleep-disordered breathing syndrome in patients with ischemic stroke HTML

Authors: A.V. Fonyakin, L.A. Geraskina, M.Yu. Maksimova, G.M. Lutokhin

Company: Researh Center of Neurology, Volokolamskoe shosse, 80, Moscow, 125367, Russian Federation

Email: Log in or register.

Heading: Original articles

UDC: 616.831-005.4:616.24-008.4

For citation: Fonyakin A.V., Geraskina L.A., Maksimova M.Yu., Lutokhin G.M. Clinical characteristics associated with moderate and severe sleep-disordered breathing syndrome in patients with ischemic stroke. Creative Cardiology. 2018; 12 (3): 225–35 (in Russ.). DOI: 10.24022/1997-3187-2018-12-3-225-235

Received / Accepted:  16.03.2018/04.04.2018

Key Words: ischemic stroke sleep-disordered breathing syndrome


Objective. To determine the clinical signs associated with the moderate and severe sleep-disordered breathing syndrome (SDBS) in patients in the acute period of ischemic stroke.

Material and methods. 78 patients with ischemic stroke were examined. The presence and structure of SDBS was studied by cardiorespiratory monitoring on the 2–5th day from the onset of stroke.

Results. SDBS was detected in 69 (88%) patients, mainly obstructive. The apnea/hypopnea index averaged 17 [9; 25]. 46 (59.0%) patients had moderate and severe SDBS. As a result of mathematical processing, a model was obtained from 8 features associated with the presence of moderate and severe SDBS, which included: age 68 years and older, males, an estimated modified Rankin score of 3 or more, cardioembolic stroke, stenosis of the brachiocephalic arteries more than 70%, congestive heart failure, recurrent stroke, the involvement of an insula in the cerebral infarction.

Conclusions. When identifying these clinical signs in patients with ischemic stroke cardiorespiratory monitoring
should be recommended. Patients with moderate/severe SDBS need timely correction of respiratory disorders in
order to improve early neurologic recovery and long-term cardiovascular prognosis.


  1. Свиряев Ю.В., Коростовцева Л.С., Звартау Н.Э., Калинкин А.Л., Конради А.О. Прогностическое значение синдрома обструктивного апноэ во сне: промежуточные результаты пятилетнего проспективного наблюдения. Артериальная гипертензия. 2011; 17 (1): 10–6.
  2. Магомедова Н.М., Голухова Е.З. Слип-апноэ и сердечно-сосудистые риски. Креативная кардиология. 2016; 3: 210–9. DOI: 10.15275/ kreatkard.2016.03.
  3. Yaggi H.K., Concato J., Kernan W.N., Lichtman J.H., Brass L.M., Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N. Engl. J. Med. 2005; 353: 2034–41. DOI: 10.1056/NEJMoa043104.
  4. Redline S., Yenokyan G., Gottlieb D.J., Shahar E., O’Connor G.T., Resnick H.E. et al. Obstructive sleep apnea-hypopnea and incident stroke: the sleep heart health study. Am. J. Respir. Crit. Care Med. 2010; 182: 269–77. DOI: 10.1164/ rccm.200911-1746OC.
  5. Полуэктов М.Г., Бахревский И.Е., Кошелев И.Ю., Елигулашвили Т.С., Вейн А.М. Расстройства дыхания во сне при неврологической патологии. Журнал неврологии и психиатрии им. С.С. Корсакова (Приложение «Инсульт»). 2002; 5: 22–6.
  6. Owens R.L., Eckert D.J., Yeh S.Y., Malhotra A. Upper airway function in the pathogenesis of obstructive sleep apnea: a review of the current literature. Cur. Opin. Pulm. Med. 2008; 14 (6): 519–24. DOI: 10.1097/MCP.0b013e3283130f66.
  7. Young T., Palta M., Dempsey J., Peppard P.E., Nieto F.J., Hla K.M. Burden of sleep apnea: rationale, design, and major findings of the Wisconsin sleep cohort study. WMJ. 2009; 108 (5): 246. PMID: 19743755.
  8. Kapur V.K. Obstructive sleep apnea: diagnosis, epidemiology, and economics. Respir. Care. 2010; 55: 1155–67. PMID: 20799998.
  9. Kaneko Y., Hajek V.E., Zivanovic V., Raboud J., Bradley T.D. Relationship of sleep apnea to functional capacity and length of hospitalization following stroke. Sleep. 2003; 26: 293–7. PMID: 12749548.
  10. Rola R., Jarosz H., Wierzbicka A., Wichniak A., Richter P., Ryglewicz D., Jernajczyk W. Sleep disorders breathing and recurrence of cerebrovascular events, case-fatality, and functional outcome in patients with ischemic stroke or transient ischemic attack. J. Physiol. Pharmacol. 2008; 59 (Suppl. 6): 615–21. PMID: 19218688.
  11. Yan-Fang S., Yu-Ping W. Sleep-disordered breathing: impact on functional outcome of ischemic stroke patients. Sleep Med. 2009; 10: 717–71. DOI: 10.1016/j.sleep.2008.08.006.
  12. Parra O., Sanchez-Armengol A., Bonnin M., Arboix A. et al. Early treatment of obstructive apnea and stroke outcome: a randomized controlled trial. Eur. Respir. J. 2011; 37: 1128–36. DOI: 10.1183/09031936.00034410.
  13. Sahlin C., Sandberg O., Gustafson Y., Bucht G., Carlberg B., Stenlund H., Franklin K.A. Obstructive sleep apnea is a risk factor for death in patients with stroke: a 10-year follow up. Arch. Intern. Med. 2008; 168: 297–301. DOI: 10.1001/archinternmed.2007.70.
  14. Верещагин Н.В., Брагина Л.К., Вавилов С.Б., Левина Г.Я. Компьютерная томография мозга. М.: Медицина; 1986; 256.
  15. International Classification of Sleep Disorders. 3rd ed. American Academy of Sleep Medicine; Darien I.L.; 2014.
  16. Johnson K.G., Johnson D.C. Frequency of sleep apnea in stroke and TIA patients: a meta-analysis. J. Clin. Sleep Med. 2010; 2: 131–7. PMID: 20411688.
  17. Peppard P.E., Young T., Barnet J.H., Palta M., Hagen E.W., Hla K.M. Increased prevalence of sleep-disordered breathing in adults. Am. J. Epidemiol. 2013; 177 (9): 1006. DOI: 10.1161/ STROKEAHA.111.000112.
  18. Shahar E., Whitney C.W., Redline S., Lee E.T., Newman A.B., Nieto F.J. et al. Sleep-disordered 234 breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am. J. Respir. Crit. Care Med. 2001; 163: 19–25. DOI: 10.1164/ajrccm.163.1.2001008.
  19. McNicholas W.T., Bonsignore M.R. Management Committee of EU COST ACTION B26. Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities. Eur. Respir. J. 2007; 29: 156–78. DOI: 10.1183/09031936.00027406.
  20. Garvey J.F., Pengo M.F., Drakatos P., Kent B.D. Epidemiological aspects of obstructive sleep apnea. J. Thorac. Dis. 2015; 7 (5): 920–9. DOI: 10.3978/j.issn.2072-1439.2015.04.52.
  21. Полуэктов М.Г. Диагностика и лечение расстройств сна. М.: МЕДпресс-информ; 2016.
  22. Matthias M.S., Chumbler N.R., Bravata D.M., Yaggi H.K., Ferguson J., Austin C. et al. Challenges and motivating factors related to positive airway pressure therapy for post-TIA and stroke patients. Behav. Sleep Med. 2014; 12: 143–57. DOI: 10.1080/15402002.2013.778200.

About Authors

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery