The majority of patients who have experienced a stroke and transient ischemic attack (TIA) also have sleep-disordered breathing (SDB),1 which is sometimes undiagnosed. As stroke patients with SDB also have worse functional outcomes2, you should consider screening for SDB3 when investigating the stroke.
Stroke has the potential to cause SDB, by either affecting:
- central mechanisms resulting in central sleep apnoea, or
- muscle tone resulting in obstructive sleep apnoea.
Can SDB predispose people to strokes?
People with SDB may be predisposed to stroke through a number of symptoms they experience.
- Repetitive drops in nocturnal blood oxygen levels caused by SDB can result in intermittent hypoxia which has been shown to be associated with systemic inflammation.4
- Sleep fragmentation from SDB results in hypersympathetic activity.5
What is the impact of SDB on post-stroke rehabilitation?
Patients with both SDB and stroke usually show poor compliance with post-stroke rehabilitation programs. This is mainly due to the combination of:
- the deficits caused by the stroke; and
- the symptoms of SDB (such as excessive daytime sleepiness, fatigue, and impaired cognitive functioning).
How do I recognise and diagnose SDB in stroke survivors?
Recognising SDB in stroke survivors is often challenging because the symptoms associated with SDB are often attributed to stroke. A complete sleep history from family members can help you determine whether SDB was present prior to the stroke or developed after the stroke.